高婧，周莉，陈慧，陈晨



·论著·

糖耐量正常的多囊卵巢综合征患者糖脂代谢情况分析

高婧，周莉，陈慧，陈晨

目的：探讨糖耐量正常的多囊卵巢综合征（PCOS）患者糖脂代谢情况。方法：对144例根据鹿特丹标准诊断的PCOS患者进行口服葡萄糖耐量试验（OGTT）和胰岛素释放试验（IRT），月经正常的女性100例作为对照组。结果：与正常对照组相比，PCOS患者0，30，60，180min的血糖和血胰岛素水平、稳态模型胰岛素抵抗指数（HOMA-IR）、胰岛β细胞功能指数（HOMA-β）及血糖和血胰岛素曲线下面积显著增高（P＜0.05），此外血脂参数中三酰甘油（TG）、胆固醇（TC）及低密度脂蛋白胆固醇PCOS组高于对照组，高密度脂蛋白胆固醇低于对照组；根据体质量指数（BMI）对糖耐量正常的PCOS组进行分组分析，发现肥胖组（BMI≥25 kg/m2）糖脂代谢能力仍低于非肥胖组（BMI＜25 kg/m2）：肥胖组0，60，120，180 min血糖和血胰岛素水平、HOMA-IR、HOMA-β及TG均高于非肥胖组（P＜0.05）。结论：对糖耐量正常的PCOS患者建议应常规进行OGTT和IRT观察血糖和血胰岛素分泌情况，从而筛查出糖耐量正常但存在胰岛素抵抗的患者，给予早期干预。对糖耐量正常的肥胖PCOS患者，应更加积极地检测并随访其胰岛素、血脂水平。

多囊卵巢综合征；葡糖耐量试验；血糖；胰岛素；胰岛素抗药性

【Abstract】Objective:To investigate the glucose and lipid metabolism indexes in patients with normal glucose tolerance and polycystic ovary syndrome（PCOS）.M ethods：PCOS was diagnosed according to the Rotterdam Criterion.One hundred and forty-four patients with PCOS undertaken the oral glucose tolerance test （OGTT）and the insulin release test（IRT）.One hundred healthy women with normalmenstrual cycle served as the control group.Results：Compared with the control group，PCOS patients with normal glucose tolerance had a higher BMI，higher serum glucose and insulin levels at 0，30，60 and 180min in OGTT and IRT，higher levels of HOMA-IR and HOMA-β，and the increased area under curves（AUCs）of glucose and insulin（P＜0.05）. Additionally，the subgroup analysis was employed based on BMI.In PCOS patients with normal glucose tolerance，the obese subgroup（BMI≥25 kg/m2）had higher serum glucose and insulin levels at 0，60，120 and 180min in OGTT and IRT，higher levels of HOMA-IR and HOMA-β，and the increased level of TG when compared with the non-obese subgroup（P＜0.05），which indicated that the ability of glucose and lipid metabolism in those obese PCOS patientswas still impaired though they were with normal glucose tolerance after OGTT.Conclusions：OGTT and IRT should be routinely suggested for those PCOS patients with normal glucose tolerance so as to find the potential insulin resistence and to intervent early.For those obese PCOS patientswith normal glucose tolerance，it should be advised to check actively the levels of insulin and serum lipid and to have termly the follow-up visit.

【Keywords】Polycystic ovary syndrome；Glucose tolerance test；Blood glucose；Insulin；Insulin resistance

（JIntReprod Health/Fam Plan，2016，35：285-288）

多囊卵巢综合征（polycystic ovary syndrome，PCOS）是青春期及育龄期女性最常见的妇科内分泌疾病，在我国不孕群体中PCOS的患病率为30%～40%［1］。在临床上以雄激素过高的临床或生化表现、持续无排卵或者稀发排卵、卵巢多囊改变为特征，并常伴有不同程度的糖脂代谢异常［2］。目前认为糖代谢紊乱的根本原因是胰岛素抵抗（insulin resistance，IR），而约50%～70%的PCOS患者存在IR［3］。……