简化PCOS患者胰岛素释放和糖耐量实验的效果评价  

Evaluation on simplified insulin release and glucose tolerance experiments among patients with polycystic ovary syndrome

作　　者：周红娣[1] 王哲蔚[1] ZHOU Hong-di;WANG Zhe-wei(Obstetrics and Gynecology Hospital of Tongji University,Shanghai 200092)

机构地区：[1]同济大学附属妇产科医院,上海200092

出　　处：《生殖医学杂志》2024年第3期316-321,共6页Journal of Reproductive Medicine

摘　　要：目的研究从检测时间点上简化多囊卵巢综合征(PCOS)患者胰岛素释放和糖耐量实验对评价胰岛素抵抗和糖代谢异常的效果。方法通过回顾性研究,选取2021年8月至2022年8月在我院就诊的320例已完成胰岛素释放和糖耐量试验(临床“金标准”)的PCOS患者,并假设研究对象只接受了简化方法一“空腹血糖和胰岛素检测”或简化方法二“空腹+糖负荷后2 h血糖和胰岛素检测”,评价两种简化方法的敏感度与临床“金标准”的一致性。结果患者总异常(即胰岛素抵抗或糖代谢异常)的发生率为80.0%(256/320),其中,超重/肥胖的患者和体重正常患者的总异常发生率分别为97.5%(115/118)和69.8%(141/202)。对于总异常的检测,超重/肥胖患者中简化方法一和简化方法二的敏感度分别为93.0%和96.5%(后者一致性检验Kappa=0.585);体重正常患者中,两种简化方法的敏感度分别为58.2%和74.5%。对于“糖代谢异常”的检测,超重/肥胖患者中,两种简化方法的敏感度分别为16.7%和100%(后者一致性检验Kappa=1.000)。结论对所有的PCOS患者均应进行胰岛素抵抗和糖代谢异常的检测;对于超重/肥胖PCOS患者,空腹+糖负荷后2 h血糖和胰岛素检测可以代替胰岛素释放和糖耐量实验;对于体重正常的PCOS患者,二种简化方法均有漏诊风险。Objective:To study the effect of simplified the insulin release and glucose tolerance experiment from a time perspective on evaluating insulin resistance(IR)and abnormal glucose metabolism in polycystic ovary syndrome(PCOS).Methods:Through the retrospective study,320 PCOS patients who had completed insulin release and glucose tolerance experiments(clinical golden standard)from August 2021 to August 2022 were selected.It was assumed that the patients only received Fast plasma glucose(FPG)and fasting insulin(FINS)test or fasting and 2-hour post glucose load blood glucose and insulin test.The sensitivity and consistency with gold standard of the two simplified method were evaluated.Results:The prevalent rate of IR or abnormality of glucose metabolism was 80.0%(256/320).And it was 97.5%(115/118)and 69.8%(141/202)among overweight and non overweight PCOS patients respectively.In detection of IR or abnormal glucose metabolism,the sensitivity of the two methods was 93.0%and 96.5%(κ=0.585)respectively among overweight patients.Whereas the sensitivity of the two methods was 58.2%and 74.5%respectively among non overweight patients.In detection of abnormal glucose metabolism,the sensitivity of the two methods was 16.7%and 100%(κ=1.000)respectively among overweight patients.Conclusions:Test of IR and abnormal glucose metabolism should be administered on all PCOS patients.For overweight PCOS patients,fasting and 2-hour post glucose load blood glucose and insulin can replace insulin release and glucose tolerance test.But for non-overweight PCOS patients,both of the two simplified methods have the risk of misdiagnose.

关 键 词：多囊卵巢综合征:胰岛素抵抗 胰岛素释放实验 糖耐量实验 

分 类 号：R711.5[医药卫生—妇产科学]