Department of Obstetrics and Gynecology and Center for Androgen-Related Disorders, Cedars-SinaiMedical Center, Los Angeles, CA 90048, USA.
J Clin Endocrinol Metab. 2013 Apr;98(4):1541-8. doi: 10.1210/jc.2012-2937. Epub 2013 Feb 28.
Polycystic ovary syndrome (PCOS) is associated with hyperandrogenism and insulin resistance. Glucose disposal occurs via noninsulin-mediated glucose uptake (NIMGU) and insulin-mediated glucose uptake (IMGU). It is unknown whether in PCOS NIMGU increases to compensate for declining IMGU and whether androgens and fat distribution influence this relationship.
The objective of the study was to compare in women with PCOS and controls the interrelationship between NIMGU [ie, glucose effectiveness (Sg)] and IMGU [ie, the insulin sensitivity index (Si)] and the role of androgens and fat distribution.
Twenty-eight PCOS (by National Institutes of Health 1990 criteria) and 28 control (age, race, and body mass index matched) women were prospectively studied. A subset of 16 PCOS subjects and 16 matched controls also underwent abdominal computed tomography.
Glucose disposal (by a frequently sampled iv glucose tolerance test), circulating androgens, and abdominal fat distribution [by waist to hip ratio and visceral (VAT) and sc (SAT) adipose tissue content] were measured.
PCOS women had lower mean Si and similar Sg and abdominal fat distribution compared with controls. PCOS women with Si below the PCOS median (more insulin resistant) had a lower mean Sg than controls with Si above the control median (more insulin sensitive). In PCOS only, body mass index, free T, modified Ferriman-Gallwey score, and waist to hip ratio independently predicted Sg, whereas Si did not. In PCOS, VAT and SAT independently and negatively predicted Si and Sg, respectively.
The decreased IMGU in PCOS is not accompanied by a compensatory increase in NIMGU or associated with excessive VAT accumulation. Increased general obesity, SAT, and hyperandrogenism are primary predictors of the deterioration of NIMGU in PCOS.
多囊卵巢综合征（PCOS）与高雄激素血症和胰岛素抵抗有关。葡萄糖的摄取是通过非胰岛素介导的葡萄糖摄取（NIMGU）和胰岛素介导的葡萄糖摄取（IMGU）来实现的。目前尚不清楚 PCOS 患者中 NIMGU 是否会增加以代偿 IMGU 的下降，以及雄激素和脂肪分布是否会影响这种关系。
本研究旨在比较 PCOS 患者和对照组中 NIMGU（即葡萄糖效应[Sg]）和 IMGU（即胰岛素敏感指数[Si]）之间的相互关系，以及雄激素和脂肪分布的作用。
28 例 PCOS（符合美国国立卫生研究院 1990 年标准）和 28 例对照组（年龄、种族和体重指数匹配）女性前瞻性研究。其中 16 例 PCOS 患者和 16 例匹配对照组还接受了腹部计算机断层扫描。
葡萄糖处置（通过频繁采样静脉葡萄糖耐量试验）、循环雄激素和腹部脂肪分布（通过腰围与臀围比以及内脏（VAT）和皮下（SAT）脂肪组织含量）。
与对照组相比，PCOS 女性的平均 Si 较低，而 Sg 和腹部脂肪分布相似。与 Si 高于对照组中位数（更胰岛素敏感）的对照组相比，Si 低于 PCOS 中位数（更胰岛素抵抗）的 PCOS 女性的平均 Sg 较低。仅在 PCOS 中，体重指数、游离 T、改良 Ferriman-Gallwey 评分和腰围与臀围比独立预测 Sg，而 Si 则不独立预测 Sg。在 PCOS 中，VAT 和 SAT 分别独立且负向预测 Si 和 Sg。
PCOS 中 IMGU 的减少并没有伴随着 NIMGU 的代偿性增加，也与过多的 VAT 积累无关。全身肥胖、SAT 和高雄激素血症是 PCOS 中 NIMGU 恶化的主要预测因素。
