多囊卵巢综合征患者胰岛素抵抗与糖脂代谢及性激素的研究

Study on insulin resistance,glycolipid metabolism,and sex hormones in patients with polycystic ovary syndrome

目的通过高胰岛素正葡萄糖钳夹试验评估多囊卵巢综合征(PCOS)患者的胰岛素抵抗,探讨伴胰岛素抵抗PCOS患者糖脂代谢及性激素水平特点。方法将2017年7月至2019年2月就诊于遵义医科大学附属医院内分泌科住院及门诊的73例PCOS患者和体重指数及年龄匹配的27名健康女性行高胰岛素正葡萄糖钳夹试验,根据葡萄糖代谢率、体重指数和稳态模型评估的胰岛素抵抗指数(HOMA-IR)分组,分析PCOS患者糖脂代谢及性激素指标的变化及差异。结果在PCOS组中,糖调节受损者占3.23%(1/31),血脂代谢异常者占9.68%(3/31);而在PCOS合并胰岛素抵抗组中,糖调节受损者占7.14%(3/42),血脂代谢异常者达47.62%(20/42),5例患者被诊断为代谢综合征,占11.90%。相关分析显示,葡萄糖代谢率与体重指数、腰臀比、收缩压、空腹血糖、空腹胰岛素、HOMA-IR、皮质醇、三酰甘油、总胆固醇、低密度脂蛋白胆固醇(LDL-C)、游离雄激素指数(FAI)和谷氨酰转肽酶(GGT)呈负相关(P<0.05),与高密度脂蛋白胆固醇(HDL-C)呈正相关(P=0.028);HOMA-IR与体重指数、腰臀比、收缩压、空腹血糖、空腹胰岛素、HbA1C、LDL-C呈正相关(P<0.05),与葡萄糖代谢率和HDL-C呈负相关(P<0.05);体重指数与腰臀比、收缩压、空腹血糖、空腹胰岛素、HOMA-IR、三酰甘油和LDL-C呈正相关(P<0.05),与葡萄糖代谢率、HDL-C和性激素结合球蛋白(SHBG)呈负相关(P<0.01)。多元线性逐步回归分析表明,体重指数、总胆固醇、三酰甘油和皮质醇是影响葡萄糖代谢率的重要因素,空腹血糖、空腹胰岛素和收缩压是HOMA-IR的重要影响因素,葡萄糖代谢率、HOMA-IR、HDL-C和SHBG仍然是影响体重指数的重要影响因素。结论FAI、SHBG和皮质醇可能参与到PCOS患者的胰岛素抵抗发生中,存在胰岛素抵抗的PCOS患者更容易发生代谢紊乱。

Objective To evaluate the insulin resistance of patients with polycystic ovary syndrome(PCOS)by hyperinsulin-euglycemic clamp test,and to explore the characteristics of glycolipid metabolism and sex hormone levels in PCOS patients with insulin resistance.Methods Seventy-three patients with PCOS and 27 healthy women with body mass index and age matched with PCOS patients who were admitted to the Department of Endocrinology of Affiliated Hospital of Zunyi Medical University from July 2017 to February 2019 were underwent hyperinsulin-euglycemic clamp test.All subjects were grouped according to glucose metabolic rate,body mass index,and homeostasis model assessment for insulin resistance(HOMA-IR),the changes and differences of glucose and lipid metabolism and sex hormone indexes in PCOS patients were analyzed.Results In the PCOS group,impaired glucose regulation accounted for 3.23%(1/31),and abnormal lipid metabolism for 9.68%(3/31).In the PCOS with insulin resistance group,impaired glucose regulation accounted for 7.14%(3/42).Abnormal blood lipid metabolism reached 47.62%(20/42),and 5 patients were diagnosed with metabolic syndrome,accounting for 11.90%.Correlation analysis showed glucose metabolic rate and body mass index,waist-to-hip ratio,systolic blood pressure,fasting plasma glucose,fasting insulin,HOMA-IR,cortisol,triglyceride,total cholesterol,low density lipoprotein-cholesterol(LDL-C),free androgen index(FAI),and glutamyl transpeptidase(GGT)were negatively correlated(all P<0.05),while positively correlated with high density lipoprotein-cholesterol(HDL-C;P=0.028).HOMA-IR was positively correlated with body mass index,waist-to-hip ratio,systolic blood pressure,fasting plasma glucose,fasting insulin,HbA1C,LDL-C(P<0.05),and negatively correlated with glucose metabolic rate and HDL-C(P<0.05).Body mass index and waist-to-hip ratio,systolic blood pressure,fasting plasma glucose,fasting insulin,HOMA-IR,triglyceride,and LDL-C(P<0.05)were positively correlated,and negatively correlated with glucose metabolic rate,HDL-C,and sex hormone binding globulin(SHBG;P<0.01).Multivariate linear stepwise regression analysis showed that body mass index,total cholesterol,triglyceride,and cortisol were principal factors affecting glucose metabolic rate.Fasting plasma glucose,fasting insulin,and systolic blood pressure were important factors influencing HOMA-IR.Glucose metabolic rate,HOMA-IR,HDL-C,while SHBG were still vital to body mass index.Conclusion FAI,SHBG,and cortisol may be involved in the insulin resistance development of PCOS patients,and PCOS patients with insulin resistance were more susceptible to metabolic disorders.