Abnormal Glucose And Lipid Metabolism In PCOS Patients And Its Correlation With Insulin Resistance

BackgroundPolycystie Ovary Syndrome(PCOS)is a common endocrine disease among female population in the world.It is closely related to the disorder of metabolism and reproductive endocrinology.PCOS is the main reason leading to infertility,whose incidence is 5%-10%in women of childbearing age.The clinical symptoms usually manifested as irregular menstrual cycle,body fat,body hairy,facial acne,acanthosis nigrunm,infertility,hair loss and so on.The main features of the disease were ovulation disorders or loss,hyperandrogenism,insulin resistance.ObjectiveDetect theabnormal glucose and lipid metabolism and insulin resistance in patients with PCOS,and to explore the relationship between glucose and lipid metabolism in PCOS patients and its relationship with insulin resistance.Research methodsTo collect the information about 205 patients with PCOS,through a retrospective analysis method,analysis of their glucose and lipid metabolism,the details are as follows:1.Ask the patient to visit the cause and history of treatment,including the initial menstrual age,whether marriage,menstrual disorders and its possible cause of the cause,whether the family history.2.Patient physical examination:including height,weight,hip circumference,waist circumference,blood pressure.3.The levels of triglyceride(TG),total cholesterol(TC),low density lipoprotein cholesterol(LDL-C)and high density lipoprotein cholesterol(HDL-C)in patients were measured by fasting venous blood in the morning.4.B ultrasound examination of patients with uterus and ovaries:the patient pelvic B-ultrasound,observation and record the number of bilateral follicles,oocyst volume and uterine volume.5.Oral glucose tolerance test and insulin release test to detect fasting blood glucose,1h blood glucose,2h blood glucose levels and fasting insulin,1h insulin,2h insulin levels.6.Patient grouping:(1)According to the level of blood glucose concentration,the patients were divided into normal group and impaired glucose tolerance group.The differences between the two groups were compared.The patients were divided into seve al groups according to BMI and age stratification.Abnormal differences in theproportion of patients.(2)According to the level of blood lipid levels,the patients were divided into normal group and dyslipidemia group.The differences between the two groups were compared.The patients were divided into several groups according to BMI and age stratification.The patients with dyslipidemia The difference in proportion.(3)Patients were divided into insulin resistance group and non-insulin resistance group according to HOMA-IR score.There was a significant difference in the proportion of patients with dyslipidemia and abnormal glucose tolerance between the two groups.And to analyze the possible correlation between HOMA-IR and each index.7.Statistical processingThe data were analyzec by SPSS 19.0.The data were expressed as the mean ±standard deviation.The count data were expressed as the percentage.The comparison between the groups was analyzed by one-way ANOVA.When there were differences between groups,L-SD or KW were used for comparison.Data were analyzed by chi-square test,and Pearson correlation analysis,test level a = 0.05,P<0.05 that the difference was statistically significant.Results1.PCOS patients with glucose tolerance test resultsAmong the 205 patients,74.4%(152/205)were patients with NGT and 21.46%(44/205)in IGT,among which DM accounted for 4.39%(9/205)and 6.3%of patients with fasting glucose 205),fasting blood glucose was associated with IGT accounted for 2.9%(5/205),impaired fasting glucose associated with NGT accounted for 3.4%(4/205).2.Comparison of Relative Indexes of Normal Glucose Tolerance and Abnormal Glucose Tolerance in PCOS PatientsPatients with impaired glucose tolerance had significant differences in age,BMI,waist-to-hip ratio,insulin resistance index(HOMA-IR),fasting insulin(FINS),I hour insulin(1h-INS),2 hours insulin(2h-INS)(t= 2.985 p = 0.010;t = 4.447p = 0.000;t=2.166 p = 0.038;t = 3.585 p = 0.003;t = 2.789 p= 0.015;t= 2.619 P = 0.021;(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C)and high density lipids(LDL-C)were significantly higher than those in the control group(P<0.05)There was no significant difference in the concentration of protein cholesterol(HDL-C)(t =1.963 p = 0.069;t = 1.085 p = 0.296;t = 0.573 p = 0.575;t = 0.728 p = 0.477).3.Analysis of IGT in PCOS patients by BMI stratificationIn this study,205 patients with PCOS were divided into 5 groups with BMI ranging from 13.17%(27/205)in the range of(-?,18)according to the age range,among which NGT accounted for 74.08%(20/27),IGT accounted for 25.92%(7/27);BMI in the range of[18,23]patients accounted for 47.80%(98/205),of which NGT accounted for 84.70%(83/98),IGT accounted for 15.30%(20/33),IGT accounting for 27.27%(9/33);BMI in the range of[23,25]in the range of.