Kurioka Hiroko, Takahashi Kentaro, Miyazaki Kohji
Department of General Medicine, Shimane Prefectural Central Hospital, Izumo, Japan.
Arch Gynecol Obstet. 2007 Mar;275(3):169-73. doi: 10.1007/s00404-006-0241-0. Epub 2006 Sep 14.
Hyperinsulinemia, which is related to obesity, played a pathogenic role in polycystic ovary syndrome (PCOS). However, the incidence of obesity in Japanese women with PCOS is different from that reported in patients with PCOS in Europe and USA. We should determine if insulin resistance occurs in Japanese PCOS. The purpose of this study is to assess the presence of insulin resistance in Japanese PCOS, while also considering obesity as a factor.
We divided the patients with polycystic ovary (PCO) into three groups based on body mass index and levels of gonadotropin. Nine obese PCOS, 34 normal body-weighted PCOS (luteinizing hormone (LH)/follicle stimulating hormone (FSH) >1.0) and 11 normal LH (LH/FSH </= 1.0), normal body-weighted PCO were studied. We compared those patients to 16 control subjects with normal ovulation or with hypothalamic anovulation. Eleven women in the control were normal body-weighted and five were obese. Patients were given an oral glucose tolerance test. Testosterone, plasma glucose and serum immunoreactive insulin after oral administration of 75 g dextrose were studied. We also compared glucose-intolerance [total plasma glucose (SigmaPG) and insulin (SigmaIRI), insulinogenic index (I.I.), fasting plasma glucose/immunoreactive insulin (FPG/IRI), homeostasis model assessment of insulin resistance (HOMA-R)] and testosterone among these groups.
There were no differences in SigmaPG, SigmaIRI, I.I., FPG/IRI or HOMA-R between PCOS and controls. However, there were significant differences in SigmaPG, SigmaIRI, FPG/IRI and HOMA-R between obese and normal body-weighted patients. Similarly, there were no differences in SigmaPG, SigmaIRI, I.I., FPG/IRI or HOMA-R between PCOS and controls in the normal body-weighted group. However, there were significant differences in SigmaPG, SigmaIRI, FPG/IRI and HOMA-R between the obese and the normal body-weighted PCOS. There were also significant differences in SigmaPG and I.I. between LH-dominant, normal body-weighted PCOS and normal LH PCO.
Japanese PCOS might have insulin-resistance but the factor of obesity had a stronger effect on insulin-resistance than did the existence of PCOS. The possibility of a different type of glucose-intolerance was suggested in the patients with ultrasonographical PCO in whom gonadotropin secretion was abnormal.
与肥胖相关的高胰岛素血症在多囊卵巢综合征（PCOS）中起致病作用。然而，日本PCOS女性的肥胖发生率与欧美报道的PCOS患者不同。我们应确定日本PCOS患者是否存在胰岛素抵抗。本研究的目的是评估日本PCOS患者胰岛素抵抗的存在情况，同时将肥胖作为一个因素考虑在内。
我们根据体重指数和促性腺激素水平将多囊卵巢（PCO）患者分为三组。研究了9例肥胖型PCOS患者、34例体重正常的PCOS患者（促黄体生成素（LH）/促卵泡生成素（FSH）>1.0）以及11例LH正常（LH/FSH≤1.0）、体重正常的PCO患者。我们将这些患者与16例排卵正常或下丘脑性无排卵的对照受试者进行比较。对照组中有11名女性体重正常，5名肥胖。患者接受口服葡萄糖耐量试验。研究口服75g葡萄糖后睾酮、血糖和血清免疫反应性胰岛素水平。我们还比较了这些组之间的糖耐量异常情况[总血糖（SigmaPG）和胰岛素（SigmaIRI）、胰岛素生成指数（I.I.）、空腹血糖/免疫反应性胰岛素（FPG/IRI）、胰岛素抵抗稳态模型评估（HOMA-R）]以及睾酮水平。
PCOS患者与对照组在SigmaPG、SigmaIRI、I.I.、FPG/IRI或HOMA-R方面无差异。然而，肥胖患者与体重正常患者在SigmaPG、SigmaIRI、FPG/IRI和HOMA-R方面存在显著差异。同样，体重正常组的PCOS患者与对照组在SigmaPG、SigmaIRI、I.I.、FPG/IRI或HOMA-R方面无差异。然而，肥胖型PCOS患者与体重正常的PCOS患者在SigmaPG、SigmaIRI、FPG/IRI和HOMA-R方面存在显著差异。LH占优势的体重正常的PCOS患者与LH正常的PCO患者在SigmaPG和I.I.方面也存在显著差异。
日本PCOS患者可能存在胰岛素抵抗，但肥胖因素对胰岛素抵抗的影响比PCOS的存在更强。对于超声检查显示PCO且促性腺激素分泌异常的患者，提示存在不同类型糖耐量异常的可能性。
