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目的探讨多囊卵巢综合征(polycystic ovary syndrome,PCOS)、胰岛素抵抗及代谢综合征(metabolicsyndrome,MS)的关系。方法临床收集101例PCOS患者的血糖、胰岛素、血脂、性激素等指标,按稳态模型(HOMA)计算胰岛素抵抗指数(HOMA-IR),依照4个不同的标准美国国家胆固醇教育计划成人治疗方案第三次报告(ATPⅢ)(2005年)、国际糖尿病联盟(IDF)(2005年)、中华医学会糖尿病学分会(CDS)(2004年)和《中国成人血脂异常防治指南》制定联合委员会(JCDCG)(2007年),计算PCOS患者中MS的发生率。并将患者分为PCOS伴MS和PCOS不伴MS两组就相关指标进行比较。结果①根据ATPⅢ(2005)I、DF(2005)、CDS(2004)、JCDCG(2007)MS诊断标准,PCOS中MS的发病率分别为45.5%、43.6%、31.7%、32.7%。②PCOS伴MS和PCOS不伴MS的患者临床指标的比较:在年龄、腰围、腰臀比(WHR)、收缩压、空腹血糖(FBG)、胰岛分泌指数(HOMA-β)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、黄体激素(LH)、卵泡刺激素(FSH)、雌二醇(E2)、睾酮(T)、泌乳素(PRL)方面,两组差异无统计学意义;在体质量指数(BMI)、舒张压、餐后2小时血糖(PBG)、空腹胰岛素、餐后2小时胰岛素、甘油三酯(TG)、血尿酸方面,PCOS伴MS较PCOS不伴MS显著升高,在HOMA-IR则显著降低,差异有统计学意义。结论按照MS的4个定义ATPⅢ(2005)I、DF(2005)、CDS(2004)J、CDCG(2007)标准,PCOS患者中均有较高的MS的患病率。PCOS伴MS患者存在较明显的胰岛素抵抗,肥胖尤其是腹型肥胖与MS、胰岛素抵抗密切相关。
Objective To investigate the relationship between polycystic ovary syndrome (PCOS), insulin resistance and metabolicsyndrome (MS). Methods Blood glucose, insulin, blood lipids and sex hormones were collected from 101 patients with PCOS. HOMA-IR was calculated according to HOMA. According to 4 different criteria, the American National Cholesterol Education Program Adult Treatment Program No. The third report (ATP III) (2005), the International Diabetes Federation (IDF) (2005), the Chinese Society of Diabetes Mellitus (CDS) (2004) and the Joint Committee for the Development of Guidelines for the Prevention and Treatment of Dyslipidemia in Chinese Adults (JCDCG) (2007) to calculate the incidence of MS in patients with PCOS. And the patients were divided into PCOS with MS and PCOS without MS two groups to compare the relevant indicators. Results ① According to diagnostic criteria of ATPⅢ (2005), DF (2005), CDS (2004) and JCDCG (2007) MS, the incidence of MS in PCOS was 45.5%, 43.6%, 31.7% and 32.7%, respectively. ②Comparison of clinical indexes between PCOS with MS and PCOS without MS: There was no significant difference in age, waist circumference, WHR, systolic blood pressure, fasting blood glucose (FBG), insulin secretion index (HOMA-β), total cholesterol , LDL-C, HDL-C, LH, FSH, E2, T and prolactin (PRL), there was no significant difference between the two groups. The body mass index (BMI), diastolic blood pressure, 2-hour postprandial blood glucose (PBG), fasting insulin, 2-hour postprandial insulin, triglyceride In uric acid, PCOS with MS was significantly higher than PCOS without MS and significantly lower with HOMA-IR, the difference was statistically significant. Conclusions The prevalence of MS in PCOS patients is higher according to the four definitions of MSM ATP Ⅲ (2005) I, DF (2005), CDS (2004) J and CDCG (2007). PCOS patients with MS more obvious insulin resistance, obesity, especially abdominal obesity and MS, insulin resistance are closely related.