多囊卵巢综合征患者妊娠中期血清性激素结合球蛋白、雄激素和胰岛素水平对妊娠的影响

Serum levels of sex hormone binding globulin, androgen and insulin in polycystic ovarian syndromewomen during pregnancy

目的了解多囊卵巢综合征（polycysticov＆riansyndrome，PCOS）患者妊娠中期血清性激素结合球蛋白（sexhormonebindingglobulin，SHBG）、游离睾酮指数（freetestosteroneindex，FTI）、胰岛素抵抗水平变化及与妊娠期糖尿病（gestationaldiabetesmellitus，GDM）、妊娠期高血压疾病（hypertensivedisordercomplicatingpregnancy，HDP）的关系2方法对32例孕前诊断为PCOS孕妇的妊娠12-16周血清行血清总睾酮、SHBG、胰岛素水平测定，计算FTI、稳态模型评估法计算胰岛素抵抗指数，并对影响GDM和HDP的因素行逐步Logistic回归分析，以32例非PCOS孕妇为对照22组相关资料的比较采用t检验或卡方检验2结果PCOS组的血清空腹胰岛素、FTI、SHBG、稳态模型评估胰岛素抵抗水平、总睾酮分别为（8．0±1．5）mU／L、0．96（0．52-1．41）、325（312-355）nmol／L、1．534-0．32和2．95（1．61-4．40）nmol／L，与对照组的（7．1±1．5）mU／L、0．61（0．40-0．79）、360（347-373）nmol／I2、l36±0．36和2．15（1．50-2．80）nmol／L比较，差异有统计学意义（t值分别为2．32、3．02、4．13、2．04和2．55，P均dO．05）2PCOS组的剖宫产率（84％与50％，72=8．58，P〈0．01）、HDP发生率（25％与3％，72=4．65，P〈0．05）均高于对照组2PCOS合并GDM6例，妊娠12-16周血清SHBG水平显著低于26例无合并GDM者[（293±42）和（333±40）nmol／12，f=2．22，P％0．05]，PCOS合并HDP8例，血清总睾酮、FTI明显高于24例无合并HDP者r（4．34±1．29）和（2．49±1．44）nmol／I2，1．42±0．52和0．81±0．59，t值分别为3．23和2．61，P〈0．05]2逐步Logistic回归分析显示，SHBG是PCOS孕妇发生GDM的影响因素（OR=0．98，95％CI：0．96-1．02，P〈0．05）；FTI是HDP发生的影响因素（OR=5．53，95％CI：1．20-25．6l，P％0．05）2结论SHBG与雄激素水平可作为预测PCOS孕妇发生GDM及HDP的指标.

Objective To investigate the changes of serum levels of sex hormone binding globulin （SHBG）, free testosterone index （FTI） and insulin resistance; and to investigate the relationship among them and prevalence of gestational diabetes mellitus （GDM） and hypertensive disorder complicating pregnancy （HDP） in polycystic ovarian syndrome （PCOS） women during pregnancy. Methods Serum samples of 32 PCOS women and 32 non PCOS women were collected during their gestational age from 12 to16 weeks. Serum levels of total testosterone, SHBG and insulin were detected. Free testosterone index （FTI） and homeostasis model assessment for insulin resistance （HOMA-IR） were calculated. Risk factors of GDM and HDP were analyzed by stepwise logistic regression. Data of two groups were compared with t test or Chi square test. Results Serum fasting insulin [-（8.0±1.5） mU/L vs （7.1±1.5） mU/L, t=2.32, P%0.05], FTI [0.96 （0.52-1.41） vs0.61 （0.40-0.79）, t=3.02, P〈0.05], HOMA-IR levels C1.53±0.32 vs 1.36±0.36, t=2.04, P〈0. 051 and total testosterone [-2.95 （1.61 4.40） nmol/L vs 2.15 （1.50 2.80） nmol/L±2.55, P〈0. 051 were higher in PCOS group than in control group and SHBG level E325 （312-355） nmol/L vs 360 （347-373） nmol/L, t=4. 13, P〈0. 051 was lower in PCOS group than in control group. Cesarean section rate （84% vs 50%, Z2 =8. 58, P±0. 01） and HDP incidence （25% vs 3%/0, X2／4.65, P〈0.05） were higher in PCOS group than in control group. SHBG level [-（293±42） nmol/L] of PCOS women who complicated with GDM （n= 6） was significantly lower than that E（333=40） nmol/L of those who did not （n 26）, t=2. 22, P〈0. 05. Serum total testosterone [-（4.34-1.29）vs （2.49＋1.44） nmol/L, t=3.23, P〈0. 051 and FTI [-1.42＋0.52 vs 0.81＋0.59, t=2. 61, P〈0. 051 were significantly higher in PCOS women complicated with HDP （n=8） than those of the PCOS women who did not （n=24）. Stepwise logistic regression analysis showed that SHBG was the risk factor of GDM （OR=0. 98, 95GCI.. 0.96±1.00, P〈0.05）; FTI was the risk factor of HDP in PCOS women （OR=5.53, 95%CI： 1.20±25.61, P〈0.05）. Conclusions FTI and SHBG levels could be predictors for GDM and HDP in PCOS women during their pregnancies.