不同睾酮水平的多囊卵巢综合征患者胰岛素敏感性和β细胞功能特点研究

Characteristics of Insulin Sensitivity and β-cell Function in Polycystic Ovarian Syndrome Patients with Different Testosterone Levels

目的评估不同睾酮水平的多囊卵巢综合征(PCOS)患者胰岛素敏感性和β细胞功能,为血糖正常的PCOS患者早期代谢干预提供依据。方法选取2005年2月—2007年9月在本院妇产科就诊的78例血糖正常的PCOS患者(PCOS组)及20例体质量正常的健康非孕成年女性(对照组)按年龄匹配,测定其血睾酮水平。根据对照组血睾酮水平,将PCOS组患者分为PCOS正常雄激素组和PCOS高雄激素组。所有受试者行口服葡萄糖耐量试验(OG-TT)、Botnia高胰岛素-正糖钳夹术,利用胰岛素敏感指数(M)及β细胞指数(DI指数)分别评估胰岛素敏感性和β细胞功能。组间比较采用方差分析及SNK法。结果 3组受试者的年龄、体质指数(BMI)、空腹血糖(FPG)水平比较,差异均无统计学意义(P>0.05);而3组的餐后血糖(PPG)、睾酮、M值、DI指数比较,差异均有统计学意义(P<0.01);其中对照组、PCOS高雄激素组、PCOS正常雄激素组PPG水平依次升高,对照组、PCOS正常雄激素组及高雄激素组睾酮水平依次升高,组间两两比较差异均有统计学意义(P<0.01);PCOS正常雄激素组及高雄激素组患者M值及DI指数低于对照组,组间比较差异均有统计学意义(P<0.01)。结论血糖正常且血睾酮水平未显著升高的PCOS患者已存在胰岛素敏感性和β细胞功能受损,应及早予以干预。

Objective To investigate the insulin sensitivity and beta cell function of polycystic ovarian syndrome （P- COS） patients with different testosterone levels in order to provide references for metabolic intervention of PCOS patients with nor- real blood glucose. Methods Blood testosterone levels were measured among 78 PCOS patients （PCOS group） admitted to ob- stetrics and gynecology department of our hospital from February 2005 to September 2007 and 20 healthy non - pregnant adult women （control group） . Patients in PCOS group were divided into normal androgen group and high androgen group according to blood testosterone levels. All the patients were given oral glucose tolerance test （OGTF） and Botnia high insulin - glucose clamp technique. Insulin sensitivity index M and DI index were used to evaluate insulin sensitivity and β - cell function respective- ly. Analysis of variance and SNK method were adopted in comparison between groups. Results The age, BMI and FPG among three groups showed no statistically significant differences （P 〉 0.05 ）, but PPG, blood testosterone levels, M value and DI in- dex among three groups showed statistically significant differences （P 〈 0. 01 ） . The PPG levels in control group, high androgen group and normal androgen group increased in turn; while the blood testosterone levels in control group, normal androgen group and high androgen group increased in turn, and showed statistically significant differences pairwise （P 〈 0. 01 ） . Compared with control group, the M value and DI index in normal androgen group and high androgen group decreased, and showed statistically significant difference （P 〈 0.01 ） . Conclusion The PCOS patients whose blo.od glucose is normal and blood testosterone has not increased obviously have already had damaged insulin sensitivity and β - cell function. Early intervention should be given to them.