多囊卵巢综合征患者雄激素过多与异常糖耐量的关系

Relationship between hyperandrogen and impaired glucose regulation in women with polycystic ovary syndrome

目的探索多囊卵巢综合征(PCOS)患者雄激素过量是否与异常糖耐量(AGT)相关,并分析高游离雄激素指数(FAI)与胰岛素敏感性和胰岛β细胞功能的关系。方法回顾性分析2013年4月至2017年3月于南京鼓楼医院门诊就诊的378例PCOS患者性激素、75 g口服葡萄糖耐量试验(OGTT)结果等临床资料,并计算FAI、1/稳态模型评估胰岛素抵抗指数(HOMA-IR)、Matsuda胰岛素敏感指数(ISIM)、稳态模型评估β细胞功能指数(HOMA-β)、早时相胰岛素分泌指数(InsAUC-30/GluAUC-30)、总时相胰岛素分泌指数(InsAUC-120/GluAUC-120)和处置指数(DI)。组间差异比较使用方差分析(校正年龄和体质指数)或χ2检验,Bonferroni方法用于事后比较,FAI和AGT之间的关系采用多元Logistic回归分析法,FAI与胰岛素敏感指数和β细胞功能的关系采用Spearman相关分析。结果378例PCOS患者平均年龄(27.8±4.4)岁,糖耐量正常(NGT)者占59.8%(226/378),糖尿病前期者占31.5%(119/378)、2型糖尿病患者占8.7%(33/378)。FAI在AGT人群[糖尿病前期6.2(3.6,10.3)、2型糖尿病7.9(4.4,15.5)]高于NGT人群[5.0(2.8,7.6)](F=9.155,P<0.001);FAI是PCOS女性AGT的独立危险因素(OR:1.166,95%CI:1.069~1.272)。随着FAI的增加,胰岛素敏感性(1/HOMA-IR和ISIM)和β细胞功能(DI-30、DI-120)下降(F=7.638、6.863、3.366,P<0.05),而胰岛素分泌(HOMA-β,InsAUC-30/GluAUC-30、InsAUC-120/GluAUC-120、DI-120)呈逐渐上升趋势,但差异无统计学意义(F=1.828、1.315,P>0.05)。结论高FAI水平与较高的AGT发生率相关,而FAI可被视为PCOS患者胰岛素抵抗和β细胞功能障碍的指标。

Objective To explore the relationship between hyperandrogen and abnormal glucose tolerance (AGT) in women with polycystic ovary syndrome (PCOS), and to analyze the potential association between free androgen index (FAI) and insulin sensitivity/islet beta cell function. Methods Clinical data of 378 PCOS women including sex hormone and other parameters obtained by 75 g glucose tolerance test (OGTT) were retrospectively analyzed from Endocrinology Department of Drum Tower Hospital between April 2013 and March 2017. Free androgen index (FAI), 1/homeostasis model assessment of insulin resistance (1/HOMA-IR) index, Matsuda insulin sensitivity index (ISIM), HOMA-β, InsAUC-30/GluAUC-30, InsAUC-120/GluAUC-120 and disposition index (DI) were calculated. Variance analysis or χ2 test was used for comparison between groups. Bonferroni method was used for post hoc comparison. Multivariate logistic regression was used to analyze the relationship between FAI and AGT. Spearman correlation (corrected by age and body mass index) was used to analyze the relationship between FAI and insulin sensitivity index/β cell function. Results Of 378 PCOS women, the mean age was (27.8±4.4) years, 59.8%(226 of 378) had normal glucose tolerance (NGT), 31.5%(119 of 378) had pre-diabetes, and 8.7%(33 of 378) had type 2 diabetes mellitus (T2DM). FAI in AGT [pre-diabetes 6.2(3.6, 10.3) and T2DM 7.9(4.4, 15.5)] were higher than those in NGT [5.0(2.8, 7.6), F=9.155, P<0.001]. FAI(OR: 1.166, 95%CI: 1.069-1.272) was an independent risk factor for AGT in women with PCOS. With the increase of FAI, insulin sensitivity [1/HOMA-IR, ISIM and β cell function (DI-30, DI-120) decreased (F=7.638, 6.863, 3.366, all P<0.05), while insulin secretion (HOMA-β, InsAUC-30/GluAUC-30 and InsAUC-120/GluAUC-120, DI-120) had a trend of increase, but the differences were not statistically significant (F=1.828, 1.315, both P>0.05). Conclusion High FAI levels are associated with high incidence of AGT, and FAI can be considered as an indicator of insulin resistance or β cell dysfunction in PCOS women.