多囊卵巢综合征性激素水平及皮质醇检测与胰岛素抵抗的相关性分析

Relationship between the levels of sex hormone,cortisol and insulin resistance in patients with polycystic ovary syndrome

目的探讨多囊卵巢综合征(PCOS)患者血清性激素水平、皮质醇(COR)变化及与胰岛素抵抗(IR)的相关关系。方法 50例PCOS患者(PCOS组)和47例正常妇女(对照组)早晨空腹采血,采用电化学发光法和放射免疫分析法测定血清性激素结合球蛋白(SHBG)、17羟孕酮(17-OHP)、硫酸脱氢表雄酮(DHEA)、雌二醇(E2)、睾酮(T)、泌乳素(PRL)、黄体生成素(LH)、促卵泡刺激素(FSH)、皮质醇(COR)等指标,并测空腹血糖(FBG)、空腹胰岛素(FINS)。IR按胰岛素抵抗指数(HOMA-IR)来评估,计算游离雄激素指数(FAI)和胰岛素敏感指数(ISI)。分析引起胰岛素抵抗的相关因素。结果 PCOS组患者血清17-OHP、DHEA、T、LH、FBG、FINS、HOMA-IR、FAI均明显高于对照组(t=4.08、14.72、10.63、8.01、3.93、4.75和9.51,均P<0.01);PCOS组患者血清SHBG、PRL、COR、ISI则低于对照组(t=10.05、9.62、8.16和3.58,均P<0.01);PCOS组患者血清E2、FSH与对照组比较差异无统计学意义(均P>0.05)。Pearson相关分析显示,HOMA-IR和FAI呈正相关(r=0.319,P=0.024),与SHBG、ISI呈负相关(r=-0.308和-0.856,P=0.029和0.000)。结论联合检测性激素结合球蛋白(SHBG)、睾酮(T)、游离雄激素指数(FAI)和胰岛素敏感指数(ISI)有助于早期诊断PCOS患者胰岛素抵抗。

[Objective] To elucidate the relationship between the levels of sex hormone, cortisol and insulin resistance in patients with polycystie ovary syndrome （PCOS）. [Methods] A total of 50 patients with PCOS and 47 healthy subjects （normal controls） were included in this study. The serum levels of sex hormone binding globulin （SHBG）, 17 hydroxy （OH） progesterone （17-OHP）, dehydro-epiandrosterone sulfate （DHEA）, estradiol （E2）, total testosterone （T）, prolactin （PRL）, Luteinizing hormone （LH）, follicle stimulating hormone （FSH）, cortisol （COR）, fasting blood glucose （FBG） and fasting insulin （FINS） were detected. Insulin resistance （IR） was assessed using both fasting insulin levels and the homeostasis model assessment （HOMA） calculation： [fasting insulin （μIU/mL） × fasting glucose （mmol/L）/22.5]. The free androgenindex （FAI） was calculated using the formula [T （nmol/L） × 100/SHBG （nmol/L）]. The insulin sensitivity index （ISI） was calculated using the formula [1/ fasting insulin （txIU/mL） × fasting glucose （mmol/L）]. The correlations between IR and related factors were analyzed. [Results] The serum 17-OHP, DHEA, T, LH, FBG, FINS, HOMA-IR, FAI in the PCOS group were significantly higher than controls （t =4.08, 14.72, 10.63, 8.01, 3.93, 4.75, 9.51, P 〈0.01）, the SHBG, PRL, COR, ISI in the PCOS group was significantly lower than controls （t =10.05, 9.62, 8.16, 3.58, P 〈0.01）. Pearson correlation analysis showed FAI was positively correlated with the HOMA-IR in the PCOS group （r=0.319, P=0.024）, SHBG, ISI were negatively correlated with the HOMA-IR in the PCOS group （r = -0.308, -0.856, P =0.029, 0.000）. [Conclusions] Combined detection of sex hormone binding globulin （SHBG）, total testosterone （T）, the free androgenindex （FAI） and the insulin sensitivity index （ISI） is helpful for the early diagnosis of insulin resistance in patients with PCOS.