胰岛素抵抗与体质量指数对PCOS妇女脂代谢及性激素的影响

Effects of insulin resistance and body mass index on lipid metabolism and sex hormones in women with polycystic ovary syndrome

目的探讨胰岛素抵抗(IR)与体质指数(BMI)对多囊卵巢综合征(PCOS)妇女脂代谢与性激素的影响。方法选取2015年7月至2016年12月在海南医学院第二附属医院东湖妇产科就诊的198例PCOS患者,根据体质指数与胰岛素抵抗指数分为胰岛素抵抗+肥胖组(A组)、胰岛素抵抗+非肥胖组(B组)、非胰岛素抵抗+肥胖组(C组)和非胰岛素抵抗+非肥胖组(D组),对比四组患者的卵泡刺激素(FSH)、促黄体生成素(LH)、雌二醇(E2)、睾酮(T)、性激素结合蛋白(SHBG)及脂代谢指标。结果四组患者BMI、腰围、腰臀比(WHR)、胰岛素抵抗指数(HOMA-IR)比较均有统计学差异(F值分别为2.657、3.024、2.997、3.223,均P<0.05),A组和C组BMI、腰围、WHR均显著高于B组和D组(t=2.446~2.780,均P<0.05),A组和B组BMI、腰围、WHR均显著高于C组和D组(t=2.409~3.127,均P<0.05)。四组患者血清FSH、E2、T比较无显著性差异(F值分别为0.790、1.030、1.103,均P>0.05),LH和SHBG比较有显著性差异(F值分别为3.112、2.579,均P<0.05),A组LH水平最高,D组SHBG水平最高。四组患者总胆固醇(TC)、甘油三酯(TG)比较有显著性差异(F值分别为2.908、2.557,均P<0.05),进一步每两组之间比较发现,A组和B组均显著高于C组和D组(t=3.408~2.676,均P<0.05),A组和B组之间、C组和D组之间比较无显著性差异(t值分别为0.788、0.457,均P>0.05)。四组患者高密度脂蛋白(HDL)、低密度脂蛋白(LDL)比较无显著性差异(F值分别为1.009、1.243,均P>0.05)。结论患有胰岛素抵抗及肥胖患者有更严重的脂代谢异常及性激素分泌紊乱,需要积极干预治疗。

Objective To investigate the effects of insulin resistance（IR）and body mass index（BMI）on lipid metabolism and sex hormones in women with polycystic ovary syndrome（PCOS）.Methods A total of 198 PCOS patients who were treated in the Second Affiliated Hospital of Hainan Medical University from July 2015 to December 2016 were divided into IR＋obesity group（group A）,IR＋non-obese group（group B）,non-IR＋obesity group（group C）and non-IR＋ obese group（group D）according to BMI and HOMA-IR.Four groups were compared in FSH,LH,E2,T,sex hormone binding protein（SHBG）and lipid metabolism.Results There were significant differences in BMI,waist circumference,WHR and HOMA-IR among four groups（F value was 2.657,3.024,2.997 and 3.223,respectively,all P〈0.05）.In group A and group C BMI,waist circumference and WHR were significantly higher than those in group B and group D（t value ranged 2.446-2.780,all P〈0.05）.There was no significant difference in serum FSH,E2 and T among four groups（F value was 0.790,1.030 and 1.103,respectively,all P〈0.05）,but there were significant differences in LH and SHBG（F value was 3.112 and 2.579,respectively,both P〈0.05）.Group A had the highest level of LH and group D had the highest level of SHBG.There was significant difference in TC and TG among four groups（F value was 2.908 and 2.908,respectively,both P〈0.05）.A further comparison between each two groups indicated that they were significantly higher in group A and group B than in group C and group D（t value ranged 3.408-2.676,all P〈0.05）but difference between group A and group B and that between group C and group D was not significant（t value was 0.788 and 0.457,respectively,both P〈0.05）.There was no significant difference in HDL and LDL among four groups（F value was 1.009 and1.243,respectively,both P〈0.05）.Conclusion Patients with IR and obesity have more severe lipid metabolism and sex hormone secretion disorder,and they need active intervention.