Robinson S, Henderson A D, Gelding S V, Kiddy D, Niththyananthan R, Bush A, Richmond W, Johnston D G, Franks S
Unit of Metabolic Medicine, St Mary's Hospital Medical School, London, UK.
Clin Endocrinol (Oxf). 1996 Mar;44(3):277-84. doi: 10.1046/j.1365-2265.1996.674495.x.
Polycystic ovary syndrome (PCOS) is characterized by hyperinsulinaemia and insulin resistance. Previous reports of lipid abnormalities in the syndrome have produced conflicting results which may, in part, be related to the lack of appropriate controls for the obese women with PCOS. Only one study has related lipid levels to insulin sensitivity. The objective of this study was to assess lipids and lipoproteins in women with PCOS, to compare the results with weight matched controls, and to relate the findings to indices of insulin secretion and action, and to menstrual history.
A cross-sectional study of insulin sensitivity and lipids in a cohort of PCO subjects compared to weight and ethnic group matched controls.
We have therefore investigated glucose tolerance, plasma lipids and lipoproteins in 19 lean (LP) and 55 obese (OP) patients with PCO and compared the results with those in 22 lean (LC) and 15 obese (OC) control women. Insulin sensitivity was measured in the same subjects with a short insulin (0.05 U/kg i.v. insulin) tolerance test (LP, n = 18; OP, n = 20; LC, n = 19; OC, n = 11).
Results are expressed as mean +/- SEM or median (interquartile range). Fasting plasma glucose levels were similar in the four groups but the plasma glucose area was higher after oral glucose (75 g) in both the lean and obese PCOS groups than in their controls (LC 32.4 +/- 0.7 vs LP 35.2 +/- 1.2, P < 0.01; OC 34.7 +/- 1.8 vs OP 37.8 +/- 1.5 mmol/l/3 h, P < 0.01). Insulin sensitivity was significantly reduced in obese PCOS women (LC 196 +/- 9 vs LP 179 +/- 9, NS; OC 168 +/- 12 vs OP 133 +/- 9 mmol/l/min, P < 0.01). Total serum cholesterol levels were similar in the four groups but HDL2-cholesterol was reduced in both obese and lean PCOS (LC 0.42 (0.38-0.62), LP 0.31 (0.26-0.44), P < 0.05; OC 0.34 (0.21-0.47), OP 0.21 (0.12-0.32) mmol/l, P < 0.01). Total HDL-cholesterol was decreased significantly only in the obese PCOS group. Body mass index correlated significantly and negatively with total HDL-cholesterol and with HDL2-cholesterol levels both within the PCOS group and the control women. Using multiple regression insulin insensitivity contributes significantly beyond BMI to the low HDL-cholesterol in women with polycystic ovaries.
Polycystic ovary syndrome is associated with biochemical risk factors for premature vascular disease, which cannot be explained by obesity alone.
多囊卵巢综合征（PCOS）的特征为高胰岛素血症和胰岛素抵抗。先前关于该综合征脂质异常的报道结果相互矛盾，这可能部分与缺乏对肥胖PCOS女性的适当对照有关。仅有一项研究将脂质水平与胰岛素敏感性相关联。本研究的目的是评估PCOS女性的脂质和脂蛋白，将结果与体重匹配的对照进行比较，并将研究结果与胰岛素分泌和作用指标以及月经史相关联。
一项对一组PCO受试者的胰岛素敏感性和脂质进行的横断面研究，并与体重和种族匹配的对照进行比较。
因此，我们调查了19名瘦型（LP）和55名肥胖型（OP）PCO患者的糖耐量、血浆脂质和脂蛋白，并将结果与22名瘦型（LC）和15名肥胖型（OC）对照女性的结果进行比较。在同一受试者中通过短胰岛素（0.05 U/kg静脉注射胰岛素）耐量试验测量胰岛素敏感性（LP，n = 18；OP，n = 20；LC，n = 19；OC，n = 11）。
结果以均值±标准误或中位数（四分位间距）表示。四组的空腹血糖水平相似，但在口服葡萄糖（75 g）后，瘦型和肥胖型PCOS组的血浆葡萄糖曲线下面积均高于其对照组（LC 32.4±0.7对LP 35.2±1.2，P < 0.01；OC 34.7±1.8对OP 37.8±1.5 mmol/l/3 h，P < 0.01）。肥胖型PCOS女性的胰岛素敏感性显著降低（LC 196±9对LP 179±9，无显著差异；OC 168±12对OP 133±9 mmol/l/min，P < 0.01）。四组的总血清胆固醇水平相似，但肥胖型和瘦型PCOS组的HDL2 - 胆固醇均降低（LC 0.42（0.38 - 0.62），LP 0.31（0.26 - 0.44），P < 0.05；OC 0.34（0.21 - 0.47），OP 0.21（0.12 - 0.32）mmol/l，P < 0.01）。仅肥胖型PCOS组的总HDL - 胆固醇显著降低。体重指数在PCOS组和对照女性中均与总HDL - 胆固醇以及HDL2 - 胆固醇水平显著负相关。使用多元回归分析，胰岛素不敏感性在BMI之外对多囊卵巢女性的低HDL - 胆固醇有显著贡献。
多囊卵巢综合征与早发性血管疾病的生化危险因素相关，这不能仅用肥胖来解释。
