低性激素结合球蛋白的截断值及其在中国多囊卵巢综合征妇女糖代谢受损中的预测作用。
The Cutoff Value of Low Sex Hormone-Binding Globulin and Its Predictive Role in Impaired Glucose Metabolism Among Chinese Women with Polycystic Ovarian Syndrome.
机构信息
Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China.
Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China.
出版信息
Metab Syndr Relat Disord. 2021 Sep;19(7):378-385. doi: 10.1089/met.2020.0071. Epub 2021 May 4.
Low levels of sex hormone-binding globulin (SHBG) is a potential predictor of type 2 diabetes mellitus (T2DM), and when combined with insulin resistance (IR), lead to impaired glucose metabolism. Few studies involve women with polycystic ovarian syndrome (PCOS). Studies on cutoff values of SHBG among Asian women were scanty. The cutoff level of SHBG was computed using the 25th percentile method. Parameters were compared between the lower and higher SHBG subgroup. Area under the curve (AUC) for sensitivity and specificity of SHBG in predicting IR and impaired glucose metabolism was calculated. This study included 733 patients with PCOS 20-45 years of age and 469 age-matched controls. The 25th percentile of SHBG in the control group was 51.90 nM. There were negative correlations between SHBG and age ( = -0.085, < 0.05), body mass index (BMI) ( = -0.461, < 0.01), waist-to-hip ratio (WHR) ( = -0.349, < 0.01), fasting plasma glucose ( = -0.242, < 0.01), Glucose-1h ( = -0.303, < 0.01), Glucose-2h ( = -0.336, < 0.01), fasting insulin ( = -0.324, < 0.01), Insulin-1h ( = -0.238, < 0.01), Insulin-2h ( = -0.307, < 0.01), and homeostasis model 2 assessment of insulin resistance (HOMA2-IR) ( = -0.329, < 0.01). Age, BMI, WHR, glucose and insulin levels (both pre- and postload), HOMA2-IR, free testosterone, and dehydroepiandrosterone sulfate were all higher in the lower than the higher SHBG subgroup. The AUC of SHBG for predicting IR was 0.706 [95% confidence interval (CI) 0.665-0.745, < 0.001], impaired fasting glucose was 0.674 (95% CI 0.513-0.838, < 0.001), impaired glucose tolerance was 0.637 (95% CI 0.586-0.690, < 0.001), and T2DM was 0.674 (95% CI 0.556-0.780, < 0.001). A 51.90 nM should be identified as the cutoff value of SHBG. Women with PCOS with lower SHBG values have a higher risk of developing impaired glucose metabolism. Low SHBG should be a predictive biomarker of impaired glucose metabolism in women with PCOS in southern China.
血清性激素结合球蛋白（SHBG）水平较低是 2 型糖尿病（T2DM）的潜在预测因子，当与胰岛素抵抗（IR）结合时，会导致葡萄糖代谢受损。很少有研究涉及多囊卵巢综合征（PCOS）女性。亚洲女性的 SHBG 截断值研究很少。SHBG 的截断值是使用第 25 百分位数法计算的。比较了较低和较高 SHBG 亚组之间的参数。计算了 SHBG 预测 IR 和葡萄糖代谢受损的敏感性和特异性的曲线下面积（AUC）。本研究纳入了 733 名 20-45 岁的 PCOS 患者和 469 名年龄匹配的对照组。对照组中 SHBG 的第 25 百分位数为 51.90nM。SHBG 与年龄（ = -0.085， < 0.05）、体重指数（BMI）（ = -0.461， < 0.01）、腰臀比（WHR）（ = -0.349， < 0.01）、空腹血糖（ = -0.242， < 0.01）、葡萄糖 1 小时（ = -0.303， < 0.01）、葡萄糖 2 小时（ = -0.336， < 0.01）、空腹胰岛素（ = -0.324， < 0.01）、胰岛素 1 小时（ = -0.238， < 0.01）、胰岛素 2 小时（ = -0.307， < 0.01）和稳态模型 2 胰岛素抵抗评估（HOMA2-IR）（ = -0.329， < 0.01）呈负相关。较低 SHBG 亚组的年龄、BMI、WHR、血糖和胰岛素水平（空腹和负荷后）、HOMA2-IR、游离睾酮和脱氢表雄酮硫酸盐均较高。SHBG 预测 IR 的 AUC 为 0.706 [95%置信区间（CI）0.665-0.745， < 0.001]，空腹血糖受损为 0.674（95%CI 0.513-0.838， < 0.001），葡萄糖耐量受损为 0.637（95%CI 0.586-0.690， < 0.001），2 型糖尿病为 0.674（95%CI 0.556-0.780， < 0.001）。51.90nM 应被确定为 SHBG 的截断值。SHBG 值较低的 PCOS 女性发生葡萄糖代谢受损的风险更高。中国南方 PCOS 女性的低 SHBG 水平可能是葡萄糖代谢受损的预测生物标志物。
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