多囊卵巢综合征患者脂联素与游离睾酮指数及胰岛素抵抗的相关性研究

Correlation between Adiponectin and Free Testosterone Index and Insulin Resistance in Patients with Polycystic Ovary Syndrome

背景多囊卵巢综合征(PCOS)与胰岛素抵抗及游离睾酮指数(FAI)密切相关,但目前仍需大量研究为其诊断及治疗提供参考。目的探究脂联素(ADPN)在PCOS患者不同睾酮浓度下与FAI及胰岛素抵抗的相关性,进一步研究ADPN在PCOS中的临床价值。方法选取2017年10月至2020年4月就诊于遵义医科大学附属医院门诊或住院的116例PCOS患者及45例体检健康的正常育龄期妇女(对照组)为研究对象。收集研究对象的一般资料,进行实验室指标检查:月经规律者于月经周期第3~5天,月经不规律者在B超检查未见优势卵泡时,禁食12 h后由专人采集患者空腹肘静脉血检测空腹血糖(FPG)、空腹胰岛素(FINS)、糖化血红蛋白(HbA_(1c))、三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、卵泡刺激素(FSH)、促黄体生成素(LH)、孕酮、睾酮(TEST)、性激素结合球蛋白(SHGB)、硫酸脱氢表雄酮(DHEA-S)、ADPN。计算稳态模型评估的胰岛素抵抗指数(HOMA-IR)及FAI。依据是否合并高雄激素血症(TEST≥2.44 nmol/L)将PCOS患者分为PCOS伴高雄激素血症组(HA组,n=65)和PCOS不伴高雄激素血症组(非HA组,n=51)。进一步按照TEST水平的四分位值将HA组和非HA组分为4个亚组。分析ADPN与其他指标的相关性及FAI和ADPN的影响因素。结果与对照组相比,PCOS患者非HA组及HA组体质量、体质指数(BMI)、腰围、臀围、腰臀比(WHR)、FPG、FINS、HOMA-IR、HbA_(1c)、TG、LDL、FSH、TEST、FAI增加,HDL降低(P<0.05)。与非HA组相比,HA组TG、HOMA-IR、TEST、FAI增高,HDL、FSH、孕酮、SHBG、ADPN降低(P<0.05)。HA组与非HA组内不同TEST水平亚组的ADPN比较,差异均有统计学意义(P<0.05)。校正BMI后,PCOS患者的ADPN与HOMA-IR、FAI、TEST呈负相关(P<0.001)。在HA组,ADPN与HOMA-IR、FAI、TEST呈负相关(P<0.05);在非HA组中ADPN与HOMA-IR、FAI呈负相关(P<0.05),与TEST无相关关系(P=0.061)。非HA组中,ADPN、BMI是FAI的影响因素,HOMA-IR、FAI、BMI是ADPN的影响因素(P<0.05)。在HA组中,ADPN是FAI的影响因素,HOMA-IR、FAI是ADPN的影响因素(P<0.05)。结论ADPN与FAI呈负相关并互为主要影响因素,且这一关系不受TEST水平影响,通过测定血清ADPN水平可以同时反映PCOS患者的高雄激素水平及胰岛素抵抗程度,ADPN有望成为该疾病诊断和病情评估的重要参考指标。

Background Polycystic ovary syndrome(PCOS)is closely related to insulin resistance and free testosterone index(FAI),but a large number of studies are still needed to provide a reference for its diagnosis and treatment.Objective To explore the correlation of adiponectin(ADPN)with FAI and insulin resistance at different testosterone concentrations in PCOS patients,and to further investigate the clinical value of adiponectin in PCOS.Methods From October 2017 to April 2020,116 patients with PCOS and 45 healthy women of normal reproductive age(control group)who were treated in outpatient or inpatient hospital of Zunyi Medical University Affiliated Hospital were selected as the research objects.The general data of the research subjects were collected,and laboratory index examinations were conducted:on the 3rd to 5th day of the menstrual cycle of regular menstruation or when there was no dominant follicle in the B-ultrasound examination of irregular menstruation,and the patient’s cubital venous blood was collected on an empty stomach after fasting for 12 hours to detect fasting blood glucose(FPG),fasting insulin(FINS),Glycated hemoglobin(HbA_(1c)),triacylglycerol(TG),total cholesterol(TC),low density lipoprotein(LDL),high density lipoprotein(HDL),follicle stimulating hormone(FSH),luteinizing hormone(LH),progesterone,testosterone(TEST),sex hormone binding globulin(SHGB),dehydroepiandrosterone sulfate(DHEA-S),ADPN.The homeostasis model-assessed insulin resistance index(HOMA-IR)and FAI were calculated.PCOS patients were divided into PCOS with hyperandrogenemia group(HA group,n=65)and PCOS without hyperandrogenemia group(non-HA group,n=51)according to whether they had hyperandrogenism(TEST≥2.44 nmol/L).The HA and non-HA groups were further divided into 4 subgroups according to the quartile values of TEST levels.The correlation between ADPN and other indicators and the influencing factors of FAI and ADPN were analyzed.Results Compared with the control group,the body mass,BMI,waist circumference,hip circumference,WHR,FPG,FINS,HOMA-IR,HbA_(1c),TG,LDL,FSH,TEST,FAI were increased,and HDL was decreased in the non-HA and HA group of PCOS patients(P<0.05).Compared with the non-HA group,the TG,HOMA-IR,TEST and FAI of the HA group were increased,while the HDL,FSH,progesterone,SHBG and ADPN of the HA group were decreased(P<0.05).There were significant differences in ADPN between HA group and nonHA group with different TEST level subgroups(P<0.05).After adjustment for BMI,ADPN in PCOS patients was negatively correlated with HOMA-IR,FAI,and TEST(P<0.001).In the HA group,ADPN was negatively correlated with HOMA-IR,FAI,and TEST(P<0.05);in the non-HA group,ADPN in the group was negatively correlated with HOMA-IR,FAI(P<0.05),and had no correlation with TEST(P=0.061).In the non-HA group,ADPN and BMI were the influencing factors of FAI,and HOMA-IR,FAI and BMI were the influencing factors of ADPN(P<0.05).In the HA group,ADPN was the influencing factor of FAI and HOMA-IR,and FAI were the influencing factors of ADPN(P<0.05).Conclusion ADPN is negatively correlated with and mutually affects free testosterone index,and this relationship is not affected by TEST concentrations,and by measuring serum ADPN levels can simultaneously reflect the high androgen levels and the degree of insulin resistance in PCOS patients,ADPN is expected to be an important reference index for the diagnosis and condition evaluation.