多囊卵巢综合征患者胰岛素抵抗的新指标评估研究  

A new criteria for evaluating insulin resistance in polycystic ovary syndrome patients

作　　者：高婧[1,2] 周莉[1] 石娟[3] 洪洁[3] 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 [2]上海交通大学医学院附属国际和平妇幼保健院妇产科 [3]上海交通大学医学院附属瑞金医院内分泌科,上海200025

出　　处：《诊断学理论与实践》2016年第4期415-420,共6页Journal of Diagnostics Concepts & Practice

基　　金：上海市浦江人才计划(11PJ1406600)

摘　　要：目的:在不同体质量指数(body mass index,BMI)的多囊卵巢综合征(polycystic ovary syndrome,PCOS)患者中,探讨评估胰岛素抵抗(insulin resistance,IR)的新方法。方法:纳入符合鹿特丹标准、糖耐量正常的PCOS患者186例和健康对照者84例,比较PCOS患者中非肥胖组和肥胖组的临床特征,计算口服葡萄糖耐量试验(oral glucose tolerance test,OGTT)和胰岛素释放试验(insulin release test,IRT)各个时相HOMA-My值,应用受试者工作特征(receiver operating characteristic,ROC)曲线来评价各HOMA-My值对不同BMI的PCOS患者IR的预测价值。结果:PCOS非肥胖亚组与肥胖亚组间的性激素结合球蛋白(sex hormone binding globulin,SHBG)及17-羟孕酮(17-hydroxyprogesterone,17-OHP)水平存在显著差异(P<0.05)。对于评价非肥胖PCOS患者的IR,HOMA-M30最有价值(临界值为27.50,曲线下面积为0.753),HOMA-IR诊断能力最差;而对于肥胖PCOS患者,HOMA-M60是最佳指标(临界值为32.17,曲线下面积为0.883),HOMA-IR稍次于它。结论 :本研究提供一种新的评估IR的方法 ,HOMA-IR在诊断非肥胖PCOS患者IR的准确性很低,应在结合其他HOMA-My值的基础上重点观察HOMA-M30。HOMA-IR在肥胖的PCOS患者中仍然推荐使用,本研究建议临界值为2.67。Objective： To investigate a new criteria for evaluating insulin resistance （IR） in polycystic ovary syndrome （PCOS） patients with different body mass index （BMI）. Methods： A total of 186 PCOS patients diagnosed according to Rotterdam criterion with normal glucose tolerance were enrolled, and 84 healthy volunteers were served as controls. Clini- cal features were compared between normal-weight and obese patients （BMI〈25 kg/m2 and BMI≥25 kg/m2）. Oral glucose tolerance test （OGTT） and insulin release test （IRT） were performed in all subjects, and HOMA-My value of IRT on diffe- rent time point were calculated. Predictivity of HOMA-My for IR in PCOS patients with different BMI was assessed by re- ceiver operating characteristic （ROC） curve. Results： The levels of sex hormone binding globulin （SHBG） and 17-hydro- xyprogesterone （17-OHP） were significantly different between normal-weight and obese subgroup. HOMA-M30 was an opti- mal parameter （cutoff value： 27.50, AUC： 0.753） for assessing IR in normal-weight patients, while HOMA-IR was the worst. For obese PCOS, predictivity of HOMA-M60 was the best （cutoff value： 32.17, AUC： 0.883）, and HOMA-IR （cutoff value： 2.67） was slightly less （cutoff value 2.67, AUC： 87.6%）. Conclusions： A new criteria is developed for evaluating IR in PCOS group. HOMA-IR is not a proper index for evaluating IR in normal-weight PCOS patients, but is still recom- mended to be used as a criteria with a cutoff value of 2.67 in obese patients. For normal-weight PCOS patients, HOMA- M30 combined with HOMA-My should be used.

关 键 词：多囊卵巢综合征 胰岛素抵抗 口服葡萄糖耐量试验 胰岛素释放试验 

分 类 号：R711.75[医药卫生—妇产科学]