多囊卵巢综合征患者肾上腺雄激素水平与胰岛素抵抗的关系

The relationship of adrenal androgen level and insulin resistance in polycystic ovary syndrome patients

    摘要
  • 摘要:
    目的 探讨多囊卵巢综合征（PCOS）患者肾上腺源性雄激素水平与胰岛素抵抗的关系。
    方法 对22名正常女性和85例PCOS患者行促肾上腺皮质激素（ACTH）兴奋试验，将PCOS患者分为高反应组（HR-PCOS）和正常反应组（NR-PCOS）。用放射免疫分析法检测血清促黄体生成素与卵泡刺激素（LH/FSH）比值、雌二醇、睾酮、孕酮，测定ACTH兴奋试验前后（0 min和60 min）血清17-羟孕酮（17-OHP）、硫酸脱氢表雄酮（DHEAS）、雄烯二酮（AD）、皮质醇，测定稳态模型下胰岛素抵抗指数（HOMA-IR），测量体质量指数（BMI）、腰臀围比。
    结果 在85例PCOS患者中，有20例的17-OHP水平高于正常，为HR-PCOS组，其余65例反应正常，为NR-PCOS组。基本情况比较: HR-PCOS组和NR-PCOS组的MBI及腰臀围比均显著高于对照组（MBI：χ2=13.874，14.512, 腰臀围比：χ2＝12.607, 15.153，P均 < 0.05），HR-PCOS组和NR-PCOS组间差异无统计学意义（χ2=4.801, 5.362，P > 0.05）；激素水平比较：HR-PCOS组和NR-PCOS组的LH/FSH比值、雌二醇显著高于对照组（LH/FSH：χ2=18.226, 16.327, 雌二醇：χ2＝17.334，19.261，P均 < 0.01），HR-PCOS组和NR-PCOS组间差异无统计学意义；HR-PCOS组血清总睾酮显著高于NR-PCOS组（χ2=12.274，P < 0.05），HR-PCOS组和NR-PCOS组均高于对照组（χ2=20.314，18.492，P均 < 0.01）；ACTH兴奋试验前后HR-PCOS组17-OHP和DHEAS显著高于NR-PCOS组和对照组（17-OHP：χ2=18.063, 19.214, DHEAS：χ2＝17.358, 19.355，P均 < 0.01），而NR-PCOS组与对照组间差异无统计学意义（χ2=4.109, 4.362，P均 > 0.05）；AD在ACTH兴奋试验前后HR-PCOS组和NR-PCOS组均高于对照组（χ2=14.062，16.549，P均 < 0.05），而HR-PCOS组和NR-PCOS组间差异无统计学意义（χ2=5.541，P > 0.05）；血清皮质醇在ACTH兴奋试验前后各组间差异无统计学意义；HR-PCOS组和NR-PCOS组的HOMA-IR均显著高于对照组（χ2=19.263，21.482，P均 < 0.01），且HR-PCOS组显著高于NR-PCOS组（χ2=13.582，P均 < 0.05）。
    结论 部分PCOS患者存在肾上腺雄激素亢进并对ACTH反应性增强，其肾上腺雄激素的水平可能与胰岛素抵抗有关。

     

    Abstract:
    Objective To investigate the relationship between adrenal androgen level and insulin resistance in polycystic ovary syndrome(PCOS)patients.
    Method Twenty-two healthy women and 85 PCOS patients were underwent adrenocorticptropic hormone(ACTH)stimulation test, and 85 PCOS patients were divided into high response-polycystic ovary syndrome(HR-PCOS)group and normal response-polycystic ovary syndrome(NR-PCOS)group.The ratio of serum luteinizing hormone to follicle stimulating hormone(LH/FSH), estradiol(E2), testosterone(T)and progestin(P)were tested by radioimmunoassay method.17-hydroxyprogesterone(17-OHP), dehydroepiandros-teronesulfate(DHEAS)and androsterone(AD)was tested at 0 and 60 min after an ACTH stimulation test.Body mass index(BMI), waist-to-hip-circumference radio(WHR)and homeostasis modes ofassessment for insulin resistence index(HOMA-IR)were also measured.
    Results There were 20 cases that 17-OHP levels were higher than normal(HR-PCOS), the other 65 cases were NR-PCOSgroup.MBI and WHR(MBI: χ2=13.874, 14.512, WHR: χ2=12.607, 15.153, P all < 0.05)of HR-PCOS group and NR-PCOS group were significantly higher than control group, but there had no significant difference between the two PCOS groups(χ2=4.801, 5.326, P all > 0.05).HR-PCOS group and NR-PCOS group were significantly higher than the control group for LH/FSH and estradiol(LH/FSH: χ2=18.226, 16.327, E2: χ2=17.334, 19.261, P all < 0.05), but there had no significant difference between the two PCOS groups.Serum T of HR-PCOS group was significantly higher than control group(χ2=12.274, P < 0.01), HR-PCOS group and NR-PCOS group were higher than control group(χ2=20.314, 18.492, P all < 0.01).17-OHP and DHEAS of HR-PCOS group were significantly higher than NR-PCOS group and control group before and after ACTH stimulation test(17-OHP: χ2=18.063, 19.214, DHEAS: χ2=17.358, 19.355, P all < 0.01).But there had no differences between NR-PCOS group and control group(χ2=4.109, 4.362, P all > 0.05).AD of HR-PCOS group and NR-PCOS group were higher than control group before and after the ACTH stimulation test(χ2=14.062, 16.549, P all < 0.05).However, there had no differences(χ2=5.541, P > 0.05)between the two PCOS groups.Serum cortisol was no difference between HR-PCOS, NR-PCOS and control groups before and after stimulation test.HOMA-IR of HR-PCOS group and NR-PCOS group were higher than control group(χ2=19.263, 21.482, P all < 0.01), and HR-PCOS group is higher than NR-PCOS group(χ2=13.582, P < 0.05).
    Conclusions There have significantly higher basal and ACTH-stimulated level of adrenal androgen hyperresponsiveness in PCOS patients.Adrenal androgen level appears to be closely associated with insulin resistance in PCOS patients.

     

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