多囊卵巢综合征患者脂联素与游离睾酮指数及胰岛素抵抗的相关性研究  

Correlation between Adiponectin and Free Testosterone Index and Insulin Resistance in Patients with Polycystic Ovary Syndrome

作　　者：唐子轩 李璟 黄琦 章莹 张晗 王茜 张琳 程峣 廖鑫 TANG Zixuan;LI Jing;HUANG Qi;ZHANG Ying;ZHANG Han;WANG Qian;ZHANG Lin;CHENGYao;LIAO Xin(Department of Endocrinology,Affiliated Hospital of Zunyi Medical University,Zunyi 563000,China;Department of Nuclear Medicine,Affliated Hospital of Zunyi Medical University,Zunyi 563000,China)

机构地区：[1]遵义医科大学附属医院内分泌科,贵州省遵义市563000 [2]遵义医科大学附属医院核医学科,贵州省遵义市563000

出　　处：《中国全科医学》2023年第8期927-932,938,共7页Chinese General Practice

基　　金：国家自然科学基金资助项目(82060273);贵州省教育厅青年科技人才成长项目[黔教合KY字(2018)237];贵州省科技计划项目[黔科合基础-ZK(2021)一般407];贵州省卫健委科学技术基金(gzwkj2022-007);遵义市科技计划基金项目[遵市科合社字(2018)79];遵义医学院附属医院硕士启动基金[院字(2018)24号]。

摘　　要：背景多囊卵巢综合征(PCOS)与胰岛素抵抗及游离睾酮指数(FAI)密切相关,但目前仍需大量研究为其诊断及治疗提供参考。目的探究脂联素(ADPN)在PCOS患者不同睾酮浓度下与FAI及胰岛素抵抗的相关性,进一步研究ADPN在PCOS中的临床价值。方法选取2017年10月至2020年4月就诊于遵义医科大学附属医院门诊或住院的116例PCOS患者及45例体检健康的正常育龄期妇女(对照组)为研究对象。收集研究对象的一般资料,进行实验室指标检查:月经规律者于月经周期第3~5天,月经不规律者在B超检查未见优势卵泡时,禁食12 h后由专人采集患者空腹肘静脉血检测空腹血糖(FPG)、空腹胰岛素(FINS)、糖化血红蛋白(HbA_(1c))、三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、卵泡刺激素(FSH)、促黄体生成素(LH)、孕酮、睾酮(TEST)、性激素结合球蛋白(SHGB)、硫酸脱氢表雄酮(DHEA-S)、ADPN。计算稳态模型评估的胰岛素抵抗指数(HOMA-IR)及FAI。依据是否合并高雄激素血症(TEST≥2.44 nmol/L)将PCOS患者分为PCOS伴高雄激素血症组(HA组,n=65)和PCOS不伴高雄激素血症组(非HA组,n=51)。进一步按照TEST水平的四分位值将HA组和非HA组分为4个亚组。分析ADPN与其他指标的相关性及FAI和ADPN的影响因素。结果与对照组相比,PCOS患者非HA组及HA组体质量、体质指数(BMI)、腰围、臀围、腰臀比(WHR)、FPG、FINS、HOMA-IR、HbA_(1c)、TG、LDL、FSH、TEST、FAI增加,HDL降低(P<0.05)。与非HA组相比,HA组TG、HOMA-IR、TEST、FAI增高,HDL、FSH、孕酮、SHBG、ADPN降低(P<0.05)。HA组与非HA组内不同TEST水平亚组的ADPN比较,差异均有统计学意义(P<0.05)。校正BMI后,PCOS患者的ADPN与HOMA-IR、FAI、TEST呈负相关(P<0.001)。在HA组,ADPN与HOMA-IR、FAI、TEST呈负相关(P<0.05);在非HA组中ADPN与HOMA-IR、FAI呈负相关(P<0.05),与TEST无相关关系(P=0.061)。非HA组中,ADPN、BMI是FAI的影响�Background Polycystic ovary syndrome(PCOS)is closely related to insulin resistance and free testosterone index(FAI),but a large number of studies are still needed to provide a reference for its diagnosis and treatment.Objective To explore the correlation of adiponectin(ADPN)with FAI and insulin resistance at different testosterone concentrations in PCOS patients,and to further investigate the clinical value of adiponectin in PCOS.Methods From October 2017 to April 2020,116 patients with PCOS and 45 healthy women of normal reproductive age(control group)who were treated in outpatient or inpatient hospital of Zunyi Medical University Affiliated Hospital were selected as the research objects.The general data of the research subjects were collected,and laboratory index examinations were conducted:on the 3rd to 5th day of the menstrual cycle of regular menstruation or when there was no dominant follicle in the B-ultrasound examination of irregular menstruation,and the patient’s cubital venous blood was collected on an empty stomach after fasting for 12 hours to detect fasting blood glucose(FPG),fasting insulin(FINS),Glycated hemoglobin(HbA_(1c)),triacylglycerol(TG),total cholesterol(TC),low density lipoprotein(LDL),high density lipoprotein(HDL),follicle stimulating hormone(FSH),luteinizing hormone(LH),progesterone,testosterone(TEST),sex hormone binding globulin(SHGB),dehydroepiandrosterone sulfate(DHEA-S),ADPN.The homeostasis model-assessed insulin resistance index(HOMA-IR)and FAI were calculated.PCOS patients were divided into PCOS with hyperandrogenemia group(HA group,n=65)and PCOS without hyperandrogenemia group(non-HA group,n=51)according to whether they had hyperandrogenism(TEST≥2.44 nmol/L).The HA and non-HA groups were further divided into 4 subgroups according to the quartile values of TEST levels.The correlation between ADPN and other indicators and the influencing factors of FAI and ADPN were analyzed.Results Compared with the control group,the body mass,BMI,waist circumference,hip circumference,WHR,FPG,

关 键 词：多囊卵巢综合征 脂联素 睾酮 游离睾酮指数 胰岛素抵抗 雄激素类 

分 类 号：R711.755[医药卫生—妇产科学] R446.11[医药卫生—临床医学]