多囊卵巢综合征患者血脂异常与胰岛素抵抗的相关性研究  

Correlation between dyslipidemia and insulin resistance in patients with polycystic ovarian syndrome

作　　者：周莉[1] 高婧[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7期614-618,共5页Journal of Reproductive Medicine

基　　金：上海浦江人才计划(11PJ1406600)

摘　　要：目的探讨多囊卵巢综合征(PCOS)患者血脂异常与胰岛素抵抗的相关性。方法收集在我院就诊的符合鹿特丹标准、未经药物治疗的PCOS患者200例,记录患者的一般资料,检测基础性激素水平及血清甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白(HDL)水平,行口服葡萄糖耐量试验(OGTT)和胰岛素释放实验(IRT),计算体重指数(BMI)、胰岛素抵抗稳态指数模型(HOMA-IR)等参数。并按TG水平将患者分为血脂正常组(TG<1.7 mmol/L)和血脂异常组(TG≥1.7mmol/L),比较两组患者的BMI、各时相血糖水平和胰岛素水平、HOMA-IR指数,以及生殖内分泌指标等的差异,探讨TG与HOMA-IR的相关性,并分析TG、HDL、低密度脂蛋白(LDL)作为评估胰岛素抵抗替代指标的可行性。结果 PCOS患者血脂异常的发生率为16.69%。除半小时血糖两组间比较无显著性差异外,血脂异常组患者的年龄、BMI、游离睾酮(FT)、HOMA-IR以及各时相血糖水平和胰岛素水平均显著高于血脂正常组(P均<0.05)。用TG作为替代指标预测胰岛素抵抗的ROC曲线下面积为0.798,最佳切点为1.025mmol/L,对应的敏感度和1-特异度分别为0.806和0.317,阳性似然比提高了2.54倍。结论 TG可以作为预测PCOS患者胰岛素抵抗的替代指标。当TG水平≥最佳切点1.025mmol/L时,患者发生胰岛素抵抗的风险显著增加。Objective： To study the association of dyslipidemia,insulin resistance and obese in the patients with polycystic ovarian syndrome （PCOS）. Methods： The 200 patients with PCOS according to Rotterdam consensus without drug treatment were collected in our hospital. The general data, lipid parameters （TG, TC and HDL）, oral glucose tolerance test （OGTT）, insulin release test （IRT）, body mass index（BMI）, homeostasis model assessment- insulin release （HOMA-IR） were measured in the patients. The PCOS patients were divided into two groups according to lipid levels：normal lipid level group（TG〈1. 7 mmol/L）and dyslipidemia group（TG≥ 1.7 mmol/L）. The BMI, blood glucose levels and insulin levels at each time phase, HOMA-IR index, reproductive hormone levels were compared between the groups, in order to explore the correlation between TG and HOMA IR, and the feasibility of using TG, HDL, and LDL as alternative marker for evaluating insulin release. Results： The abnormal lipid incidence was 16. 69% in PCOS patients. The age,BMI,free testosterone （FT）, HOMA-IR,and blood glucose levels and insulin levels at each time phase except a half-hour plasma glucose levels in dyslipidemia patients were significantly higher than in normal blood lipid group（P〈0.05） . The ROC curve analysis demonstrated that the best marker for insulin resistance was triglyceride （TG）, with the areas under the ROC curve of 0. 798,and the optimal cut-off point was 1. 025. The corresponding sensitivity and 1-specificity were 0. 806 and 0. 317 respectively, and the positive likelihood ratio of the patients increases 2.54 times. Conclusions： TG can be used as a useful alternative marker for insulin resistance in the patients with PCOS. When TG levels are equal or more than optimal cut point 1. 025 mmol/L, the risk of suffering insulin resistance is significantly increased.

关 键 词：多囊卵巢综合征 胰岛素抵抗 肥胖 血脂异常 

分 类 号：R[医药卫生]