口服葡萄糖耐量试验和胰岛素释放试验在多囊卵巢综合征患者中的临床应用  

Clinical application of oral glucose tolerance test and insulin release test in patients with polycystic ovary syndrome

作　　者：高婧[1] 周莉[1] 陈慧[1] 陈晨[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院妇产科,上海200025

出　　处：《生殖医学杂志》2016年第6期505-510,共6页Journal of Reproductive Medicine

基　　金：上海浦江人才计划(11PJ1406600)

摘　　要：目的探讨口服葡萄糖耐量试验(OGTT)和胰岛素释放试验(IRT)在筛查多囊卵巢综合征(PCOS)患者糖代谢异常中的应用情况,并分析不同糖代谢状态下的PCOS患者糖、脂代谢特点。方法纳入符合鹿特丹标准、未经治疗的PCOS患者191例,测定身高、体重、基础生殖内分泌激素、血脂水平,并行OGTT和IRT检测,计算体重指数(BMI)、胰岛素抵抗稳态指数模型(HOMA-IR)、β细胞功能指数(HOMA-β)等参数。根据血糖水平将PCOS分成糖代谢正常(NGT)组、空腹血糖受损(IFG)组、糖耐量受损(IGT)组、以及2型糖尿病(T2DM)组,筛查各组的检出情况,并比较各组糖、脂代谢的差异。结果 PCOS患者糖代谢异常的发生率24.61%(47/191),其中IFG为3.66%,IGT为18.85%,T2DM为4.19%(其中4例为IFG合并IGT,重复纳入IFG组和IGT组);随着糖代谢紊乱加重,年龄、BMI有上升的趋势(P<0.05)。血胰岛素高峰值出现在2h,滞后于血糖高峰值出现的1h。随着糖代谢的恶化,各时相的血糖及胰岛素水平逐渐升高,各组血脂紊乱也逐渐加剧(P<0.05)。结论 PCOS患者糖代谢异常发生率较高,利用OGTT和IRT筛查PCOS患者糖代谢异常是十分必要和重要的。Objective： To investigate application of oral glucose tolerance test（OGTT）and insulin release test（IRT）for screening hyperglycemia in patients with polycystic ovary syndrome（PCOS）and discuss the clinical features of glucose and lipid metabolism in different glucose metabolism status.Methods： Height,weight,basal sexual hormones and lipid parameters,OGTT and IRT were measured from 191 women with PCOS according to Rotterdam consensus.Body mass index（BMI）,Insulin resistance homeostasis model（HOMA-IR）and homa beta cell function index（HOMA-β）were calculated.The PCOS patients were divided into normal glucose test（NGT）group,impaired fasting glucose（IFG）group,impaired glucose tolerance（IGT）group and type 2diabetes mellitus（T2DM）group based on OGTT results.The glucose metabolism indexes and lipid metabolism indexes were compared among the groups.Results：In the 191 PCOS patients,24.61%（47/191）had abnormal glucose metabolism.The ratio of IFG,IGT and T2 DM were 3.66%,18.85% and 4.19% respectively.The increased degree of impairedglucose metabolism was correlated positively with the age and BMI.The insulin peak occurred at 2hours,which was 1hour later than glucose peak time.With the aggravation of glucose metabolism,the glucose and insulin levels gradually increased.And the abnormality of lipid was in accordance with intensifying hyperglycemia（P〈0.05）.Conclusions： Women with PCOS had a greater incidence of hyperglycemia.OGTT and IRT are necessary for screening hyperglycemia in patients with PCOS.

关 键 词：多囊卵巢综合征 口服葡萄糖耐量试验 糖耐量受损 2型糖尿病 

分 类 号：R[医药卫生]