Legro Richard S, Castracane V Daniel, Kauffman Robert P
Department of Obstetrics and Gynecology, Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033, USA.
Obstet Gynecol Surv. 2004 Feb;59(2):141-54. doi: 10.1097/01.OGX.0000109523.25076.E2.
Approximately 50% to 70% of all women with polycystic ovary syndrome (PCOS) have some degree of insulin resistance, and this hormone insensitivity probably contributes to the hyperandrogenism that is responsible for the signs and symptoms of PCOS. Although uncertainty exists, early detection and treatment of insulin resistance in this population could ultimately reduce the incidence or severity of diabetes mellitus, dyslipidemia, hypertension, and cardiovascular disease. Even if that proves to be the case, there are still several problems with our current approach to insulin sensitivity assessment in PCOS, including the apparent lack of consensus on what defines PCOS and "normal" insulin sensitivity, ethnic and genetic variability, the presence of other factors contributing to insulin resistance such as obesity, stress, and aging, and concern about whether simplified models of insulin sensitivity have the precision to predict treatment needs, responses, and future morbidity. Although the hyperinsulinemic-euglycemic clamp technique is the gold standard for measuring insulin sensitivity, it is too expensive, time-consuming, and labor-intensive to be of practical use in an office setting. Homeostatic measurements (fasting glucose/insulin ratio or homeostatic model assessment [HOMA] value) and minimal model tests (particularly the oral glucose tolerance test [OGTT]) represent the easiest office-based assessments of insulin resistance in the PCOS patient. The OGTT is probably the best simple, office-based method to assess women with PCOS because it provides information about both insulin resistance and glucose intolerance. The diagnosis of glucose intolerance holds greater prognostic and treatment implications. All obese women with PCOS should be screened for the presence of insulin resistance by looking for other stigmata of the insulin resistance syndrome such as hypertension, dyslipidemia, central obesity, and glucose intolerance.
大约50%至70%的多囊卵巢综合征（PCOS）女性存在一定程度的胰岛素抵抗，这种激素不敏感性可能导致了导致PCOS体征和症状的高雄激素血症。尽管存在不确定性，但在该人群中早期发现和治疗胰岛素抵抗最终可能降低糖尿病、血脂异常、高血压和心血管疾病的发病率或严重程度。即便如此，我们目前评估PCOS患者胰岛素敏感性的方法仍存在几个问题，包括在PCOS的定义以及“正常”胰岛素敏感性方面明显缺乏共识、种族和基因变异性、存在肥胖、压力和衰老等导致胰岛素抵抗的其他因素，以及对胰岛素敏感性简化模型是否有足够精度来预测治疗需求、反应和未来发病率的担忧。尽管高胰岛素正葡萄糖钳夹技术是测量胰岛素敏感性的金标准，但它过于昂贵、耗时且劳动强度大，无法在门诊环境中实际应用。稳态测量（空腹血糖/胰岛素比值或稳态模型评估[HOMA]值）和最小模型测试（特别是口服葡萄糖耐量试验[OGTT]）是评估PCOS患者胰岛素抵抗最简单的门诊方法。OGTT可能是评估PCOS女性最好的简单门诊方法，因为它能提供有关胰岛素抵抗和葡萄糖不耐受的信息。葡萄糖不耐受的诊断具有更大的预后和治疗意义。所有肥胖的PCOS女性都应通过寻找胰岛素抵抗综合征的其他特征，如高血压、血脂异常、中心性肥胖和葡萄糖不耐受，来筛查胰岛素抵抗的存在。
