胰岛素抵抗的多囊卵巢综合征患者血糖波动变化研究

The study of daily glucose change in insulin resistance with polycystic ovary syndrome women

目的探讨胰岛素抵抗的多囊卵巢综合征（PCOS）患者血糖波动特点及其糖脂代谢特征。方法69例初诊PCOS患者进行75g口服葡萄糖耐量试验（OGTr）及胰岛素释放试验，按胰岛素抵抗指数（HOMA-IR）分为两组，35例PCOS胰岛素抵抗（PCOS—IR）为研究组，34例PCOS非胰岛素抵抗（PCOS．NIR）为对照组，进行动态血糖监测（CGMS），比较两组患者组间连续48h的平均血糖（MBG）、血糖标准差（SDBG）及最大血糖波动幅度（LAGE）、平均血糖波动幅度（MAGE）、日间血糖平均绝对差（MODD）及比较两组临床及生化指标。结果PCOS—IR组MBG、SDBG、LAGE、MAGE均高于PCOS—NIR组（P〈0．05）。PCOS—IR组体重指数、腰围、甘油三酯、糖化血红蛋白、空腹血糖、2h血糖、游离睾酮指数均高于PCOS—NIR组，高密度脂蛋白低于PCOS—NIR组（P〈0．01）。两组总胆固醇、低密度脂蛋白、MODD差异无统计学意义（P〉0．05）。结论胰岛素抵抗的多囊卵巢综合征患者更易出现血糖波动，存在更为严重的糖脂代谢紊乱。

Objective To explore the clinical metabolic characteristics and the blood glucose variability in the insulin resistance polycystic ovary syndrome （PCOS） patients. Methods Totally 69 cases of PCOS patients were divided into two groups ： PCOS with insulin resistance （ PCOS-IR ） group and PCOS without insulin-resistance （PCOS-NIR） group. Their clinical and metabolic characteristics were analyzed, and continuous glucose monitoring system （CGMS） was used to monitor the glucose concentration of subcu-taneous interstitial fluid to reflect the blood glucose level. Mean blood glucose level （MBG） and its standard deviation （SDBG）, mean amplitude of glycemic excursion （MAGE）, peak level of postprandial plasma glu-cose as well as its peaking time during a 48-hour period CGMS were calculated. Results MBG, SDBG, large amplitude of glycemic excursions （LAGE）, MAGE level in PCOS-IR group, were significantly higher than those in PCOS-NIR （P 〈 0.05 ）. Body mass index （BMI）, triglycerides, glycated hemoglobin Alc （HbAlc） , fasting blood glucose （FBG）, 2 hours glucose, free androgen index （FAI） level in PCOS-1R group were higher than in PCOS-NIR group （ P〈0.01 ）. The difference of total cholesterol, low-density lipoprotein, mean of daily difference （MODD） level were not statistically significant （ P〉0. 05 ）. Conclusions PCOS-IR patients suffer from more serious metabolic disorder and blood glucose variability.