PCOS患者胰岛素抵抗和β细胞功能的改变及与体脂的关系

Insulin Resistance,β-Cell Function and Their Relationship with Body Fat Distribution in the PCOS Women

目的通过匹配体重指数,比较多囊卵巢综合征(polycystic ovary syndrome,PCOS)患者的胰岛素抵抗和β细胞分泌指数,分析PCOS患者胰岛素抵抗和β细胞分泌功能的改变及与体脂的关系。方法收集PCOS患者和年龄、体重指数(body mass index,BMI)相匹配的正常对照,按BMI将PCOS患者158例分为:正常体重组(P1组,n=62,BMI<24kg/m^2)、超重组(P2组,n=41,24kg/m2≤BMI<28kg/m^2)和肥胖组(P3组,n=55,BMI≥28kg/m^2);正常对照116例也按相同的标准分为:正常体重组(C1组,n=73)、超重组(C2组,n=22)和肥胖组(C3组,n=21)。测体脂分布指标和常规生化,计算并比较各组间胰岛素抵抗指数和β细胞分泌指数的变化。通过相关分析和多元回归统计分析与高雄激素血症的关系。结果随体重指数的增加,PCOS患者和正常对照者组内胰岛素抵抗指数逐渐增高,伴胰岛β细胞代偿性分泌增加,差异有统计学意义(P<0.05);而与BMI匹配的对照者相比,PCOS患者存在更明显的胰岛素抵抗(P<0.05);在相同体脂含量下,PCOS患者存在更严重的血脂异常(P<0.05)。相关性分析发现,体脂百分比(FAT%)与T呈正相关,进一步逐步回归分析发现FAT%和TG为高雄激素的独立危险因素。结论匹配体脂后,PCOS组存在更显著的脂代谢紊乱和胰岛素抵抗,提示PCOS患者糖脂代谢异常有体脂分布异常以外的因素参与。相对于其他体质测量指数,FAT%与总睾酮水平更密切。

Objective By matched BMI, the degree of insulin resistance, islet β-cell function and their relationship with body fat distribution were evaluated in PCOS patients.Methods Totally 158 women suffered with PCOS （group P） and 116 healthy women （group C） were enrolled matched with age-and BMI. Each group was divided into three subgroups according to the BMI：group P1 and C1（BMI〈24kg/m2）; group P2 and C2（24 ≤ BMI 〈 28kg/m2）; group P3 and C3（BMI ≥ 28kg/m2）. Serum glucose, insulin, lipids and some body fat distribution index were measured. The index of insulin sensitivity and islet β-cell function were calculated. The relationships between anthropometric measures, insulin sensitivity, serum levels of testosterone were evaluated by Spearman＇s correlation tests. The stepwise multiple linear regression analysis was used to determine the association between testosterone and anthropometric/biochemical parameters in all participants of the study.Results Insulin resistance index were markedly elevated with the increase of BMI both in the PCOS patients and control. On the contrary, the insulin sensitivity index was decreased with the increase of BMI. Insulin resistance index of patients with PCOS was higher than that in control groups, while the insulin sensitivity index and deposition index were decreased compared with the BMI-matched control groups. More severe dyslipdimia was shown in the PCOS subjects than the healthy women matched with BMI.Conclusion After being matched with BMI, patients suffered with PCOS exist more severe dyslipdimia and insulin resistance, which suggests other mechanism may participate besides the body fat distribution. Compared with others anthropometric index, FAT% was an independent risk factor for high level of serum total testosterone.