Lord J, Thomas R, Fox B, Acharya U, Wilkin T
Department of Obstetrics and Gynaecology, Royal Cornwall Hospital, Truro, Cornwall, UK.
BJOG. 2006 Oct;113(10):1203-9. doi: 10.1111/j.1471-0528.2006.00973.x. Epub 2006 Jun 2.
To establish whether visceral fat mass is the most significant variable correlating with insulin resistance and other metabolic parameters in women with polycystic ovary syndrome (PCOS).
Prospective cross-sectional trial.
Reproductive medicine clinic.
Forty women with anovulatory PCOS.
Measurements were taken at recruitment, and analysis was performed to define correlations between the outcome measures and the explanatory variables.
Visceral and subcutaneous fat by computed tomography scan, insulin resistance, anthropometric measures, markers of the metabolic syndrome and androgens.
Strong linear correlation of visceral fat to insulin resistance (r = 0.68, P < 0.001) was observed. There were also statistically significant correlations with fasting insulin (r = 0.73, P < 0.001), homeostasis model assessment beta-cell function (r = 0.50, P = 0.007), triglycerides (r = 0.45, P = 0.003), high-density lipoprotein cholesterol (r = -0.42, P = 0.007), urate (r = 0.47, P = 0.002), Sex hormone binding globulin (r = -0.39, P = 0.01) and luteinising hormone (r = -0.32, P = 0.02). There were no significant correlations of testosterone with fat distribution or metabolic parameters. Insulin resistance showed closest correlation to visceral fat mass (r = 0.68, P < 0.001), then to waist circumference (r = 0.62, P < 0.001), with the weakest correlation being waist:hip ratio (r = 0.36, P = 0.01). The best regression model for predicting insulin resistance is with visceral fat mass and triglycerides as the explanatory variables (r = 0.72, P < 0.001).
Visceral fat is the most significant variable correlating with metabolic dysfunction in women with PCOS. Our data support the hypothesis that visceral fat either causes insulin resistance or is a very early effect of it. It also implies that reducing visceral fat should reduce insulin resistance which may account for the observations that exercise and weight loss appear to be more effective interventions than pharmacological treatments. The best anthropometric measure of insulin resistance is waist circumference.
确定在多囊卵巢综合征（PCOS）女性中，内脏脂肪量是否是与胰岛素抵抗及其他代谢参数相关的最显著变量。
前瞻性横断面试验。
生殖医学诊所。
40例无排卵型PCOS女性。
招募时进行测量，并进行分析以确定结果指标与解释变量之间的相关性。
通过计算机断层扫描测量内脏和皮下脂肪、胰岛素抵抗、人体测量指标、代谢综合征标志物及雄激素。
观察到内脏脂肪与胰岛素抵抗呈强线性相关（r = 0.68，P < 0.001）。与空腹胰岛素（r = 0.73，P < 0.001）、稳态模型评估β细胞功能（r = 0.50，P = 0.007）、甘油三酯（r = 0.45，P = 0.003）、高密度脂蛋白胆固醇（r = -0.42，P = 0.007）、尿酸（r = 0.47，P = 0.002）、性激素结合球蛋白（r = -0.39，P = 0.01）及促黄体生成素（r = -0.32，P = 0.02）也存在统计学显著相关性。睾酮与脂肪分布或代谢参数无显著相关性。胰岛素抵抗与内脏脂肪量相关性最强（r = 0.68，P < 0.001），其次是腰围（r = 0.62，P < 0.001），与腰臀比相关性最弱（r = 0.36，P = 0.01）。预测胰岛素抵抗的最佳回归模型是以内脏脂肪量和甘油三酯作为解释变量（r = 0.72，P < 0.001）。
内脏脂肪是PCOS女性中与代谢功能障碍相关的最显著变量。我们的数据支持以下假设：内脏脂肪要么导致胰岛素抵抗，要么是胰岛素抵抗的早期效应。这也意味着减少内脏脂肪应能降低胰岛素抵抗，这可能解释了运动和体重减轻似乎比药物治疗更有效的观察结果。胰岛素抵抗的最佳人体测量指标是腰围。
