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目的探讨超重与多囊卵巢综合征(polycystic ovarian syndrome,PCOS)患者的内分泌指标和胰岛素抵抗的相关性,为PCOS的临床防治提供指导和依据。方法选取体质量指数(body mass index,BMI)>23 kg/m2的115例PCOS患者作为研究对象,并依据四分位法分为q1、q2、q3和q4四个区间,30例BMI位于18.5~23.0 kg/m2的PCOS患者作为对照组。比较对照组和四分位区间的内分泌指标[雌二醇(E2)、总睾酮(T)、黄体生成素(LH)、卵泡刺激素(FSH)和催乳素(PRL)]和代谢指标[空腹葡萄糖(FPG)、空腹胰岛素(FINS)和稳态模型胰岛素抵抗指数(HOMA-IR)],采用logistic回归分析体重与T和HOMA-IR的关系。结果 q1、q2、q3和q4四个区间的BMI范围分别为<24.30 kg/m2、>24.30~25.51 kg/m2、>25.51~26.53 kg/m2和>26.53 kg/m2。对照组与BMI四个区间的FSH比较差异均无统计学意义(P>0.05);对照组的E2、LH和PRL与BMI四个区间比较,差异均具有统计学意义(P<0.05),但BMI的q1、q2、q3和q4四个区间的E2、LH和PRL比较差异均无统计学意义(P>0.05);对照组的T与BMI四个区间比较及BMI的q1、q2、q3和q4四个区间的T比较差异均具有统计学意义(P<0.05)。对照组与BMI的q1、q2、q3和q4四个区间的FPG、FINS和HOMA-IR比较差异均具有统计学意义(P<0.05),BMI的q1、q2、q3和q4四个区间的FPG、FINS和HOMA-IR比较差异均具有统计学意义(P<0.05)。较<24.30 kg/m2,>24.30~25.51 kg/m2、>25.51~26.53 kg/m2和>26.53 kg/m2三个区间的T水平分别增加1.65(95%CI 1.33~2.05)、2.51(95%CI 1.84~3.52)和4.25(95%CI 2.16~8.36),HOMA-IR分别增加1.68(95%CI 1.41~2.00)、2.65(95%CI 1.68~4.18)和4.45(95%CI 2.57~7.74)。结论超重的PCOS患者的雄激素浓度更高、胰岛素抵抗更为严重。
Objective To investigate the relationship between endocrine markers and insulin resistance in patients with overweight and polycystic ovarian syndrome (PCOS) and provide guidance and evidence for clinical prevention and treatment of PCOS. Methods A total of 115 PCOS patients with a body mass index (BMI)> 23 kg / m2 were selected as the study subjects and divided into four intervals of q1, q2, q3 and q4 according to the quartile method. The BMI of 30 patients was 18.5 ~ 23.0 kg / m2 of PCOS patients as a control group. The levels of endocrine (estradiol, total testosterone, LH, FSH and PRL) and metabolic indices (fasting (FPG), fasting insulin (FINS) and homeostasis model insulin resistance index (HOMA-IR). Logistic regression was used to analyze the relationship between body weight and T and HOMA-IR. Results The BMI ranges of q1, q2, q3 and q4 were <24.30 kg / m2,> 24.30-25.51 kg / m2,> 25.51-26.53 kg / m2 and> 26.53 kg / m2 respectively. There were no significant differences in the FSH between the control group and the BMI (P> 0.05). The differences of E2, LH, PRL and BMI in the control group were statistically significant (P <0.05) There were no significant differences in E2, LH and PRL between the four ranges of q1, q2, q3 and q4 in BMI (P> 0.05); the comparison of T and BMI in control group and q1, q2, q3 and q4 four intervals T were statistically significant differences (P <0.05). There were significant differences in FPG, FINS and HOMA-IR between q1, q2, q3 and q4 in the control group and BMI (P <0.05), FPG in the four ranges of q1, q2, q3 and q4 of BMI , FINS and HOMA-IR differences were statistically significant (P <0.05). T levels increased by 1.65 (95% CI 1.33 ~ 2.05) and 2.51 (95% CI) in the three ranges of <24.30 kg / m2,> 24.30-25.51 kg / m2,> 25.51-26.53 kg / m2 and> 26.53 kg / HOMA-IR increased by 1.68 (95% CI 1.41-2.00), 2.65 (95% CI 1.68-4.18) and 4.45 (95% CI 2.57-7.74), respectively, from 1.84 to 3.52 and 4.25 (95% CI 2.16 to 8.36) . Conclusions Overweight patients with PCOS have higher androgen concentrations and more severe insulin resistance.