不同胰岛素抵抗及肥胖水平对多囊卵巢综合征患者高雄激素血症特征的影响

发布时间：2018-04-24 06:07

本文选题：多囊卵巢综合征 + 胰岛素抵抗　；参考：《广东医学》2017年03期

【摘要】：目的探讨不同胰岛素抵抗(IR)与肥胖(OB)水平对多囊卵巢综合征(PCOS)患者内分泌代谢及高雄激素血症特征的影响。方法根据胰岛素抵抗指数及体质指数(BMI)将112例PCOS患者分为IR+NOB组、IR+OB组、NIR+NOB组、NIR+OB组,对比4组患者糖尿病及糖调节受损、血脂紊乱发生率,以及临床、内分泌特征的不同,并分析PCOS患者游离雄激素指数(FAI)的影响因素。结果 (1)4组患者多毛发生率、痤疮发生率差异无统计学意义(P0.05)。(2)IR+OB组糖尿病、糖调节异常、血脂紊乱发生率及超敏C反应蛋白(hs-CRP)较NIR+NOB组高(P0.05)。(3)IR+OB组的空腹血糖(FPG)、血糖曲线下面积(PGAUC)较NIR+NOB组升高(P0.05);IR+NOB、IR+OB组的空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)、胰岛素曲线下面积(INSAUC)均较NIR+NOB、NIR+OB组升高(P0.05)。(4)IR+NOB、IR+OB组的总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)均较NIR+NOB组升高(P0.05)。(5)IR+NOB、IR+OB、NIR+OB组的性激素结合蛋白(SHBG)较NIR+NOB组降低(P0.05),IR+OB组的FAI较NIR+NOB组升高(P0.05),4组间黄体生成素(LH)/卵泡刺激素(FSH)、LH、总睾酮(T)、硫酸去氢表雄酮(DHEAS)比较差异无统计学意义(P0.05)。(6)各组间平均卵巢大小、平均卵泡个数、卵泡最大直径差异无统计学意义(P0.05)。(7)FAI与HOMA-IR、BMI、LH、LH/FSH、T呈明显正相关关系(P0.05),与DHEAS呈明显负相关关系(P0.05)。多元逐步回归分析显示BMI、LH是FAI的独立影响因素。剔除BMI后回归分析提示FINS、LH是FAI的独立影响因素。结论 IR与OB加重PCOS患者糖脂代谢紊乱及高雄激素血症。高胰岛素血症及LH水平升高是高雄激素血症形成的主要原因。
[Abstract]:Objective to investigate the effects of different levels of insulin resistance (IR) and obesity (OB) on endocrine metabolism and hyperandrogenemia in patients with polycystic ovary syndrome (PCOS). Methods according to insulin resistance index and body mass index, 112 patients with PCOS were divided into IR NOB group and NIR NOB group. The diabetes mellitus and impaired glucose regulation, the incidence of dyslipidemia, and the difference of clinical and endocrine characteristics were compared among the 4 groups. The influencing factors of free androgen index (FAI) in patients with PCOS were analyzed. Results there was no significant difference in the incidence of hirsutism and acne in the 4 groups. There was no significant difference in the incidence of acne. The incidence of dyslipidemia and hypersensitive C-reactive protein hs-CRP) were higher in NIR NOB group than in NIR NOB group. The area under the blood glucose curve was higher than that in NIR NOB group. The fasting insulin FINSINS, insulin resistance index (HOMA-IRN) and insulin resistance index (HOMA-IRN) in NIR NOB group were higher than those in NIR NOB group. Compared with the NIR NOBN NIR OB group, the total cholesterol and low density lipoprotein cholesterol (LDL-C) of the NIR NOBN NIR OB group were higher than that of the NIR NOB group. The FAI of the low density lipoprotein cholesterol (LDL-C) group was higher than that of the NIR NOB group. The sex hormone binding protein SHBGs of the NIR NOB group were lower than that of the NIR NOB group. The FAI of the P0.05IR OB group was higher than that of the NIR NOB group. The FAI of the low density lipoprotein cholesterol group was higher than that of the NIR NOB group. The FAI level of the low density lipoprotein cholesterol group was higher than that of the NIR NOB group. The FAI level of the low density lipoprotein cholesterol group was higher than that of the NIR NOB group. There was no significant difference in the mean ovarian size among the three groups. There was no significant difference in the average number of follicles and the maximum follicle diameter. There was a significant positive correlation between FFAI and HOMA-IRM LH / FSHT, but a negative correlation with DHEAS (P0.05). Multiple stepwise regression analysis showed that BMI-LH was an independent factor of FAI. The regression analysis after removing BMI showed that FINSL-LH was an independent factor of FAI. Conclusion IR and OB aggravate the disorder of glucose and lipid metabolism and hyperandrogenemia in patients with PCOS. Hyperinsulinemia and high LH level are the main causes of hyperandrogenemia.
【作者单位】：广州医科大学附属第三医院内分泌科;广州医科大学附属第三医院妇产科;
【基金】：国家自然科学基金资助项目(编号:81200607) 广东省产科重大疾病重点实验室自主课题(编号:2012Z05)
【分类号】：R711.75

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