Chen Fu, Liao Yingyang, Chen Minjie, Yin Huihuang, Chen Guishan, Huang Qingxia, Chen Lan, Yang Xiaoping, Zhang Weichun, Wang Ping, Yin Guoshu
Department of Clinical Nutrition, The First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong Province, China.
Department of Nutrition, The Affiliated Tumor Hospital of Guangxi Medical University, Nanning, 530021, Guangxi Province, China.
Reprod Sci. 2021 Sep;28(9):2504-2513. doi: 10.1007/s43032-021-00535-0. Epub 2021 Mar 15.
This study aimed to evaluate the efficacy of SHBG in predicting insulin resistance (IR) in newly diagnosed, untreated patients with polycystic ovary syndrome (PCOS). Hundred newly diagnosed, untreated patients with PCOS and 61 subjects without PCOS (41 healthy volunteers with normal BMI and 20 subjects with overweight/obese) were included in the study. Receiver-operating characteristic (ROC) analysis was used to assess the effectiveness of SHBG in predicting IR in overweight/obese and non-overweight PCOS patients and the optimal cut-off values of SHBG. The results showed negative correlations between log-SHBG and log-I (r = - 0.372, P < 0.001) and log-SHBG and log-Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) (r = - 0.393, P < 0.001) after adjusting for blood pressure, serum lipid, age, and body mass index (BMI) in all of the PCOS patients. In patients with IR (defined as HOMA-IR ≥2.29), the area under the ROC curves (AUCs) of the SHBG for ROC analysis in the non-overweight group, overweight/obese group, and all PCOS patients were 0.774 (P = 0.0001), 0.922 (P = 0.0001), and 0.885 (P = 0.0001), respectively. The optimal cut-off value of SHBG was 37 nmol/L with a sensitivity of 97.62% and specificity of 80.85% in the overweight group. In patients with IR (HOMA-IR ≥2.5), the AUCs of SHBG for ROC analysis in the non-overweight group, overweight/obese group, and all PCOS patients were 0.741 (P = 0.0003), 0.928 (P = 0.0001), and 0.880 (P = 0.0001), respectively. The optimal cut-off value of SHBG was 30.2 nmol/L with a sensitivity of 97.44% and specificity of 82.69% in the overweight/obese group. In conclusion, this study observed a negative correlation between SHBG and HOMA-IR in PCOS patients after adjustment of confounding factors. SHBG was an independent influential factor of HOMA-IR and can be used as a positive predictive marker for IR in PCOS patients, especially in those who are overweight/obese.
本研究旨在评估性激素结合球蛋白（SHBG）在预测新诊断的未经治疗的多囊卵巢综合征（PCOS）患者胰岛素抵抗（IR）方面的疗效。该研究纳入了100例新诊断的未经治疗的PCOS患者以及61名非PCOS受试者（41名BMI正常的健康志愿者和20名超重/肥胖受试者）。采用受试者工作特征（ROC）分析来评估SHBG在预测超重/肥胖和非超重PCOS患者IR方面的有效性以及SHBG的最佳截断值。结果显示，在所有PCOS患者中，校正血压、血脂、年龄和体重指数（BMI）后，log-SHBG与log-I（r = - 0.372，P < 0.001）以及log-SHBG与log-胰岛素抵抗稳态模型评估（HOMA-IR）（r = - 0.393，P < 0.001）之间呈负相关。在IR患者（定义为HOMA-IR≥2.29）中，非超重组、超重/肥胖组和所有PCOS患者中用于ROC分析的SHBG的ROC曲线下面积（AUC）分别为0.774（P = 0.0001）、0.922（P = 0.0001）和0.885（P = 0.0001）。超重组中SHBG的最佳截断值为37 nmol/L，敏感性为97.62%，特异性为80.85%。在IR患者（HOMA-IR≥2.5）中，非超重组、超重/肥胖组和所有PCOS患者中用于ROC分析的SHBG的AUC分别为0.741（P = 0.0003）、0.928（P = 0.0001）和0.880（P = 0.0001）。超重/肥胖组中SHBG的最佳截断值为30.2 nmol/L，敏感性为97.44%，特异性为82.69%。总之，本研究观察到校正混杂因素后PCOS患者中SHBG与HOMA-IR之间呈负相关。SHBG是HOMA-IR的独立影响因素，可作为PCOS患者IR的阳性预测标志物，尤其是在超重/肥胖患者中。
