糖耐量正常的多囊卵巢综合征患者口服葡萄糖耐量试验1 h血糖增高时胰岛β细胞的功能状态研究  

The functional status of pancreaticβ-cells in patients with polycystic ovary syndrome with normal glucose tolerance during oral glucose tolerance test with increased blood glucose at 1 hour

作　　者：许明芳 蒙丽恒[1] 周嘉[1] 梁杏欢[1] 李励[1] 黄振兴[1] 秦映芬[1] Xu Mingfang;Meng Liheng;Zhou Jia;Liang Xinghuan;Li Li;Huang Zhenxing;Qin Yingfen(Department of Endocrinology,First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China;Department of Endocrinology,Liuzhou People's Hospital,Liuzhou 545000,China)

机构地区：[1]广西医科大学第一附属医院内分泌科,南宁530021 [2]柳州市人民医院内分泌科,柳州545000

出　　处：《中华糖尿病杂志》2022年第3期260-265,共6页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：广西医疗卫生适宜技术开发与推广应用项目(S2017026);广西壮族自治区教育厅科研项目(YB2014077)。

摘　　要：目的探讨糖耐量正常(NGT)的多囊卵巢综合征(PCOS)患者口服葡萄糖耐量试验(OGTT)1 h血糖增高时胰岛β细胞的功能状态。方法回顾性分析2012年1月至2020年1月在广西医科大学第一附属医院内分泌科就诊的87例PCOS患者。根据OGTT结果将患者分为NGT组(65例)和糖耐量减低(IGT)(22例),再以1 h血糖8.6 mmol/L为切点,将NGT组分为NGT A组(1 h血糖<8.6 mmol/L,43例)和NGT B组(1 h血糖≥8.6 mmol/L,22例)。行OGTT检查测定稳态模型评估胰岛素抵抗指数(HOMA-IR)、稳态模型评估β细胞功能指数(HOMA-β)、修正的胰岛β细胞功能指数(MBCI)、0~3 h胰岛素曲线下面积(AUC_(ins0~3)h)、AUC_(ins0~3)h和0~3 h血糖曲线下面积的比值(AUC_(ins0~3)h/AU_(Cglu 0~3)h)、峰值胰岛素和峰值胰岛素/基础胰岛素比值(I_(p)/I_(0)),评价胰岛素2相分泌功能。行静脉葡萄糖耐量试验(IVGTT)检查测定峰值胰岛素(I_(p))、峰值胰岛素/基础胰岛素比值(I_(p)/I_(0))、急性时相胰岛素分泌(AIR_(0~10 min))和0~10 min胰岛素曲线下面积(AUC_(ins 0~10 min)),评价评价胰岛素1相分泌功能。采用单因素方差分析或非参数检验进行多组间比较。结果行OGTT检查,NGT A组与NGT B组胰岛素峰值落在1 h,NGT A组低于NGT B组,而IGT组胰岛素峰值落在2 h。3组患者间的HOMA-IR、MBCI、AUC_(ins0~3)h和I_(p)差异有统计学意义,其中IGT组的HOMA-IR高于NGT A组和NGT B组,NGT A组的AUC_(ins0~3)h和I_(p)低于NGT B组和IGT组,NGT A组的MBCI高于NGT B组和IGT组,差异均有统计学意义(均P<0.05);3组间的HOMA-β、AUC_(ins0~3)h/AU_(Cglu 0~3)h和I_(p)/I_(0)差异均无统计学意义(均P>0.05)。在IVGTT中,3组间的I_(p)/I_(0)差异有统计学意义,其中IGT组低于NGT A组(均P<0.05);3组间的I_(p)、AIR_(0~10 min)和AUC_(ins 0~10 min)差异无统计学意义(均P>0.05)。结论糖耐量正常的PCOS患者OGTT 1 h血糖≥8.6 mmol/L时与IGT存在相似的胰岛素分泌功能受损,属于糖尿病高危人群。MBCI可作为PCOS�Objective To investigate the functional status of pancreaticβ-cells in patients with polycystic ovary syndrome(PCOS)with normal glucose tolerance(NGT)during oral glucose tolerance test(OGTT)1 h blood glucose increase.Methods This is a retrospective analysis.A total of 87 PCOS patients in the Department of Endocrinology,the First Affiliated Hospital of Guangxi Medical University from January 2012 to January 2020 were enrolled.According to the OGTT results,the patients were divided into NGT group(65 cases)and impaired glucose tolerance(IGT)(22 cases).Then,the 1-h blood glucose was 8.6 mmol/L as the cut-off point,and the NGT component was divided into NGT A group(1-h blood glucose<8.6 mmol/L,43 cases)and NGT B group(1 hour blood glucose≥8.6 mmol/L,22 cases).OGTT was performed to determine the homeostatic model to evaluate the insulin resistance index(HOMA-IR),the homeostatic model to evaluate theβ-cell function index(HOMA-β),the modified isletβ-cell function index(MBCI),the area under the insulin curve for 0 to 3 h(AUC_(ins0-3)h),AUC_(ins0-3)h and 0 to 3 h blood glucose curve area ratio AUC_(ins0-3)h/AU_(Cglu 0-3)h,peak insulin and peak insulin/basal insulin ratio(I_(p)/I_(0)),and evaluate the function of insulin 2-phase secretion.Intravenous glucose tolerance test(IVGTT)was performed to determine I_(p),I_(p)/I_(0),acute phase insulin secretion(AIR_(0-10 min))and the area under the insulin curve at 0 to 10 min(AUC_(ins 0-10 min))to evaluate the insulin secretion function in phase 1.One-way analysis of variance(ANOVA)or non-parametric test was used to compare multiple groups.Results The OGTT examination showed that the insulin peak value of the NGT A group and NGT B group fell at 1 h,the NGT A group was lower than the NGT B group,and the IGT group insulin peak fell at 2 h.There was a statistically significant difference in HOMA-IR,MBCI,AUCins 0-3h and I_(p)among the 3 groups.The HOMA-IR of the IGT group was higher than that of NGT A and NGT B groups,and AUC_(ins0-3)h and I_(p)in NGTA group were lower than those

关 键 词：多囊卵巢综合征 胰岛Β细胞功能 口服葡萄糖耐量试验 

分 类 号：R711.75[医药卫生—妇产科学]