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 heMthy women and 85 PCOS patients were underwent adrenocortieptropic 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 pmgestin (P) were tested by radioimmunoassay method.17-hydroxy-progesterone (17-OHP),dehydroepiandros-teronesulfate (DHEAS) and andmsterone (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 of assessment 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-PCOS group.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,Pχ2=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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