Department of Obstetrics and Gynecology, Stanford Healthcare-ValleyCare Hospital, Pleasanton, CA, USA.
Department of Obstetrics and Gynecology, and Center for Androgen-Related Disorders, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Clin Endocrinol (Oxf). 2020 Aug;93(2):163-172. doi: 10.1111/cen.14193. Epub 2020 May 20.
Polycystic ovary syndrome (PCOS) is a highly prevalent disorder associated with insulin resistance (IR) and compensatory hyperinsulinemia. Although variations in cardiometabolic risks across race and ethnicities have been reported in the general population, racial/ethnic disparities in the metabolic dysfunction of PCOS remain relatively unstudied.
To determine whether markers of metabolic function differ in nondiabetic Asian American (AS), African American (AA), Hispanic White (HW), compared to non-Hispanic White (NHW) women with PCOS.
Prospective cross-sectional study in a tertiary institution.
A total of 259 nondiabetic women with PCOS (by NIH 1990 criteria) who completed a 2-hour 75-g oral glucose tolerance test measuring plasma glucose and insulin levels. Basal IR and insulin secretion, assessed by the homeostasis model assessment (HOMA-IR and HOMA-β%, respectively), and two-hour hyperglycaemia and hyperinsulinemia after an oral glucose load, were compared in 21 AS, 24 AA, 53 HW and 161 NHW consecutive nondiabetic adult PCOS women.
After adjusting for age and body mass index, HW and AA PCOS women demonstrated higher fasting and post-glucose challenge insulin levels, and higher HOMA-IR and HOMA-β%, than NHW women, although glucose levels were similar. In contrast, AS PCOS women had or tended to have lower HOMA-β% than any other racial/ethnic groups, lower HOMA-IR, and fasting and post-challenge insulin levels than AA or HW, and also had higher (albeit still normal) mean post-challenge glucose levels than NHW women with PCOS despite similar HOMA-IR, and fasting insulin and post-challenge insulin levels. Waist-hip ratio was similar across the four groups.
Both HW and AA women with PCOS have increased basal state IR and higher β-cell response, and post-challenge hyperinsulinemia compared to NHW and AS subjects. The trend towards a lesser insulin response among Asian women requires further investigation. These findings suggest that the screening and management of metabolic dysfunction in PCOS should consider patients' race/ethnicity.
多囊卵巢综合征（PCOS）是一种与胰岛素抵抗（IR）和代偿性高胰岛素血症相关的高度普遍存在的疾病。尽管在普通人群中已经报道了不同种族和民族之间心血管代谢风险的差异，但 PCOS 代谢功能障碍的种族/民族差异仍相对研究不足。
确定患有 PCOS 的非糖尿病亚裔美国人（AS）、非裔美国人（AA）、西班牙裔白人（HW）与非西班牙裔白人（NHW）女性之间，代谢功能的标志物是否存在差异。
在一所三级医疗机构进行的前瞻性横断面研究。
共有 259 名患有 PCOS 的非糖尿病女性（符合 NIH 1990 年标准）完成了 2 小时 75 克口服葡萄糖耐量试验，测量血浆葡萄糖和胰岛素水平。在 21 名 AS、24 名 AA、53 名 HW 和 161 名 NHW 连续非糖尿病成年 PCOS 女性中，比较了基础胰岛素抵抗和胰岛素分泌（分别用稳态模型评估的 HOMA-IR 和 HOMA-β%评估），以及口服葡萄糖负荷后两小时高血糖和高胰岛素血症。
调整年龄和体重指数后，HW 和 AA 的 PCOS 女性的空腹和葡萄糖后胰岛素水平以及 HOMA-IR 和 HOMA-β%均高于 NHW 女性，尽管血糖水平相似。相比之下，AS 的 PCOS 女性的 HOMA-β%低于任何其他种族/民族群体，HOMA-IR、空腹和葡萄糖后胰岛素水平低于 AA 或 HW，尽管与 NHW 女性的 HOMA-IR、空腹胰岛素和葡萄糖后胰岛素水平相似，但 HOMA-β%、空腹和葡萄糖后胰岛素水平均较低，且葡萄糖后血糖水平较高（尽管仍在正常范围内）。四个组的腰围-臀围比相似。
HW 和 AA 的 PCOS 女性与 NHW 和 AS 受试者相比，基础状态 IR 增加，β 细胞反应更高，葡萄糖后胰岛素血症更高。亚洲女性胰岛素反应较小的趋势需要进一步研究。这些发现表明，在 PCOS 中代谢功能障碍的筛查和管理应考虑患者的种族/民族。
