多囊卵巢综合征人群中基于补体C3的胰岛素敏感性评分模型的建立  

Development and validation of an insulin sensitivity score in female with polycystic ovary syndrome

作　　者：何文雯[1] 李卫平[2] 罗梅[3] 杨淑敏[1] 李启富[1] 

机构地区：[1]重庆医科大学附属第一医院内分泌科,重庆400016 [2]汕头大学医学院第一附属医院内分泌科,汕头515041 [3]重庆市第一人民医院内分泌科,重庆400011

出　　处：《重庆医科大学学报》2016年第11期1154-1158,共5页Journal of Chongqing Medical University

基　　金：国家自然科学基金资助项目(编号:81300310;81370954);国家临床重点专科建设资助项目(编号:财社[2011]170号);重庆市卫生计生委医学科研资助项目(编号:2016MSXM004)

摘　　要：目的:以多囊卵巢综合征(polycystic ovary syndrome,PCOS)人群为研究对象,通过构建包含补体C3的胰岛素敏感性(insulin sensitivity,IS)评分模型,探索一种简便易行的方法对PCOS患者的IR进行评估。方法:纳入99名PCOS患者及116名年龄匹配的正常女性,测量人体参数及空腹血生化指标(胰岛素、hs-CRP、补体C3等),计算稳态模型胰岛素抵抗指数(homeostasis model assessment of insulin resistance,HOMA2-IR)。对所有PCOS患者及其中20名正常对照行高胰岛素-正葡萄糖钳夹术,结果以M值表示。在PCOS组中,采用多元线性回归,以M值为应变量,以BMI、LDL-C、补体C3、超敏C反应蛋白、空腹血清胰岛素为自变量,建立IS评分(即M值的预测值)模型方程,用ROC曲线评估该模型诊断IR的价值。结果:IS评分=19.36-0.35×BMI-2.28×C3(R^2=0.54,P=0.000)。IS评分和HOMA2-IR诊断PCOS患者IR的ROC曲线下面积分别为0.89(95%CI=0.82~0.96)和0.75(95%CI=0.64~0.86),当IS评分=8.93时,其诊断PCOS患者IR的灵敏度和特异度分别为0.70和0.95,Youden指数0.63。当HOMA2-IR=0.47时,其诊断的灵敏度和特异度分别为0.60和0.88,Youden指数0.47。结论:包含补体C3的IS评分模型评估PCOS人群的IR具有较好的诊断价值。Objective：To establish a scoring model with complement C3 to evaluate insulin sensitivity（IS）in polycystic ovary syndrome（PCOS）population. Methods：Ninety-nine PCOS patients and 116 age-matched healthy women were included in this study. Anthropometric parameters and fasting biochemical indicators（including insulin,hs-CRP,complement C3,etc.）were determined and homeostasis model assessment of insulin resistance（HOMA2-IR）was calculated. All PCOS patients and 20 healthy controls underwent hyperinsulinemic-euglycemic clamp assay. The equation of IS score was established by multiple liner regression among PCOS patients,and the value of this equation for IR diagnosis was assessed according to the ROC curve. Results：The IS score=19.36-0.35×BMI-2.28 ×C3（R^2=0.54,P =0.000）. Areas under the ROC curve of IS score and HOMA2-IR were 0.89（0.83 to 0.96） and 0.75（0.64 to0.86）respectively. The sensitivity and specificity of IS score were 0.70 and 0.95,and Youden index equaled to 0.63. The sensitivity and specificity of HOMA2-IR were 0.6 and 0.88,and Youden index equaled to 0.47. Conclusion：IS scoring model with complement C3 is valuable for the diagnosis of IR in PCOS population.

关 键 词：多囊卵巢综合征 胰岛素敏感性 胰岛素敏感性评分 稳态模型胰岛素抵抗指数 诊断价值 

分 类 号：R588.6[医药卫生—内分泌]