[23,25](18/25),IGT accounted for 32.00%(8/25);patients with BMI in the range of[28,+ ?)accounted for 10.73%of the patients%(22/205),of which NGT accounted for 36.37%(8/22),IGT accounted for 63.63%(14/22).The difference between the two groups was statistically significant(X2= 10.879,P = 0.031).4.Analysis of impaired glucose tolerance in PCOS patients by age stratification205 cases of PCOS patients,according to the different age range will be divided into live groups.There were 5.37%(11/205)of patients aged 16 to 20,of which NGT accounted for 100%(11/11),IGT was 0%(0/11);patients with age between 21 and 25 Accounting for 21.95%(45/205),of which NGT accounted for 80%(36/45),IGT accounted for 20%(9/45);age between 26 to 30 patients accounted for 44.88%(92/205),of which NGT accounted for 69.57%(64/92),IGT accounted for 30.43%(28/92);age between 31 and 35 patients accounted for 21.95%(45/205),of which NGT accounted for 75.55%(34/45)IGT accounted for 24.45%(11/45);5.85%(12/205)were older than 36 years old,among which NGT accounted for 58.34%(7/12)and IGT accounted for 41.66%(5/12).The difference between the two groups was statistically significant(X2 = 12.683,p= 0.017).5.PCOS patients with abnormal lipid metabolismIn 205 patients with PCOS,the abnormal lipid metabolism was 17.56%(36/205),and TC increased 3.41%(7/205);TG increased 4.87%(10/205);LDL-C increased 2.43%(5/205);HDL-C decreased by 10.73%(22/205).6.Comparison of relative indexes of patients with fatty metabolism and abnormal patients in PCOS patientsPatients with abnormal lipid metabolism were significantly higher than those with normal lipid metabolism in BMI,waist-hip ratio,systolic blood pressure,diastolic blood pressure,insulin resistance index and fasting insulin(t=2.270,P=0.039;t=3.421,P=0.004;t=3.501,P=0.003;t=2.927,P=0.011;t=3.364,P=0.003;t=4.323,P=0.000).There vas no significant differencein fasting blood glucose,1h blood glucose,2h blood glucose,1 hour insulin 1h-INS),2-hour insulin(2h-INS)(t=0.849,P=0.193;t=1.630,P=0.122;t=1.818,P=0.090;t=2.207,P=0.054;t= 0.326,P=0.747;t=0638,P=0.197).7.Analysis of Abnormal Lipid Metabolism in PCOS Patients by BMI StratificationIn 205 patients with PCOS,the percentage of BMI in the(-?,18)interval was 100%(27/27)and the lipid metabolism was 0%(0/27).The BMI was in the range of[18,(84/98),lipid metabolism was 14.28%(14/98);BMI in the range of[23,25]in patients with normal lipid metabolism accounted for 84.84%(28/65),lipid metabolism abnormalities accounted for 15.16%(5/33);BMI range in the[25,28]interval of patients with normal lipid metabolism accounted for 64.00%(16/25),abnormal lipid metabolism accounted for 36.00%(9/25);BMI in the range of[28,+?)in patients with normal lipid metabolism accounted for 63.64%(14/22),abnormal lipid metabolism accounted for 36.36%(8/22).The difference between the two groups was statistically significant(X2 = 11.237,P = 0.020).The difference between the two groups was statistically significant(X2 = 11.237,P = 0.020).8.Analysis of Abnormal Lipid Metabolism in PCOS Patients by Age StratificationIn 205 cases of PCOS patients,the age of 16 to 20 patients in the normal lipid metabolism accounted for 72.73%(8/11),lipid metabolism abnormalities accounted for 27.27%(3/11);age between 21 to 25(37/45),lipid metabolism abnormalities accounted for 17.78%(8/45);age of 26 to 30 patients in the normal lipid metabolism accounted for 83.70%(77/92),the proportion of lipid metabolism in the patients accounted for 82.22%Abnormal lipid metab(?)lism accounted for 16.30%(15/92);age in 31 to 35 patients between the normal lioid metabolism accounted for 71.11%(32/45),lipid metabolism was 28.89%(13/45);older than 36-year-old patients with normal lipi(?)metabolism accounted for 75.00%(9/12),lipid metabolism accounted for 25.00%(3/12).There was no statistically significant difference between the two groups(X2 = 4.689,P = 0.438).9.Analysis of factors related to PCOS in patients with insulin resistanceIn 205 cases of PCOS patients,IR accounted for 28.78%(59/205).Among them,the proportion of patients with elevated triglyceride(TG)concentration,the incicdence of abnormal lipid metabolism and the incidence of impaired glucose tolerance were significantly higher in IR group than in non-insulin resistant group(X2=4.569,P=0.035;X2=6.899,P=0.010;X2=9.505,P=0.005);(LDL-C)and high-density lipoprotein cholesterol(HDL-C)in the two groups were significantly higher than those in the control group(X2 = 0.165,P = 0.900;X2 = 0.598,P = 0.307;X2 = 1.771,P = 0.376),the difference was not statistically significant(P<0.05).10.The correlation between insulin resistance index and each indexThere was a significant positive correlation between insulin resistance index(HOMA-IR)and fasting blood glucose,1 h blood glucose,2h blood glucose,glucose tolerance,TC,triglyceride(TG)and low density lipoprotein cholesterol(LDL-C)=0.407,P ? 0.001;R = 0.298,P = 0.000;R = 0.439,P = 0.000;R = 0.302,P = 0.001;R = 0.478,,P = 0.001;R = 0.225,P = 0.001).At the same time,it had a significant negative correlation with HDL-C(R=-0.271,P = 0.000).Conclusion1.The proportion of IGT in PCOS which was related to age and body weight.The incidence of IGT was higher in middle-aged patients than in young patients,and the incidence of IGT was higher than that of weight less than those with weight.Therefore,in the clinical diagnosis of PCOS IGT to be detected,especially for older and severe body weight.2.PCOS patients with abnormal lipid metabolism,its occurrence and no significant correlation with age,but with the increase in body weight,therefore,clinically for PCOS patients with excessive weight should not only pay attention to blood glucose monitoring,Also pay attention to blood lipid examination.3.There was a positive correlation between IR and PCOS in blood glucose,TC,TG,LDL-C and glucose and lipid metabolism,and negatively correlated with HDL-C concentration.Therefore,IR was the direct and underlying cause of PCOS glucose and lipid metabolism disorder,In the clinical treatment of PCOS,not only direct use of hypoglycemic and lipid-lowering drugs,but also pay attention to the control of IR,in order to achieve the purpose of controlling blood glucose and lipid levels.