“瘦型”多囊卵巢综合征患者骨骼肌间脂肪与胰岛素抵抗关系的研究

The relationship of intermuscular adipose tissue with insulin resistance in 'thin type' PCOS patients

目的比较BMI在正常范围内的"瘦型"多囊卵巢综合征(PCOS)患者骨骼肌间脂肪含量与糖代谢参数之间的关系,为早期干预该类患者糖脂代谢紊乱提供理论依据。方法收集BMI在正常范围内的"瘦型"PCOS患者40例(病例组)以及同期非PCOS女性30例(对照组),测定糖代谢参数包括空腹血糖和空腹胰岛素,胰岛素抵抗指数(HOMA-IR)采用HOMA模型评价;采用双能X线仪(DXA)测量全身脂肪量以及腹部脂肪含量,MRI测量下肢骨骼肌间脂肪。结果病例组空腹胰岛素水平以及HOMA-IR均高于对照组,并且骨骼肌间脂肪含量亦明显高于对照组,即使调整了全身脂肪及腹部脂肪变量后,该差异仍有统计学意义。进一步相关性分析提示,病例组骨骼肌间脂肪含量与空腹胰岛素水平及HOMA-IR均呈正相关(r=0.45、0.34,均P<0.05)。结论即使是BMI在正常范围的"瘦型"PCOS患者,其体内脂肪分布仍与对照组存在明显差异,尤其是骨骼肌部位的脂肪异位沉积,在外周胰岛素抵抗的发生中可能发挥着潜在的作用。

Objective To compare the intermuscular adipose tissue distribution characteristic and clinical parameters of PCOS patients in normal BMI range with control group. Methods PCOS patients(case group, n=40) and physical examination women(control group, n=30) in normal BMI range were enrolled from June, 2015 to Dec, 2017. Glucose metabolism data including fasting glucose and insulin were measured, and insulin resistance index was evaluated by HOMA model. Total body fat and android fat were scanned by DXA, and intermuscular adipose tissue were measured(IMAT) by MRI. Results Compared with control group, the fasting insulin, HOMA index and IMAT were higher in PCOS group, and the difference of IMAT was still significant even adjusted total fat and android fat(P<0.05). Pearson analysis showed the significant positively correlation of IMAT with fasting insulin and HOMA index in PCOS group(r=0.45 and r= 0.34,respectively, P<0.05). Conclusion The distribution of adipose tissue, especially the ectopic adipose deposition in the intermuscular site,was significantly different from that of the normal control, which may play potential role in ’thin type’ PCOS peripheral insulin resistance.