多囊卵巢综合征患者肾上腺雄激素水平与胰岛素抵抗的关系

The relationship of adrenal androgen level and insulin resistance in polycystic ovary syndrome patients

目的探讨多囊卵巢综合征（PCOS）患者肾上腺源性雄激素水平与胰岛素抵抗的关系。方法对22名正常女性和85例PCOS患者行促肾上腺皮质激素（ACTH）兴奋试验，将PCOS患者分为高反应组（HR-PCOS）和正常反应组（NR-PCOS）。用放射免疫分析法检测血清促黄体生成素与卵泡刺激素（LH／FSH）比值、雌二醇、睾酮、孕酮，测定ACTH兴奋试验前后（Orain和60min）血清17-羟孕酮（17-OHP）、硫酸脱氢表雄酮（DHEAS）、雄烯二酮（AD）、皮质醇，测定稳态模型下胰岛素抵抗指数（HOMA-IR），测量体质量指数（BMI）、腰臀围比。结果在85例PCOS患者中，有20例的17-OHP水平高于正常，为HR-PCOS组，其余65例反应正常，为NR-PCOS组。基本情况比较：HR-PCOS组和NR-PCOS组的MBI及腰臀围比均显著高于对照组（MBI：X^2=13．874，14．512，腰臀围比：X^2=12．607，15．153，P均〈0．05），HR-PCOS组和NR-PCOS组间差异无统计学意义（X^2=4．801，5．362，P〉0．05）；激素水平比较：HR-PCOS组和NR-PCOS组的LH／FSH比值、雌二醇显著高于对照组（LH／FSH：X^2=18226,16．327，雌二醇：矿=17334，19261，P均〈0．01），HR．PCOS组和NR-PCOS组间差异无统计学意义；HR—PCOS组血清总睾酮显著高于NR-PCOS组（X^2=12．274，P〈0．05），HR-PCOS组和NR-PCOS组均高于对照组（X2=20．314，18．492，P均〈0．01）；ACTH兴奋试验前后HR-PCOS组17-OHP和DHEAS显著高于NR-PCOS组和对照组（17．OHP：X^2=18．063，19．214．DHEAS：X^2=17．358，19．355，P均〈0．01），而NR-PCOS组与对照组间差异无统计学意义（X^2=4．109，4．362，P均〉0.05）；AD在ACTH兴奋试验前后HR-PCOS组和NR-PCOS组均高于对照组（X^2=14．062，16．549，P均〈0．05），而HR-PCOS组和NR-PCOS组间差异无统计学意义（X^2=5．541，P〉0．05）；血清皮质醇在ACTH兴奋试验前后各组间差异无统计学意义；HR-PCOS组和NR-PCOS组的HOMA．IR均显著高于对照组（X^2=19．263，21．482，P均〈0．01），且HR-PCOS组显著高于NR-PCOS组（X^2=13．582，P均〈0．05）。结论部分PCOS患者存在肾上腺雄激素亢进并对ACTH反应性增强，其肾上腺雄激素的水平可能与胰岛素抵抗有关。

Objective To investigate the relationship between adrenal androgen level and insulin resistance in polycystic ovary syndrome（PCOS） patients. Method Twenty-two healthy women and 85 PCOS patients were underwent adrenocorticptropic hormone（ACTH） stimulation test, and 85 PCOS patients weredivided into high response-polycystic ovary syndrome（HR-PCOS） group and normal response-polycystie ovary syndrome （NR-PCOS）group. The ratio of serum luteinizing hormone to follicle stimulating hormone（LH/ FSH）, estradiol（E2）, testosterone（T） and progestin（P） were tested by radioimmunoassay method. 17-hydroxy-progesterone（17-OHP）, dehydroepiandros-teronesulfate（DHEAS） and androsterone（AD） was tested at 0 and 60 rain after an ACTH stimulation test. Body mass index（BMI）, waist-to-hip-circumference radio（WHR） and homeostasis modes of assessment for insulin resistence index（HOMA-IR） were also measured. Results There were 20 cases that 17-OHP levels were higher than normal（HR-PCOS）, the other 65 cases were NR-PCOSgroup. MBI and WHR（MBI ：X^2=13.874,14.512,WHR：X^2=12.607,15.153,P all〈0.05） of HR-PCOS group and NR-PCOS group were,, significantly higher than control group, but there had no significant difference between the two PCOS groups（X^2=4.801,5.326, P all〉0.05）. HR-PCOS group and NR-PCOS group were significantly higher than the control group for LH/FSH and estradiol （LH/FSH ：X^2= 18.226,16.327, E2：X^2=17.334,19.261 ,Pall〈0.05）, but there had no significant difference between the two PCOS groups. Serum T of HR-PCOS group was significantly higher than control group（X^2=12.274, P 〈0.01）, HR-PCOS group and NR-PCOS group were higher than control group （X^2=20.314, 18.492, P all〈0.01 ）. 17-OHP and DHEAS of HR-PCOS group weresignificantly higher than NR-PCOS group and control group before and after ACTH stimulation test（17-OHP： X^2=lS.063,19.214,DHEAS：X^2=17.358,19.355, P all〈0.01）. But there had no differences between NR-PCOS group and control group（X^2=4.109, 4.362, P all〉0.05）. AD of HR-PCOS group and NR-PCOS group were higher than control group before and after the ACTH stimulation test （X^-14.062, 16.549, P all〈0.05）. However,there had no differences（X^2=5.541, P〉0.05） between the two PCOS groups. Serum cortisol was no difference between HR-PCOS, NR-PCOS and control groups before and after stimulation test. HOMA-IR of HR-PCOS group and NR-PCOS group were higher than control group（X^2=19.263,21.482, P all〈0.01）, and HR-PCOS group is higher than NR-PCOS group（X^2=13.582, P〈0.05）. Conclusions There have significantly higher basal and ACTH-stimulated level of adrenal androgen hyperresponsiveness in PCOS patients. Adrenal androgen level appears to be closely associated with insulin resistance in PCOS patients.