体质量指数正常的多囊卵巢综合征伴胰岛素抵抗患者的临床特征及胰岛素抵抗影响因素分析

The Impact of Insulin Resistance on Clinical Features in Polycystic Ovary Syndrome with Normal Body Mass Index

目的:观察体质量指数(BMI)正常的多囊卵巢综合征(PCOS)伴胰岛素抵抗(IR)患者的临床及生化表现,探讨其临床特征及IR的影响因素。方法:收集2015年8月至2016年6月就诊于黑龙江中医药大学附属第一医院妇科门诊的BMI正常(18.5 kg/m^2≤BMI≤23.9 kg/m^2)的PCOS患者116例,其中PCOS伴IR患者50例,PCOS不伴IR患者66例,分析、比较两组的临床特征、性激素水平、糖脂代谢水平,采用Spearman或Pearson相关分析稳态模型胰岛素抵抗指数(HOMA-IR)的影响因素。结果:1PCOS伴IR组患者腰臀比、多毛评分明显高于PCOS不伴IR组患者,差异有统计学意义(P<0.05);2PCOS伴IR组患者空腹葡萄糖(FPG)、空腹胰岛素(FINS)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL)显著高于PCOS不伴IR组患者,差异有统计学意义(P<0.05),PCOS伴IR组患者高密度脂蛋白(HDL)显著低于PCOS不伴IR组患者,差异有统计学意义(P<0.05);3对BMI正常的PCOS患者进行相关分析,HOMA-IR与年龄、BMI、卵泡刺激素(FSH)、黄体生成激素(LH)、LH/FSH、睾酮(T)、硫酸脱氢表雄酮(DHEAS)、雄烯二酮(AND)无关(P>0.05);与腰臀比(r=0.386)、FPG(r=0.459)、FINS(r=0.981)、TC(r=0.360)、TG(r=0.343)和LDL(r=0.467)呈正相关(P<0.01),与性激素结合球蛋白(SHBG)(r=-0.220,P<0.05)、HDL(r=-0.288,P<0.01)呈负相关。结论:BMI正常的PCOS伴IR患者腰臀比、多毛评分及糖、脂代谢指标较无IR的PCOS患者均有改变。BMI正常的PCOS患者的IR与腰臀比、FPG、FINS、TC、TG、LDL及SHBG、HDL相关。

Objective ：To observe the clinical characteristics of polycystic ovary syndrome（PCOS） with normal body mass index（BMI） and discuss the influencing factors of insulin resistance（IR）. Methods：116 PCOS patients with normal BMI accepted treatment at department of Gynecology, No. 1 Affiliated Hospital of Heilongjiang University of Chinese Medicine from August 2015 to June 2016 were selected in this study. Patients were divided into two groups according to homeostasis model assessment IR index（ HOMA-IR）, including IR-positive group（n =50） and IR-negaive group（n =66）. A HOMA-IR value ≥2.69 was used to indicate IR. The characteristics and related influencing factors of IR were analyzed. Results： （1）The waist-to-hip ratio （WHR） ,Frriman-Gallwey scores in IR-positive group was significantly higher than in IR-negative group（ P〈 0. 05）.（2）The levels of FPG, FINS,TC,TG,LDL were significantly higher in IR-positive group than those in IR-negative group（ P 〈 0.05）. （3）However,the level of HDL in I R-positive group was significantly lower than in IR-negative group （ P 〈 0. 05）. HOMA-IR values were found to be correlated with WHR （ r = 0. 386, P 〈 0.01 ）, FPG（r=0. 459,P〈0.01） ,FINS（r=0. 981 ,P〈0.01）,TC（r=0. 360,P〈0. 01 ） ,TG（r=0. 343,P〈0.01） and LDL （ r = 0. 467, P 〈 0.01 ） ; HOMA-IR values were negative correlated with SHBG （ r = - 0. 220, P 〈 0.05） and HDL（ r = - 0. 288, P 〈 0.01 ）. Conclusions. The WHR, FG scores, glucose and lipid metabolism in IR-positive with normal BMI group compared with in IR-negative group was significantly altered. The IR of PCOS with normal BMI was correlated with WHR, FPG, FINS,TC,TG ,LDL and SHBG ,HDL.