多囊卵巢综合征患者肥胖指标对胰岛素抵抗的预测价值  

Predictive value of obesity index for insulin resistance in patients with polycystic ovary syndrome

作　　者：董梦姣 张杉杉[1] 李程 邱阳[1] Dong Mengjiao;Zhang Shanshan;Li Cheng;Qiu Yang(Department of Endocrinology, Shengjing Hospital of China Medical University, Liaoning Province, Shenyang 110001, China)

机构地区：[1]中国医科大学附属盛京医院内分泌科,沈阳110001

出　　处：《疑难病杂志》2021年第8期811-815,共5页Chinese Journal of Difficult and Complicated Cases

基　　金：国家自然科学基金资助项目(81170779)。

摘　　要：目的分析腰臀比(WHR)、内脏脂肪指数(VAI)和体质量指数(BMI)对多囊卵巢综合征(PCOS)患者胰岛素抵抗(IR)的预测价值。方法收集2018年11月—2021年3月在中国医科大学附属盛京医院诊治的PCOS患者301例的临床资料,根据是否存在胰岛素抵抗(HOMA-IR≥2.69)分为胰岛素抵抗PCOS组(IR-PCOS组)251例和非胰岛素抵抗PCOS组(NIR-PCOS组)50例。比较2组临床资料、PCOS性激素指标、肥胖指标水平,分析比较WHR、VAI和BMI对IR的影响程度及预测价值。结果IR-PCOS组的WHR、VAI和BMI显著高于NIR-PCOS组(t/P=6.012/<0.001,U/P=5.818/<0.001,5.739/<0.001);IR-PCOS组的FPG、FINS、HOMA-IR、TC、TG和LDL-C均显著高于NIR-PCOS组,HDL-C低于NIR-PCOS组(U/t/P=5.148/<0.001、11.137/<0.001、11.155/<0.001、2.164/0.031、5.194/<0.001、2.121/0.034、5.015/<0.001);IR-PCOS组的FAI、SHBG水平显著高于NIR-PCOS组(U/P=4.045/<0.001、4.165/<0.001);Logistic回归分析表明,WHR、BMI、VAI、FAI升高均为PCOS患者发生IR的危险因素[OR(95%CI)=3.18(2.05~4.94)、1.29(1.18~1.42)、1.67(1.34~2.09)、1.07(1.02~1.12),P均<0.05],而HDL-C升高为IR的保护因素[OR(95%CI)=0.05(0.003~0.652),P<0.05];WHR预测IR的曲线下面积(AUC)为0.76(95%CI 0.70~0.82),最佳临界值为0.86;VAI预测IR的AUC为0.79(95%CI 0.71~0.86),最佳临界值为3.52;BMI预测IR的AUC为0.76(95%CI 0.69~0.84),最佳临界值为26.25 kg/m2。结论伴随IR的PCOS患者具有更显著的代谢紊乱,BMI、WHR、VAI均对IR有一定的预测价值。Objective To analyze the predictive value of waist-to-hip ratio(WHR),visceral fat index(VAI)and body mass index(BMI)for insulin resistance(IR)in patients with polycystic ovary syndrome(PCOS).Methods Collected the clinical data of 301 PCOS patients diagnosed and treated in Shengjing Hospital Affiliated to China Medical University from 2018 to 2021,and divided them into insulin-resistant PCOS group(IR-PCOS group)251 cases and non-insulin resistance according to the presence or absence of insulin resistance PCOS group(NIR-PCOS group)50 cases.Compare the two groups of clinical data,PCOS sex hormone index,obesity index level,analyze and compare the influence degree and predictive value of WHR,VAI and BMI on IR.Results The WHR,VAI and BMI of the IR-PCOS group were significantly higher than those of the NIR-PCOS group(t/P=6.012/<0.001,U/P=5.818/<0.001,5.739/<0.001).FPG,FINS,HOMA-IR of the IR-PCOS group,TC,TG and LDL-C were significantly higher than the NIR-PCOS group,and HDL-C was lower than the NIR PCOS group(U/t/P=5.148/<0.001,11.137/<0.001,11.155/<0.001,2.164/0.031,5.194/<0.001,2.121/0.034,5.015/<0.001);the levels of FAI and SHBG in the IR-PCOS group were higher than those in the NIR-PCOS group(U/P=4.045/<0.001,4.165/<0.001).Logistic regression analysis showed that elevated WHR,BMI,VAI,and FAI were all risk factors for IR in PCOS patients[OR(95%CI)=3.18(2.05 to 4.94),1.29(1.18 to 1.42),1.67(1.34 to 2.09),1.07(1.02~1.12),P<0.05],and the increase of HDL-C is the protective factor of IR[OR(95%CI)=0.05(0.003-0.652),P<0.05].The area under the curve(AUC)of WHR predicted IR is 0.76(95%CI 0.70~0.82),and the best critical value is 0.86.The AUC of VAI predicted IR is 0.79(95%CI 0.71~0.86),and the best critical value is 3.52.The AUC of IR predicted by BMI is 0.76(95%CI 0.69~0.84),and the best critical value is 26.25 kg/m2.Conclusion PCOS patients with IR have more significant metabolic disorders.BMI,WHR,and VAI all have a certain predictive value for IR.

关 键 词：多囊卵巢综合征 胰岛素抵抗 内脏脂肪指数 腰臀比 体质量指数 肥胖 

分 类 号：R711.75[医药卫生—妇产科学]