Holte J, Bergh T, Berne C, Berglund L, Lithell H
Department of Obstetrics and Gynecology, Uppsala University, Sweden.
J Clin Endocrinol Metab. 1994 May;78(5):1052-8. doi: 10.1210/jcem.78.5.8175959.
Insulin secretion in response to iv glucose and insulin sensitivity (euglycemic hyperinsulinemic clamp) were evaluated in 49 women with polycystic ovary syndrome (PCOS) [body mass index (BMI), 17.6-37.2 kg/m2] and 42 control subjects (BMI, 18.8-38.1 kg/m2). Seven women with PCOS exhibited glucose intolerance with subnormal insulin secretion. Compared with control subjects, women with PCOS and normal glucose tolerance had an increased (36-56%) insulin increment, not explained by insulin resistance, and over the whole range of BMI. In contrast, insulin sensitivity was similar in women with PCOS and control subjects at BMI 21 kg/m2, but showed a more pronounced decline with increasing BMI in women with PCOS, who had 35% and 70% lower insulin sensitivities at BMI 28 and 35 kg/m2, respectively. After adjusting for truncal-abdominal sc fat distribution, which was more pronounced in the women with PCOS, the two groups had similar insulin sensitivity over the entire range of BMI (P = 0.9), whereas the difference in insulin increment was insignificant after adjusting for the free androgen index (testosterone x 100/sex hormone binding globulin; P = 0.16). Hemoglobin A1C levels were lower in women with PCOS than in the control subjects. It is concluded that the early insulin response to glucose was increased in women with PCOS, not accounted for by insulin resistance, closely associated to the increased androgenicity, and present also at low-normal BMI. In contrast, insulin resistance was seen only at higher BMI levels and was largely determined by the increased truncal-abdominal fat mass in PCOS.
对49名多囊卵巢综合征（PCOS）女性患者（体重指数[BMI]为17.6 - 37.2kg/m²）和42名对照受试者（BMI为18.8 - 38.1kg/m²）进行了静脉注射葡萄糖后的胰岛素分泌及胰岛素敏感性（正常血糖高胰岛素钳夹试验）评估。7名PCOS女性患者表现出葡萄糖不耐受且胰岛素分泌低于正常水平。与对照受试者相比，糖耐量正常的PCOS女性患者胰岛素增量增加（36% - 56%），这并非由胰岛素抵抗所致，且在整个BMI范围内均如此。相比之下，BMI为21kg/m²时，PCOS女性患者和对照受试者的胰岛素敏感性相似，但随着BMI增加，PCOS女性患者的胰岛素敏感性下降更为明显，在BMI为28kg/m²和35kg/m²时，其胰岛素敏感性分别低35%和70%。在调整了PCOS女性患者中更为明显的躯干 - 腹部皮下脂肪分布后，两组在整个BMI范围内的胰岛素敏感性相似（P = 0.9），而在调整游离雄激素指数（睾酮×100/性激素结合球蛋白；P = 0.16）后，胰岛素增量差异无统计学意义。PCOS女性患者的糖化血红蛋白水平低于对照受试者。研究得出结论，PCOS女性患者对葡萄糖的早期胰岛素反应增强，并非由胰岛素抵抗引起，与雄激素水平升高密切相关，且在BMI略低于正常水平时也存在。相比之下，仅在较高BMI水平时才出现胰岛素抵抗，且在PCOS中很大程度上由躯干 - 腹部脂肪量增加所决定。
