Alviggi Carlo, Conforti Alessandro, De Rosa Pasquale, Strina Ida, Palomba Stefano, Vallone Roberta, Gizzo Salvatore, Borrelli Rosaria, Andersen Claus Yding, De Placido Giuseppe, Guerriero Stefano
Department of Neuroscience, Reproductive Medicine, Odontostomatology, University of Naples Federico II, Naples, Italy.
Department of Woman and Child Health, University of Padua, Padua, Italy.
Front Endocrinol (Lausanne). 2017 May 31;8:117. doi: 10.3389/fendo.2017.00117. eCollection 2017.
Although insulin resistance plays an important pathogenetic role in polycystic ovary syndrome (PCOS), no correlation between ultrasound PCOS pattern and insulin resistance has yet been reported. The aim of this retrospective observational study was to assess whether the ovarian ultrasonographic parameter differed between PCOS women with insulin resistance and those with a hyperandrogenic profile.
Women who fulfilled the Rotterdam criteria for PCOS were retrospectively studied. Anthropometric, biochemical, and clinical data were recorded. Women were divided into two groups based on specific transvaginal ultrasound parameters: subjects with more than half of the follicles measuring between 5 and 9 mm in diameter, an ultrasonographic determined stroma/total area (S/A) > 0.34 and a "necklace" sign of antral follicles (Group A); and subjects with more than half of the antral follicles measuring between 2 and 4 mm in diameter, an S/A ≤ 0.34; no "necklace" sign but ubiquitously distributed follicles determined by ultrasound (Group B). The association between these ultrasound patterns and the presence of insulin resistance was also evaluated.
Seventy-eight patients were enrolled: 33 with ultrasound sound pattern A and 45 with pattern B. The latter pattern had a sensitivity of 88% and a specificity of 78% in predicting PCOS women with insulin resistance. There were no differences in age, Ferriman-Gallwey score, and serum gonadotropin or androgen levels between the two groups. Body mass index, the waist-to-hip ratio, and homeostasis model assessment were significantly higher in group B than in group A ( < 0.05). Conversely, sex hormone binding globulin levels and ovarian volume were significantly higher in group A ( < 0.05). Insulin resistance was more frequent in group B than in group A (36/41, 87.8% versus 7/32, 21.8%; < 0.05).
These results suggest that insulin resistance could be associated with a specific ultrasound pattern in PCOS patients.
尽管胰岛素抵抗在多囊卵巢综合征（PCOS）的发病机制中起重要作用，但超声检查的PCOS模式与胰岛素抵抗之间尚未见相关性报道。这项回顾性观察研究的目的是评估胰岛素抵抗的PCOS女性与高雄激素血症的PCOS女性之间的卵巢超声参数是否存在差异。
对符合鹿特丹PCOS标准的女性进行回顾性研究。记录人体测量学、生化和临床数据。根据特定的经阴道超声参数将女性分为两组：卵泡直径一半以上在5至9毫米之间、超声测定的基质/总面积（S/A）>0.34且有窦卵泡“项链征”的受试者（A组）；以及直径一半以上的窦卵泡在2至4毫米之间、S/A≤0.34、无“项链征”但超声显示卵泡普遍分布的受试者（B组）。还评估了这些超声模式与胰岛素抵抗存在之间的关联。
共纳入78例患者：33例为超声模式A，45例为模式B。后一种模式在预测胰岛素抵抗的PCOS女性方面的敏感性为88%，特异性为78%。两组之间在年龄、费里曼-加洛韦评分、血清促性腺激素或雄激素水平方面无差异。B组的体重指数、腰臀比和稳态模型评估值显著高于A组（<0.05）。相反，A组的性激素结合球蛋白水平和卵巢体积显著更高（<0.05）。B组的胰岛素抵抗比A组更常见（36/41，87.8%对7/32，21.8%；<0.05）。
这些结果表明，胰岛素抵抗可能与PCOS患者的特定超声模式相关。
