胰岛素抵抗对多囊卵巢综合征患者内分泌及卵巢形态的影响

The effect of insulin resistance on endocrine and ovary morphology in patients with polycystic ovarian syndrome

目的:探讨胰岛素抵抗(IR)对多囊卵巢综合征(PCOS)患者内分泌及卵巢形态的影响。方法:选取2014年2月至2017年2月陕西省人民医院收治的PCOS患者106例,根据稳态模型评估胰岛素抵抗指数(HOMA-IR),分为IR组(HOMA-IR≥2.69)59例和非IR(NIR)组(HOMA-IR<2.69)47例,另选取同期健康体检者60例为对照组(NC组)。比较3组的内分泌指标(糖代谢指标、性激素水平)及卵巢形态参数[卵巢体积(OV)、卵巢包膜厚度(OED)、卵泡数(FN)、卵泡最大直径(FD)]。结果:NIR组和IR组的OED、OV及FN均显著高于NC组,FD显著低于NC组(P<0.05),且IR组的OV、FN显著高于NIR组,FD显著低于NIR组(P<0.05);NIR组和IR组的雌二醇(E2)、性激素结合球蛋白(SHBG)显著低于NC组,睾酮(T)、黄体生成素(LH)、卵泡刺激素(FSH)、LH/FSH均显著高于NC组(均P<0.05),且IR组的SHBG显著低于NIR组,T显著高于NIR组(P<0.05);IR组的体重指数(Ibm)、FPG、餐后2h血糖(2hPG)、空腹胰岛素(FINS)、餐后2h胰岛素(2hINS)、HOMA-IR均显著高于NIR组和NC组(均P<0.05),且NIR组的FINS、2hINS、HOMA-IR均显著高于NC组(均P<0.05)。结论:PCOS伴IR可导致患者的卵巢体积增大,影响卵巢形态及内分泌功能。

Objective：To investigate the influence of insulin resistance （IR） on the endocrine and ovarian morphology in patients with polycystic ovary syndrome （PCOS）. Methods： 106 PCOS patients in our hospi- tal from February 2014 to February 2017 were selected and divided into IR group （HOMA-IR≥2.69, n= 59） and non-IR （NIR） group （HOMA-IR〈2.69, n=47）. 60 healthy volunteers were selected as a control group （NC group）. The endocrine indexes included glucose metabolism and sex hormone levels as well as the morphological parameters of ovary included ovarian volume （OV）, ovarian envelope depth （OED）, fol- licle number （FN） and follicular diameter （FD） were compared. Results：OED, OV, and FN in NIR group and IR group were significantly higher than those in NC group, whereas FD was significantly lower （P〈 0.05）. OV and FN in IR group were significantly higher than NIR group, but FD was significantly lower （P〈0.05）. The serum levels of estradiol （E2） and sex hormone-binding globulin （SHBG） in NIR group and IR group were significantly lower than those in NC group, while levels of testosterone （T）, luteinizing hormone （LH）, follicle-stimulating hor- mone （FSH） and LH/FHS ratio were significantly higher （P〈0.05）. The level of SHBG in IR group was significantly lower than NIR group, but the level of T was significantly higher （P〈0.05）. Body mass index, fasting plasma glucose （FPG）, 2 hours postprandial blood glucose （2 h PG）, fasting insulin （FINS）, 2 hours postprandial insulin （2 h IFS）, and HOMA-IR in IR group were significantly higher than those in NIR group and NC group （P〈0.05）. The levels of FINS, 2 h IFS and HOMA-IR in IR group were significantly higher than NC group （P〈0.05）. Conclusion： PCOS patients with IR might lead to in- creased OV volume and dysfunction of endocrine.