多囊卵巢综合征患者雄激素与糖代谢指标的关系研究  

Relationship between Androgen and Glucose Metabolism in Patients with Polycystic Ovary Syndrome

作　　者：翁瑞文 刘义[2] 张蔚[1] 刘恒炜 WENG Ruiwen;LIU Yi;ZHANG Wei;LIU Hengwei(Department of Obstetrics and Gynecology,Zhongnan Hospital of Wuhan University,Wuhan 430071,China;Department of Obstetrics and Gynecology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China)

机构地区：[1]武汉大学中南医院妇产科,湖北省武汉市430071 [2]华中科技大学同济医学院附属协和医院妇产科,湖北省武汉市430022

出　　处：《中国全科医学》2022年第32期4046-4051,共6页Chinese General Practice

基　　金：国家自然科学基金青年基金项目(82001524)——ALKBH5通过m6A修饰介导lncRNA UBOX5-AS1调控子宫内膜异位症自噬的机制研究;湖北省自然科学基金一般面上项目(2020CFB310)——低氧微环境下circ-MDM2调控子宫内膜异位症自噬的机制研究。

摘　　要：背景高雄激素血症作为多囊卵巢综合征(PCOS)重要的临床特征之一,与代谢综合征密切相关。雄激素与2型糖尿病和胰岛素抵抗的相关研究尚不深入,研究结果不完全一致,尚未形成统一的科学结论。目的探讨不同糖耐量PCOS患者雄激素水平变化,及雄激素与糖代谢指标的关系。方法回顾性分析2018年3月至2020年12月在华中科技大学同济医学院附属协和医院就诊的954例PCOS患者雄激素、75 g口服糖耐量试验、胰岛素释放试验检测结果,计算体质指数(BMI)、游离雄激素指数(FAI)和稳态模型胰岛素抵抗指数(HOMA-IR)。依据葡萄糖耐量状态将患者分为正常葡萄糖耐量组(NGT组)、糖尿病前期组(IGT组)和2型糖尿病组(T2DM组)。依据FAI四分位数由低到高将PCOS患者分为Q1~Q4亚组,依据BMI将PCOS患者分为正常体质量(BMI<24.0 kg/m2)、超重(24.0 kg/m2≤BMI<28.0 kg/m2)和肥胖(BMI≥28.0 kg/m2)。比较不同葡萄糖耐量状态下的PCOS患者雄激素变化及雄激素对糖代谢指标的影响;分析雄激素对胰岛素抵抗的影响。结果NGT组490例,IGT组369例,T2DM组95例,三组患者BMI、游离睾酮(FT)、性激素结合球蛋白(SHBG)和游离雄激素指数(FAI)比较,差异均有统计学意义(P<0.01)。多元线性回归分析结果显示,总睾酮(T)是口服75 g葡萄糖后0.5 h血糖(Glu 30 min)(β=0.068,P=0.037)、胰岛素(β=0.098,P=0.002)、HOMA-IR(β=0.086,P=0.008)的影响因素,SHBG、FAI是口服75 g葡萄糖前后血糖(Glu 0 min、Glu 30 min、Glu 60 min、Glu 120 min、Glu 180 min)、糖化血红蛋白(HbA1c)(β=-0.187、0.277,P<0.001)、胰岛素(β=-0.226、0.371,P<0.001)、HOMA-IR(β=-0.224、0.377,P<0.001)的影响因素。与Q4亚组相比,Q1~Q3亚组的Ins 0 min、Ins 30 min、Ins 60 min、Ins 120 min、Ins 180 min、HOMA-IR较低(P<0.05)。正常体质量者的FT(β=0.119,P=0.031)和SHBG(β=-0.155,P=0.005)是HOMA-IR的影响因素,超重者SHBG(β=-0.199,P<0.001)和FAI(β=0.249,P<0.001)是HOMA-IR的影Background Hyperandrogenemia is one of the most important clinical features of polycystic ovary syndrome(PCOS)and is closely related to metabolic syndrome.The related researches evaluating the relationship between androgen and type 2 diabetes mellitus and insulin resistance were not enough,and their results were inconsistent,thus not forming an unified scientific conclusion.Objective To investigate the changes of androgen level in PCOS patients with different glucose tolerance,and the relationship between androgen and glucose metabolism.Methods This study selected 954 PCOS patients in Union Hospital,Tongji Medical College,Huazhong University of Science and Technology from March 2018 to December 2020,and collected data about androgen,75 g glucose tolerance test and insulin release test.Body mass index(BMI),free androgen index(FAI)and homeostasis model insulin resistance index(HOMA-IR)were calculated.These patients were divided into normal glucose tolerance group(NGT),prediabetes group(IGT)and type 2 diabetes group(T2DM)according to the glucose tolerance status.PCOS patients were divided into Q1-Q4 subgroups based on the FAI quartile from low to high.PCOS patients were divided into normal(BMI<24.0 kg/m2),overweight(24.0 kg/m2≤BMI<28.0 kg/m2)and obesity subgroup(BMI≥28.0 kg/m2)according to BMI.This study compared the changes of androgen level,and the effects of androgen level on glucose metabolism in PCOS patients with different glucose tolerance,and analyzed the effect of androgen on insulin resistance.Results There were 490 patients in NGT group,369 patients in IGT group and 95 patients in T2DM group.There were significant differences in BMI,FT,SHBG and FAI among these three groups(P<0.01).Multiple linear regression analysis showed that T was a factor that affects Glu 30 min(β=0.068,P=0.037),Ins(β=0.098,P=0.002),HOMA-IR(β=0.086,P=0.008).SHBG and FAI were the factors that affect Glu 0 min,Glu 30 min,Glu 60 min,Glu 120 min,Glu 180 min,HbA1c(β=-0.187,0.277,P<0.001),INS(β=-0.226,0.371,P<0.001),HOMA-IR(β=-0.2

关 键 词：多囊卵巢综合征 雄激素类 游离雄激素指数 胰岛素抵抗 代谢 影响因素分析 

分 类 号：R711.75[医药卫生—妇产科学]