黑棘皮病和非黑棘皮病患者的总睾酮水平与胰岛素抵抗的相关性

Correlation between total testosterone levels and insulin resistance in patients with acanthosis nigricans and non-acanthosis nigrican

目的探讨在黑棘皮病(AN)和非黑棘皮病(NAN)人群中的总睾酮水平对胰岛素分泌和胰岛素抵抗的影响及其相关性。方法选取超重患者(体质量指数≥24 kg/m^(2))639例,根据性别及是否有黑棘皮病分为四组:AN女性137例,NAN女性227例,AN男性129例,NAN男性146例。每组按照总睾酮(TT)四分位数分为4个亚组,比较不同TT水平胰岛素分泌和抵抗的差异及变化规律。结果无论男性和女性AN组较非AN组胰岛素分泌水平明显增加、胰岛素曲线下面积增加(P<0.05),稳态模型-胰岛素抵抗指数升高(HOMA-IR)(P<0.05),总体胰岛素敏感性指数(WBISI)下降(P<0.01),但并未观察到随TT变化趋势。NAN女性随着TT水平升高,胰岛素分泌水平逐渐升高,TT升高至Q4水平,胰岛素曲线下面积显著升高(P<0.01)、WBISI明显下降(P<0.05);而NAN男性随着TT水平下降,胰岛素分泌水平逐渐升高,TT降至Q1水平,胰岛素曲线下面积明显升高(P<0.05)、WBISI明显下降(P<0.05)。结论总睾酮水平对胰岛素抵抗和胰岛素分泌有明显影响,在男女中具有不同作用,并且在NAN患者中较AN患者中更为明显。

Objective To investigate the correlation of the total testosterone(TT)level with insulin secretion and resistance in patients with acanthosis nigricans(AN)and non-acanthosis nigricans(NAN).Methods This study was conducted in a total of 639 overweight patients(body mass index≥24 kg/m^(2)),including 137 female AN patients,277 female NAN patients,129 male AN patients,and 146 male NAN patients.Each group was further divided into 4 subgroups according to the quartile of TT level for comparison of insulin secretion and insulin resistance parameters.Results Both female and male patients with AN showed obvious hyperinsulinemia with increased area under the curve for insulin(AUC-INS)(P<0.05),increased homeostatic model assessment of insulin resistance(HOMA-IR)index(P<0.05)and decreased whole-body insulin sensitivity index(WBISI)(P<0.01)as compared with those in NAN groups,but these parameters did not show significant variations with the change of TT levels.In female patients with NAN,insulin secretion level increased progressively as the TT level increased;the AUC-INS increased(P<0.01)and WBISI decreased significantly(P<0.05)when the TT levels increased to Q4.In male patients with NAN,insulin secretion level increased progressively as the TT levels decreased,and the AUC-INS increased(P<0.05)and the WBISI decreased significantly(P<0.05)when the TT levels decreased to Q1.Conclusions The TT level has a significant effect on insulin resistance and insulin secretion,but its effect varies between genders and is more significant in NAN patients than in AN patients.