多囊卵巢综合征患者不同糖代谢状态的临床分析

A Clinical Analysis of Glucose Metabolism Status in PCOS Patients

目的:探讨多囊卵巢综合征(PCOS)患者不同糖代谢状态的临床表现以及生殖内分泌和糖脂代谢特点。方法:选择连续就诊的1 212 PCOS患者,检测双侧卵巢窦前卵泡数、血清性激素、血脂水平,并行口服葡萄糖糖耐量试验(OGTT)及胰岛素(Ins)检测,计算体质量指数(BMI)、葡萄糖(Glu)和Ins曲线下面积等参数。根据血糖水平将PCOS患者分为糖耐量正常(NGT)组、空腹血糖受损(IFG)组、糖耐量受损(IGT)组、混合型糖耐量受损(CGI)组及糖尿病(T2DM)组,比较各组PCOS患者糖、脂代谢指标及激素水平的差异。结果:PCOS患者糖耐量异常的发生率为35.3%(428/1 212),其中10.3%(125/1 212)为IFG,18.5%(224/1 212)为IGT,6.5%(79/1 212)为CGI,糖尿病发生率为5.9%(71/1 212)。随着糖代谢紊乱的加重,BMI明显上升,多囊卵巢(PCO)表现的比例有所减少,雄激素水平下降,LH/FSH比值逐渐下降。在IGT组、CGI组和T2DM组,随着糖代谢状态的恶化,各时相的血糖及胰岛素水平逐渐升高,糖负荷后2 h的Ins分泌较糖负荷后1 h明显增加,但在IFG组不明显,且其InsAUC和GluAUC较NGT组无统计学差异;各组的血脂水平逐渐增高,高密度脂蛋白(HDL)逐渐下降,但IFG组血脂较NGT组无升高(P>0.05)。结论:PCOS患者糖代谢紊乱与脂代谢异常明显相关;雄激素异常水平与糖代谢异常无关。

Objective： To discuss the clinical features of glucose metabolism in PCOS patients in northern Chinese Han women and to analyze their reproductive endocrinology and glucose and lipid metabolism.Methods： A total of 1 212 consecutive PCOS patients aged 23-38 years old were recruited in this study. All patients met the PCOS diagnosis standard set by 2003 Rotterdam conference. Patients＇ height, weight, pelvic examination, transvaginal B-ultrasound examination were taken; antral follicles counts （AFC）, serum sex hormone level, blood lipid parameters, OGTT and insulin release test were measured; and body mass index （BMI）, HOMA-IR, HOMA- β, glucose, insulin area under curve （GluAUC, InsAUC） were calculated. PCOS patients were divided into normal glucose test （NGT） group, impact of fasting glucose （IFG） group, impact of glucose test （IGT） group, combined glucose impact （CGI） group, and type 2 diabetes mellitus （T2DM） group, according to their glucose levels. The glucose metabolism indexes, lipid metabolism indexes, and androgen levels among the groups were also compared. Results： In the 1 212 PCOS patients, 35.3% had glucose tolerance abnormalities, 5.9% （71/1 212） had T2DM. Among the patients with glucose tolerance abnormalities, 10.3% （125/1 212） had IFG, 18.5% （224/1 212） had IGT, and 6.5% （79/1 212） had a mixture of IFG and IGT. When the glucose metabolism abnormality worsen, there was an increase of the BMI and a decrease of the manifestation of PCO, androgen level, and the LH/FSH. Among the groups of IGT, CGI, and T2DM, there was no significant difference of androgen levels and LH/FSH. With the aggravation of glucose metabolism, the glucose level and insulin level gradually increased. The secretion of insulin 2 h after glucose load was significantly higher than that 1 h after glucose load in IGT, CGI, and T2DM groups, but in IFG group the increase of insulin was insignificant. In all groups, HOMA-IR increased and HOMA-β decreased. There were no differences of the InsAUC and GluAUC between IFG group and NGT group. When the glucose metabolism abnormality intensifies, TCHO, TG, and LDL levels of all groups increased while HDL gradually decreased, but in IFG group the changes were not significant. Conclusion： Glucose metabolism abnormality in PCOS patients is significantly related with lipid metabolism abnormality, there is no relationship between abnormal androgen levels and glucose metabolism abnormality.