Fulghesu Anna Maria, Angioni Stefano, Portoghese Elaine, Milano Francesca, Batetta Barbara, Paoletti Anna Maria, Melis Gian Benedetto
Dipartimento Chirurgico Materno-Infantile e di Scienze delle Immagini, Sezione di Clinica Ginecologica, Ostetrica e di Fisiopatologia della riproduzione, University of Cagliari, via Ospedale, 09124, Cagliari, Italy.
Fertil Steril. 2006 Aug;86(2):398-404. doi: 10.1016/j.fertnstert.2006.01.024. Epub 2006 Jun 12.
To verify whether the homeostatic model assessment (HOMA) test is a suitable method for the identification of metabolic deterioration in normal-weight patients affected by polycystic ovary syndrome (PCOS).
Prospective clinical study.
Academic clinic and research environment in Cagliari, Italy.
PATIENT(S): Forty-nine PCOS normal-weight adolescent subjects, and 50 eumenorrheic, normal-weight, nonhirsute controls matched for age and body mass index (BMI).
INTERVENTION(S): History and physical examination, oral glucose tolerance test (OGTT) and blood sampling, ultrasound.
MAIN OUTCOME MEASURE(S): The HOMA score and integrated secretory area under the curve of insulin values (I-AUC) during the OGTT were calculated.
RESULT(S): Normal insulin sensitivity was defined as upper control 95th percentile by HOMA values <65.6, I-AUC at 180 minutes <16,921, and I-AUC at 120 minutes <11,817. When applying the calculated I-AUC cutoff, 27 PCOS patients were classified as normoinsulinemic and 22 as hyperinsulinemic, whereas using the calculated HOMA cutoff, only 9 PCOS patients could be classified as insulin resistant (IR). Thirteen of the 40 non-IR PCOS patients presented with hyperinsulinemia; fasting glucose and insulin levels and HOMA scores were not sufficient to identify these subjects. Thus, the HOMA test displayed a low sensitivity (41%) and specificity (100%) in the diagnosis of the metabolic disorder disclosed by I-AUC. Moreover, analysis of I-AUC after 120 and 180 minutes revealed how the shorter evaluation period did not suffice for identification of all hyperinsulinemic subjects, implying an unrecognized condition in 11 of 22 subjects.
CONCLUSION(S): In young, normal-weight patients with PCOS, the prevalence of hyperinsulinemia is not detectable by HOMA studies. The prevalence of IR was 18% according to HOMA evaluation, whereas hyperinsulinemia was found in 44% of subjects examined by I-AUC. Normal-weight, young PCOS patients should undergo a 3-hour OGTT to detect early metabolic abnormalities.
验证稳态模型评估（HOMA）试验是否是识别受多囊卵巢综合征（PCOS）影响的正常体重患者代谢恶化的合适方法。
前瞻性临床研究。
意大利卡利亚里的学术诊所和研究环境。
49名PCOS正常体重青少年受试者，以及50名年龄和体重指数（BMI）相匹配的月经正常、正常体重、无多毛症的对照者。
病史和体格检查、口服葡萄糖耐量试验（OGTT）及血液采样、超声检查。
计算HOMA评分以及OGTT期间胰岛素值曲线下的综合分泌面积（I-AUC）。
正常胰岛素敏感性定义为HOMA值<65.6、180分钟时I-AUC<16,921且120分钟时I-AUC<11,817时处于对照上限第95百分位数。应用计算出的I-AUC临界值时，27例PCOS患者被分类为正常胰岛素血症，22例为高胰岛素血症；而使用计算出的HOMA临界值时，只有9例PCOS患者可被分类为胰岛素抵抗（IR）。40例非IR的PCOS患者中有13例存在高胰岛素血症；空腹血糖和胰岛素水平以及HOMA评分不足以识别这些受试者。因此，HOMA试验在诊断I-AUC所揭示的代谢紊乱方面显示出低敏感性（41%）和特异性（100%）。此外，对120分钟和180分钟后的I-AUC分析表明，较短的评估期不足以识别所有高胰岛素血症受试者，这意味着22名受试者中有11名存在未被识别的情况。
在年轻的PCOS正常体重患者中，HOMA研究无法检测出高胰岛素血症的患病率。根据HOMA评估，IR的患病率为18%，而通过I-AUC检查发现44%的受试者存在高胰岛素血症。正常体重的年轻PCOS患者应进行3小时OGTT以检测早期代谢异常。
