正常糖耐量PCOS患者不同中医证型糖代谢特征  

Characteristics of Glucose Metabolism in Different TCM Syndromes of Polycystic Ovary Syndrome Patients with Normal Blood Glucose

作　　者：王颖[1] 王宇 侯丽辉[1] 匡洪影[1] WANG Ying;WANG Yu;HOU Lihui(Department of Gynecology,The First Affiliated Hospital of Heilongjiang University of Chinese Medicine,Heilongjiang 150040,China)

机构地区：[1]黑龙江中医药大学附属第一医院妇二科,哈尔滨150040 [2]黑龙江中医药大学研究生院,哈尔滨150040

出　　处：《医学研究杂志》2023年第7期46-50,55,共6页Journal of Medical Research

基　　金：国家自然科学基金青年科学基金资助项目(81904235);黑龙江省自然科学基金资助项目(LH2022H078);黑龙江省普通高校青年创新人才培养计划项目(UNPYSCT-2018227);黑龙江中医药大学优秀创新人才(青年教师)(2018RCQ03)。

摘　　要：目的分析痰湿证与非痰湿证正常糖耐量(normal glucose tolerance,NGT)的多囊卵巢综合征(polycystic ovary syndrome,PCOS)患者的临床特征,通过口服葡萄糖耐量试验和胰岛素释放试验评估痰湿证PCOS-NGT患者胰岛素敏感度及胰岛β细胞分泌功能变化情况。方法859例PCOS-NGT患者,其中499例痰湿证,360例非痰湿证,记录患者临床信息,进行血清生化检测。结果痰湿证PCOS-NGT患者与代谢综合征相关的危险因素变化更为显著,且雄激素水平显著升高。非痰湿证PCOS-NGT患者LH、LH/FSH显著升高。痰湿证PCOS-NGT患者I_(0)、I_(30)、I_(60)、I_(120)、I_(180)水平均显著高于非痰湿证患者。痰湿证PCOS-NGT患者I_(0)水平(18.99±9.68)显著高于正常值,胰岛素回落缓慢,I_(180)未恢复到基础水平。痰湿证PCOS-NGT患者胰岛素敏感度相关指标HOMA-IR、ISI matsuda、AUC GLU、AUC INS,β细胞功能相关指标HOMA-β、DI显著高于非痰湿证患者。痰湿证PCOS-NGT患者SHBG与I_(0)、I_(30)、I_(60)、I_(120)、I_(180)、HOMA-IR、HOMA-β呈负相关,FAI与I_(0)、I_(30)、I_(60)、I_(120)、I_(180)、HOMA-IR、HOMA-β呈正相关,且血清SHBG高低能很好地反映各时相胰岛素变化及HOMA-IR、HOMA-β水平。结论NGT的PCOS患者表现出不同程度的胰岛素反应受损。痰湿证PCOS-NGT患者普遍存在高胰岛素血症、IR及胰岛β细胞功能受损,同时其糖代谢调节受血清雄激素影响。Objective To analyze the clinical characteristics of polycystic ovary syndrome(PCOS)patients with normal glucose tolerance(NGT)in phlegm-dampness syndrome and non-phlegm-dampness syndrome,and to evaluate the changes of insulin sensitivity and pancreatic β-cell secretion function in PCOS-NGT patients with phlegm-dampness syndrome by oral glucose tolerance test and insulin release test.Methods Eight hundred and fifty-nine patients with PCOS-NGT,including 499 patients with phlegm-dampness syndrome(PD)and 360 patients with non-phlegm-dampness syndrome(NPD).Clinical information was recorded,and serum biochemical indexes were detected.Results The changes of risk factors related to metabolic syndrome in PCOS-NGT-PD were more significant,androgen level were significantly increased.LH and LH/FSH in PCOS-NGT-NPD patients were significantly higher than PCOS-NGT-PD patients.The levels of I_(0),I_(30),I_(60),I_(120) and I_(180) in PCOS-NGT-PD patients were significantly higher than those in PCOS-NGT-NPD patients.I_(0)(18.99±9.68)in PCOS-NGT-PD patients was significantly higher than the normal value,but the insulin decreased slowly and I_(180) did not return to the basic level.The insulin sensitivity related indexes HOMA-IR,ISI matsuda,AUC GLU,AUC INS,β-cell function related indexes HOMA-β and DI in PCOS-NGT-PD patients were significantly higher than PCOS-NGT-NPD patients.In PCOS-NGT-PD patients,SHBG was negatively correlated with I_(0),I_(30),I_(60),I_(180),HOMA-IR,HOMA-β,while FAI was positively correlated with I_(0),I_(30),I_(60),I_(120),I_(180),HOMA-IR,HOMA-β,and serum SHBG level could well reflect the changes of insulin in each phase and the levels of HOMA-IR,HOMA-β.Conclusion PCOS patients with NGT show impaired insulin response to different degrees.Hyperinsulinemia,insulin resistance,and impaired pancreatic β-cell function were common in PCOS-NGT-PD patients.Meanwhile,glucose metabolism regulation was affected by serum Androgen level.

关 键 词：多囊卵巢综合征 痰湿证 胰岛素释放试验 胰岛素抵抗 

分 类 号：R271.9[医药卫生—中西医结合]