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目的:通过不同糖代谢状态多囊卵巢综合征(PCOS)患者胰岛素曲线变化特点，分析PCOS患者糖代谢特点。方法:回顾1 212例PCOS患者临床信息、血清激素、血脂水平及葡萄糖耐量试验、胰岛素释放试验。根据血糖水平分为血糖正常、糖调节受损、2型糖尿病组，比较组间差异及糖代谢特点。以是否有糖代谢异常为因变量，进行n logistic回归分析，并分别按游离雄激素指数(FAI)、性激素结合球蛋白(SHBG)四分位数将PCOS患者平均分为4个亚组，分析PCOS患者糖代谢影响因素。n 结果:1 212例患者中，血糖正常者占70.87%(859/1 212)，糖调节受损者占23.60%(286/1 212)，2型糖尿病者占5.53%(67/1 212)；血糖正常PCOS者的胰岛素曲线变化虽与正常人相似，但胰岛素180 min值显著高于正常水平，且稳态模型评估的胰岛素抵抗指数(HOMA-IR)显著升高。糖调节受损、2型糖尿病者各时相胰岛素水平均显著高于血糖正常者，并出现胰岛素高峰延迟。糖调节受损、2型糖尿病者总睾酮、FAI水平显著高于血糖正常者，SHBG显著低于血糖正常者。n Logistic回归分析显示，SHBG(n OR＝1.007，95%n CI 1.000～1.014, n P＝0.045)和FAI(n OR＝1.106，95%n CI 1.032～1.186, n P＝0.004)是影响PCOS患者糖代谢的独立危险因素。分别以FAI和SHBG四分位水平将患者各分为4个亚组，结果显示各时相血糖、胰岛素、HOMA-IR、稳态模型评估的胰岛β细胞功能指数、血糖曲线下面积、胰岛素曲线下面积与FAI值呈正相关，与SHBG呈负相关。FAI高四分位数组、SHBG低四分位数组的血糖曲线变化与糖调节受损者相似，胰岛素曲线变化与2型糖尿病组相似。n 结论:糖耐量正常的PCOS患者也普遍存在胰岛素抵抗。高水平的FAI或低水平的SHBG可作为PCOS患者糖代谢异常的预测指标。“,”Objective:Characteristics of glucose metabolism in polycystic ovary syndrome(PCOS)women were analyzed through the insulin release curve according to plasma glucose categories.Methods:The clinical information, serum hormones, lipid level, glucose tolerance test, insulin release test of 1 212 PCOS women were reviewed. The PCOS women were divided into 3 groups: normal blood glucose, impaired glucose regulation, and type 2 diabetes mellitus according to plasma glucose categories to compare the differenc and glucose metabolism characteristics. The influencing factors of glucose metabolism in PCOS patients were analyze by a binary logistic regression model with or without abnormal glucose metabolism as the dependent variable. Furthermore, all patients were divided into 4 subgroups according to quartiles of free androgen index(FAI)and sex hormone binding globulin(SHBG).Results:Of the 1212 subjects enrolled, 70.87%(859)had normal blood glucose, 23.60%(286)were with impaired glucose regulation, and 5.53%(67)were with type 2 diabetes. Though the insulin curve was similar to that of normal people in normal blood glucose PCOS women, their 180 min insulin were significantly higher than the normal level and homeostasis model assessment for insulin resistance(HOMA-IR)was significantly increased. The insulin levels of different times in impaired glucose regulation and type 2 diabetic women were significantly higher than those with normal blood glucose, and the insulin peak was delayed. The levels of total testosterone and FAI in impaired glucose regulation, type 2 diabetes subjects were significantly higher than those with normal blood glucose, and SHBG was significantly lower than that in normal blood glucose individuals. Logistic regression analysis showed that SHBG(n OR=1.007, 95%n CI 1.000-1.014, n P=0.045)and FAI(n OR=1.106, 95%n CI 1.032-1.186, n P=0.004)were independent risk factors for glucose metabolism in PCOS patients. Glucose and insulin levels, HOMA-IR, homeostasis model assessment for β cell function, area under the glucose curve, area under the insulin curve were positively correlated with FAI and negatively correlated with SHBG. The glucose curves in the high quartile of FAI and the low quartile of SHBG were similar to that in the impaired glucose regulation, and the insulin curves were similar to those in the type 2 diabetes.n Conclusions:Insulin resistance is also common in PCOS patients with normal glucose tolerance. High level of FAI or low level of SHBG can be used as predictors of abnormal glucose metabolism in PCOS women.