| Objective:The changes of insulin resistance and sensitivity index between patients with polycystic ovary syndrome(PCOS)and women of normal reproductive age were compared by retrospective analysis method: Homeostasis model insulin resistance index(HOMA-IR),quantitative insulin sensitivity detection index(QUICKI),Li Guangwei index,the ratio of fasting glucose to insulin(G/I),Bennett ISI index,the ratio of glucose to insulin area under the OGTT curve,ROC(Receiver Operating Characteristic)curve analysis was carried out to explore the most specific and sensitive indexes for the assessment of insulin resistance in PCOS patients.By comparing the characteristic indexes of obesity between the two groups: body mass index(BMI),waist circumference,hip circumference,waist-to-hip ratio(WHR),glucose metabolism indexes: glucose tolerance test(OGTT)and insulin release test at each time point,insulin,early insulin secretion function(△I30/△G30),glucose disposal index(DI),lipid metabolism indexes:Total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C)and high-density lipoprotein cholesterol(HDL-C)in patients with PCOS,to investigate the characteristics of obesity body type,insulin secretion pattern,blood glucose and lipid changes.Methods:A total of 48 PCOS patients and 21 women of childbearing age were selected from the Department of Endocrinology and Obstetrics and Gynecology of Bethune Hospital in Shanxi Province from December 2019 to December 2020.The diagnosis of PCOS refers to the diagnostic criteria of PCOS for women of childbearing age according to theChinese guidelines for diagnosis and treatment of polycystic ovary syndrome: the necessary condition is oligomenorrhea or amenorrhea or irregular uterine bleeding;one of the following conditions should be met at the same time: clinical manifestation of hyperandrogenism or hyperandrogenemia.Gynecological ultrasonography showed that the number of follicles with a diameter of 2-9mm in one or both ovaries was≥12,and /or the volume of ovary was ≥ 10 ml,and other diseases that might cause hyper androgenism and ovulation abnormality were excluded.The height,weight,blood pressure,waist circumference and hip circumference of the subjects were collected by medical professionals,and the characteristic indexes of obesity were calculated: BMI=weight(kg)/ height(m2),WHR=waist circumference/hip circumference.The differences of obesity characteristic indexes between the two groups were compared.All subjects underwent 75 g OGTT and insulin release test.Fasting blood glucose and insulin were measured by glucose oxidase method and radioimmunoassay at 30 minutes,1 hour,2hours and 3 hours after glucose load,which were recorded as FPG,Glu30,Glu60,Glu120,Glu180 and FINS,Ins30,Ins60,Ins120,Ins180.Insulin resistance and sensitivity index,islet function index and DI were calculated.Insulin resistance index: HOMA-IR = FPG ×FINS / 22.5;Insulin sensitivity index: QUICK=1/(Log FPG+ Log FINS),Li Guangwei index = 1 /(FPG × FINS),Bennett ISI=1/(Log FPG × Log FINS),G/I=FPG/FINS,OGTT curve ratio of glucose area to insulin area [AUC(Glu180/Ins180)] = area under glucose curve [AUC(Glu180)] / area under insulin curve [AUC(Ins180)].Islet function index: basic islet function: HOMA-β = 20 × FINS /(FPG-3.5)early phase islet function:△I30/△G30 =(Ins30-FINS)/(Glu30-FPG);DI= MBCI×IAI;MBCI =(FINS × FPG)/(PG2h + PG1h-7);IAI= 1 /(FPG × FINS).Venous blood samples were taken from all subjects on an empty stomach,and blood lipids such as TC,TG,LDL-C and HDL-C were determined by chemical analysis.Venous blood was collected from the second to fifth day of menstruation,and the serum was collected by centrifugation and stored at-20.The LH/FSH was calculated by radio immunoassay of