Department of Internal Medicine, Division of Endocrinology, Clinical Nutrition and Vascular Medicine, University of California, Davis, Davis, California, USA.
Diabetes Care. 2010 Apr;33(4):887-93. doi: 10.2337/dc09-1525. Epub 2010 Jan 12.
To determine insulin resistance and response in patients with polycystic ovary syndrome (PCOS) and normal glucose tolerance (NGT), impaired fasting glucose (IFG), impaired glucose tolerance, and combined glucose intolerance (CGI).
In this cross-sectional study, 143 patients with PCOS (diagnosed on the basis of National Institutes of Health criteria) underwent oral glucose tolerance testing (OGTT), and 68 patients also had frequently sampled intravenous glucose tolerance tests. Changes in plasma glucose, insulin, cardiovascular risk factors, and androgens were measured.
Compared with patients with NGT, those with both IFG and CGI were significantly insulin resistant (homeostasis model assessment 3.3 +/- 0.2 vs. 6.1 +/- 0.9 and 6.4 +/- 0.5, P < 0.0001) and hyperinsulinemic (insulin area under the curve for 120 min 973 +/- 69 vs. 1,470 +/- 197 and 1,461 +/- 172 pmol/l, P < 0.0001). Insulin response was delayed in patients with CGI but not in those with IFG (2-h OGTT, insulin 1,001 +/- 40 vs. 583 +/- 45 pmol/l, P < 0.0001). Compared with the NGT group, the CGI group had a lower disposition index (1,615 +/- 236 vs. 987 +/- 296, P < 0.0234) and adiponectin level (11.1 +/- 1.1 vs. 6.2 +/- 0.8 ng/ml, P < 0.0096). Compared with the insulin-resistant tertile of the NGT group, those with IFG had a reduced insulinogenic index (421 +/- 130 vs. 268 +/- 68, P < 0.05). Compared with the insulin-sensitive tertile of the NGT group, the resistant tertile had higher triglyceride and high-sensitivity C-reactive protein (hs-CRP) and lower HDL cholesterol and sex hormone-binding globulin (SHBG). In the entire population, insulin resistance correlated directly with triglyceride, hs-CRP, and the free androgen index and inversely with SHBG.
Patients with PCOS develop IFG and CGI despite having significant hyperinsulinemia. Patients with IFG and CGI exhibit similar insulin resistance but very different insulin response patterns. Increases in cardiac risk factors and free androgen level precede overt glucose intolerance.
确定多囊卵巢综合征（PCOS）伴正常糖耐量（NGT）、空腹血糖受损（IFG）、糖耐量受损和联合糖不耐受（CGI）患者的胰岛素抵抗和反应。
在这项横断面研究中，143 名 PCOS 患者（根据美国国立卫生研究院标准诊断）接受了口服葡萄糖耐量试验（OGTT），其中 68 名患者还接受了频繁采样静脉葡萄糖耐量试验。测量了血浆葡萄糖、胰岛素、心血管危险因素和雄激素的变化。
与 NGT 患者相比，IFG 和 CGI 患者的胰岛素抵抗明显增加（稳态模型评估 3.3±0.2 与 6.1±0.9 和 6.4±0.5，P<0.0001），且胰岛素水平升高（120 分钟胰岛素曲线下面积 973±69 与 1470±197 和 1461±172 pmol/l，P<0.0001）。CGI 患者的胰岛素反应延迟，但 IFG 患者的胰岛素反应没有延迟（2 小时 OGTT，胰岛素 1001±40 与 583±45 pmol/l，P<0.0001）。与 NGT 组相比，CGI 组的胰岛素敏感性指数（1615±236 与 987±296，P<0.0234）和脂联素水平（11.1±1.1 与 6.2±0.8 ng/ml，P<0.0096）较低。与 NGT 组胰岛素抵抗的三分之一相比，IFG 患者的胰岛素生成指数降低（421±130 与 268±68，P<0.05）。与 NGT 组胰岛素敏感的三分之一相比，胰岛素抵抗的三分之一的甘油三酯和高敏 C 反应蛋白较高，高密度脂蛋白胆固醇和性激素结合球蛋白较低。在整个人群中，胰岛素抵抗与甘油三酯、高敏 C 反应蛋白和游离雄激素指数直接相关，与性激素结合球蛋白水平呈负相关。
尽管 PCOS 患者存在明显的高胰岛素血症，但仍会出现 IFG 和 CGI。IFG 和 CGI 患者表现出相似的胰岛素抵抗，但胰岛素反应模式却非常不同。心脏危险因素和游离雄激素水平的增加先于明显的糖耐量受损。
