Thomann Robert, Rossinelli Nadia, Keller Ulrich, Tirri Brigitte Frey, De Geyter Christian, Ruiz Juan, Kränzlin Marius, Puder Jardena J
Division of Endocrinology, Diabetes and Clinical Nutrition, University Hospital Basel, Basel, Switzerland.
Gynecol Endocrinol. 2008 Apr;24(4):199-206. doi: 10.1080/09513590801893398.
Polycystic ovary syndrome (PCOS) and gestational diabetes mellitus (GDM) are both characterized by an increase in insulin resistance. Our goal in the present study was to measure insulin resistance (as estimated by homeostasis model assessment, sex hormone-binding globulin (SHBG) and adiponectin concentrations) and parameters of low-grade inflammation in non-diabetic, non-hyperandrogenic ovulatory women with previous GDM (pGDM) and in non-diabetic women with classic PCOS, characterized by hyperandrogenism and oligo/anovulation.
We evaluated 20 women with PCOS, 18 women with pGDM and 19 controls, all matched according to body mass index (BMI). Fasting blood samples were drawn in all women 3-6 days after spontaneous or dydrogesterone-induced withdrawal bleeding. Body fat distribution was assessed using dual-energy X-ray absorptiometry in all women.
After adjusting for age and percent body fat, measures of insulin resistance such as SHBG and adiponectin concentrations were decreased and central obesity was increased in women with PCOS and pGDM compared with controls (all p < 0.05). Parameters of low-grade inflammation such as serum tumor necrosis factor-alpha and highly sensitive C-reactive protein concentrations, white blood cell and neutrophil count were increased only in women with PCOS compared with BMI-matched controls (all p < 0.05).
Certain markers of insulin resistance are increased in both women with PCOS and women with pGDM, while low-grade inflammation is increased only in PCOS. PCOS and GDM might represent specific phenotypes of one disease entity with an increased risk of cardiovascular disease, whereby women with PCOS demonstrate an augmented cardiovascular risk profile.
多囊卵巢综合征（PCOS）和妊娠期糖尿病（GDM）均以胰岛素抵抗增加为特征。我们在本研究中的目标是测量非糖尿病、非高雄激素血症排卵型既往有妊娠期糖尿病（pGDM）的女性以及以高雄激素血症和少/无排卵为特征的经典PCOS非糖尿病女性的胰岛素抵抗（通过稳态模型评估、性激素结合球蛋白（SHBG）和脂联素浓度估算）及低度炎症参数。
我们评估了20例PCOS女性、18例pGDM女性和19例对照，所有患者均根据体重指数（BMI）进行匹配。在所有女性自发或地屈孕酮诱导的撤退性出血后3 - 6天采集空腹血样。所有女性均使用双能X线吸收法评估体脂分布。
在调整年龄和体脂百分比后，与对照组相比，PCOS和pGDM女性的胰岛素抵抗指标如SHBG和脂联素浓度降低，中心性肥胖增加（所有p < 0.05）。与BMI匹配的对照组相比，仅PCOS女性的低度炎症参数如血清肿瘤坏死因子-α和高敏C反应蛋白浓度、白细胞和中性粒细胞计数增加（所有p < 0.05）。
PCOS女性和pGDM女性的某些胰岛素抵抗标志物均增加，而低度炎症仅在PCOS中增加。PCOS和GDM可能代表一种疾病实体的特定表型，心血管疾病风险增加，其中PCOS女性表现出更高的心血管疾病风险特征。
