多囊卵巢综合征患者的脂肪组织形态和功能异常：体积增大的脂肪细胞和低血清脂联素与胰岛素抵抗密切相关，但与循环性激素无关。

Adipose tissue has aberrant morphology and function in PCOS: enlarged adipocytes and low serum adiponectin, but not circulating sex steroids, are strongly associated with insulin resistance.

机构信息

Institute of Neuroscience and Physiology, Department of Physiology, Sahlgrenska Academy, University of Gothenburg, SE-405 30 Gothenburg, Sweden.

出版信息

J Clin Endocrinol Metab. 2011 Feb;96(2):E304-11. doi: 10.1210/jc.2010-1290. Epub 2010 Nov 17.

DOI:10.1210/jc.2010-1290

PMID:21084397

Abstract

CONTEXT

Comprehensive characterization of the adipose tissue in women with polycystic ovary syndrome (PCOS), over a wide range of body mass indices (BMIs), is lacking. Mechanisms behind insulin resistance in PCOS are unclear.

OBJECTIVE

To characterize the adipose tissue of women with PCOS and controls matched pair-wise for age and BMI, and to identify factors, among adipose tissue characteristics and serum sex steroids, that are associated with insulin sensitivity in PCOS.

DESIGN/OUTCOME MEASURES: Seventy-four PCOS women and 31 controls were included. BMI was 18-47 (PCOS) and 19-41 kg/m(2) (controls). Anthropometric variables, volumes of subcutaneous/visceral adipose tissue (magnetic resonance imaging; MRI), and insulin sensitivity (clamp) were investigated. Adipose tissue biopsies were obtained to determine adipocyte size, lipoprotein lipase (LPL) activity, and macrophage density. Circulating testosterone, free testosterone, free 17β-estradiol, SHBG, glycerol, adiponectin, and serum amyloid A were measured/calculated.

RESULTS

Comparison of 31 pairs revealed lower insulin sensitivity, hyperandrogenemia, and higher free 17β-estradiol in PCOS. Abdominal adipose tissue volumes/distribution did not differ in the groups, but PCOS women had higher waist-to-hip ratio, enlarged adipocytes, reduced adiponectin, and lower LPL activity. In regression analysis, adipocyte size, adiponectin, and waist circumference were the factors most strongly associated with insulin sensitivity in PCOS (R(2)=0.681, P < 0.001).

CONCLUSIONS

In PCOS, adipose tissue has aberrant morphology/function. Increased waist-to-hip ratio indicates abdominal/visceral fat accumulation, but this is not supported by MRI. Enlarged adipocytes and reduced serum adiponectin, together with a large waistline, rather than androgen excess, may be central factors in the pathogenesis/maintenance of insulin resistance in PCOS.

摘要

背景

多囊卵巢综合征（PCOS）患者的脂肪组织特征在很大的体质量指数（BMI）范围内尚未得到全面描述。PCOS 患者胰岛素抵抗的机制尚不清楚。

目的

对多囊卵巢综合征患者和年龄、BMI 相匹配的对照组的脂肪组织进行特征描述，并确定脂肪组织特征和血清性激素中与 PCOS 患者胰岛素敏感性相关的因素。

设计/观察指标：共纳入 74 例 PCOS 患者和 31 例对照组。BMI 范围分别为 18-47（PCOS）和 19-41kg/m(2)（对照组）。检测了人体测量学变量、皮下/内脏脂肪组织体积（磁共振成像；MRI）和胰岛素敏感性（钳夹试验）。同时获取脂肪组织活检标本，以确定脂肪细胞大小、脂蛋白脂酶（LPL）活性和巨噬细胞密度。测定/计算了循环睾酮、游离睾酮、游离 17β-雌二醇、性激素结合球蛋白（SHBG）、甘油、脂联素和血清淀粉样蛋白 A。

结果

对 31 对配对患者进行比较后发现，PCOS 患者的胰岛素敏感性降低、高雄激素血症和游离 17β-雌二醇水平升高。两组患者的腹部脂肪组织体积/分布无差异，但 PCOS 患者的腰围/臀围比值更高、脂肪细胞增大、脂联素降低、LPL 活性降低。在回归分析中，脂肪细胞大小、脂联素和腰围是与 PCOS 患者胰岛素敏感性最相关的因素（R(2)=0.681，P＜0.001）。