多囊卵巢综合征患者心血管代谢指数及胰岛素早期分泌关系研究  

Relationship between cardiometabolic index and early phase p-cell function in overweight or obese patients with polycystic ovarian syndrome

作　　者：杨佳苗 沈山梅[1] 王静[2] 邵飞 李忆昆 乔程程 连雨阳 毕艳[1] 朱大 Yang Jiamiao;Shen Shanmei;Wang Jing;Shao Fei;Li Yikun;Qiao Chengcheng;Ze Yuyang;Bi Yan;Zhu Dalong(Department of Endocrinology,Nanjing Drum Tower Hospital Affiliated to Medical School of Nanjing University,Nanjing 210008,China;department of Weight Managment,Nanjing Drum Tower Hospital Affiliated to Medical School of Nanjing University,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院内分泌科,210008 [2]南京大学医学院附属鼓楼医院体重管理科,210008

出　　处：《中华糖尿病杂志》2019年第11期747-751,共5页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：江苏省医学重点学科资助(XK201105);江苏省中医药局科技项目(YB2015072)。

摘　　要：目的探究超重/肥胖多囊卵巢综合征(PCOS)患者心血管代谢指数(CMI)及其胰岛素早期分泌能力之间的关系,为超重/肥胖PCOS患者的长程管理提供理论依据和新思路方法收集2016年4月至2017年9月于南京鼓楼医院内分泌科、体重管理门诊就诊的382例肥胖/超重患者的就诊资料,其中包含匹配体质指数(BMI)的单纯性超重/肥胖患者(超重/肥胖组)174例和超重/肥胖合并PCOS患者(PCOS组)307例进一步根据CMI水平将PCOS组患者平均分为4个亚组,从低到高分别为Q1(CMIW1.06)亚组77例、Q2(1.06<CMIW 1.42)亚组77例、Q3(1.42<CMIw2.15)亚组77例及Q4(CMI>2.15)亚组76例。记录所有患者初次就诊时身高、体重、腰围、臀围、血压、心率及相关实验室检査结果,进一步计算胰岛P细胞功能指数[30 min胰岛素释放曲线下面积/30 min血糖曲线下面积(AUCIns/AUCGlum)、30 min处置指数(Dc)、30 min胰岛素/空腹胰岛素(lns30/FINS)」及CMI水平。采用独立样本/检验、单因素方差分析、相关性分析进行数据处理结果与超重/肥胖组比较,PCOS组腰臀比(WHR)、口服葡萄糖耐量试验各时间点血清胰岛素水平、CMI(1.86±0.69比1.64±0.91)及lgAUCIns/AUCGlu^1,08±0.24比0.98±0.32)均升高(t=-5.631—2.522,均P<0.05),高密度脂蛋白胆固醇(HDL-C)J/HOMA-IR(0.20±0.13比0,28±0.16),DIW(1.69±0.69比1.88±0.72)及InS3O/FINS(5.76±3.29比6.79±3.90)均降低(z=1.938-4.974,均P<0.05);各亚组胰岛素早期分泌相关参数比较,差异有统计学意义(均P<0.05);在校正年龄、BMI、血压、心率后,相关性分析显示,CMI与lgDg'Ins/FINS呈负相关(r=-0.167,-0.162/=0.004,0.006)。结论合并PCOS的超重/肥胖患者较单纯性超重/肥胖患者具有更高的心血管代谢风险,及更弱的胰岛素早时相分泌水平.胰岛素早时相分泌功能与超重合并PCOS患者的心血管代谢指数存在显著的相关性。Objective To explore the levels of cardiometabolic index(CMI)and its relationship with early phase P-cell function in overweight/obese polycystic ovary syndrome(PCOS)women.Method Three hundred and eighty-two overweight and obese women from Nanjing Drum Tower Hospital between April,2016 and September,2017 were recruited and divided into body mass index matched simple overweight/obese group(n=75)and overweight/obese PCOS group(n=307).Data of weight,height,blood pressure,heart rate and related laboratory examinations at their first visit were collected,indexes of early phase p-cell function(AUCIns30/AUCGlu30,DI30,Ins30/FINS)and CMI were calculated.Independent sample I test,analysis of variance and Pearson correlation coefficient were used for statistical analysis.Result Compared with simple overweight/obese women,waist-hip ratio,serum insulin levels during oral glucose tolerance test(OGTT),CMI(1.86±0.69 vs 1.64±0.91)and AUCIns30/AUCGlu30(1.08±0.24 vs 0.98±0.32)were significantly higher respectively(/=-5.631一一2.522,PvO.05),while HDL-C,1/HOMA-IR(0.20±0.13 vs 0.28±0.16),DI30(1.69±0.69 vs 1.88±0.72)and Ins3()/FINS(5.76±3.29 vs 6.79±3.90)were significantly lower respectively(Z=l.938-4.974,P<0.05)in overweight/obese PCOS women.Indexes relating early phase insulin secretion were significantly lower in overweight/obese PCOS women with higher CMI levels than those in overweight/obese PCOS women with lower CMI levels(P<0.05).In addition,CMI was negatively correlated with lgDI30 and Ins30/FINS after adjusting age,BMI,blood pressure and heart rate￠=-0.167,-0.162,P=0.004,0.006).Conclusion Compared with simple overweight/obese women,overweight/obese PCOS women have higher cardiovascular risk and impaired early phase insulin secretion function.Early phase P^cell function indexes were negatively correlated with cardiovascular metabolic risk in overweight/obese PCOS women.

关 键 词：多囊卵巢综合征 超重 肥胖症 胰岛细胞功能 心血管代谢风险 

分 类 号：R71[医药卫生—妇产科学]