正常葡萄糖耐量多囊卵巢综合征患者胰岛素释放试验分析

Analysis of insulin release pattern in patients with polycystic ovary syndrome and normal glucose tolerance

目的探讨胰岛素释放试验在诊断正常糖耐量的多囊卵巢综合征（PCOS）患者胰岛素抵抗中的价值。方法对63例PCOS患者进行口服葡萄糖耐量（OGTT）及胰岛素释放试验，正常排卯女性34名作对照。结果63例PCOS患者，肥胖型（体重指数≥25kg／m^2）为33例，其中5例出现OGTT异常；非肥胖型为30例，OGTT均在正常范围内。采用稳态模型评估的胰岛素抵抗指数（HOMA—IR）及空腹胰岛素水平分析．发现肥胖型PCOS患者、非肥胖型PCOS患者和正常对照组的胰岛素抵抗患病率分别为78．8％、16．7％和9．0％。3组出现胰岛素释放曲线异常分别占84．5％、70．0％和14．7％。对58例OGTT正常的PCOS患者进行分析发现，胰岛素抵抗患病率为44．8％，胰岛素释放曲线异常率为75．9％。其中HOMA—IR及空腹胰岛素正常亚组（n=32）的体重指数与正常对照组无统计学差异[（20．52±2．86对20．01±2．54）kg／m^2，P〉0．05]．结论胰岛素释放试验能更敏感反映PCOS患者尤其是非肥胖型患者胰岛素抵抗状态，正常糖耐量PCOS患者普遍存在胰岛素释放亢进现象。

Objective To investigate the release pattern of insulin after the load of glucose in patients with polycystic ovary syndrome （PCOS） and normal oral glucose tolerance. Methods Sixty-three patients with PCOS were undertaken oral glucose tolerance test （OGTT） and insulin release test, while 34 women with normal menstrual cycle served as control. Results Among 63 patients with PCOS, 33 cases were obese with body mass index over 25 kg/m2 , including 5 with abnormal OGTT. All 30 non-obese patients with PCOS had normal OGTT. The prevaiences of insulin resistance were 78.8% , 16.7% , and 9.0% in obese PCOS, non-obese PCOS, and control groups, respectively. Abnormal insulin release curve were found in 84. 5%, 70. 0%, and 14. 7% of subjects in these 3 groups, respectively. In 58 PCOS patients with normal OGTT, the prevalence of insulin resistance was 44.8% , and 75.9% with abnormal insulin release curve. Among them, body mass index of 32 patients, whose homeostasis model assessment for insulin resistance （HOMA-IR） and fasting insulin remained in normal range, was similar to those of control group [ （ 20.52 ± 2.86 vs 20.01 ± 2.54 ） kg/m2, P〉0.05 ]. Conclusion These findings indicate that insulin release test is useful in detecting insulin resistance. Insulin release is elevated in PCOS patients even with normal OGTT.