prolactin(PRL),estrogen(E2),progesterone(Prog),follicle stimulating hormone(FSH),luteinizing hormone(LH)and testosterone(T).All the subjects were examined by Philip HDI-4000 color ultrasound. BMI,WHR,Glu30,Glu60,Glu120,HOMA-β and LDL-C of the two groups accorded with normal distribution,and the above indexes were compared by independent t-test.Waist circumference,hip circumference,FPG,Glu180,FINS,Ins180,insulin resistance and sensitivity index,islet function index,DI,TC,TG,HDL-C and sex hormone index accorded with non-normal distribution.The above indexes were compared by MannWhitney U nonparametric rank sum test.The indexes of insulin resistance and sensitivity were analyzed by ROC curve to explore the most specific and sensitive index for the diagnosis of insulin resistance in patients with PCOS.The difference was statistically significant(P < 0.05).Results:1.Compared with the control group,sex hormone changes in PCOS group:compared with the control group,T,LH and LH/FSH were increased,E2 and PROG were decreased in PCOS group,the difference was statistically significant(P < 0.05).PRL increased and FSH decreased,and the difference was not statistically significant(P > 0.05).T [0.27(0.23,0.35)vs0.76(0.58,0.85)],LH [4.83(3.66,5.76)vs 7.68(5.79,12.44)],LH/FSH [0.781 ± 0.216 vs1.719 ± 1.050] and E2 [60.75(47.51,72.05)vs25.00(22.00,41.04)],Prog [1.36(0.275,5.07)vs0.49(0.40,0.67)],the difference was statistically significant(P < 0.05);PRL [14,13(12.56,14,75)vs 12.51(9.14,22.60)] and FSH [6.36(6.02,6.66)vs 6.29(4.61,7.09)] showed no statistically significant difference(P > 0.05).2.Compared with the control group,changes in BMI,waist circumference,hip circumference,WHR and blood pressure in PCOS group were: compared with the control group,BMI,waist circumference,WHR and SBP in PCOS group were increased,the difference was statistically significant(P < 0.05).There was no significant difference in hip circumference and DBP(P > 0.05).BMI(19.104±3.704 vs 26.534±4.133),waist circumference(81.408(75.622,88.232)vs 88.23(77.235,94.920),WHR(0.786±0.179 vs0.855±0.072)and systolic blood pressure [109(105.5,112.0)vs 120(109.5,124.5)],the difference was statistically significant(P < 0.05).There was no significant difference in hip circumference [107.71(93.510,139.025)vs 101.5(98.0,112.5)] and diastolic blood pressure(75.524±7.393 vs 78.667±10.570)(P > 0.05).3.Changes in insulin resistance,sensitivity index,blood glucose and insulin secretion pattern in the PCOS group:(1)Compared with the control group,changes in insulin resistance and sensitivity index of the PCOS group: compared with the control group,the insulin resistance index HOMA-IR of the PCOS group was increased,and the insulin sensitivity index was: G/I,Bennett ISI,Li Guangwei index,QUICKI and AUC(Glu180/Ins180)decreased,and the differences were statistically significant(P < 0.05).HOMA-IR [1.714(1.255,2.075)vs3.508(2.294,4.925)],G/I [0.59(0.495,0.655)vs 0.34(0.2375,0.465)],AUC(Glu180/Ins180)[0.17(0.11,0.36)vs 0.12(0.08,0.15)],Bennett ISI [1.621(1.470,1.936)vs 1.198(1.072,1.419)],Li Guangwei Index [0.026(0.021,0.036)vs 0.013(0.009,0.019)],QUICKI [0.352(0.342,0.370)vs 0.317(0.303,0.337)] there were statistically significant differences(P < 0.05).(2)Compared with the control group,the changes of blood glucose and insulin secretion pattern in PCOS group: Compared with the control group,FINS,Ins60,Ins120 and Ins180 in PCOS group were increased,with statistical significance(P < 0.05).FPG,Glu30,Glu60,Glu120 and Glu180 increased blood glucose,and the differences were not statistically significant(P > 0.05).FINS [ 8.32(6.570,9.285)vs 15.4(10.310,24.825)],Ins60 [49.65(75.700,95.035)vs 82.8(58.1225,120)],Ins120 [ 38.66(15.165,79.760)vs73.8(44.275,105.375)] and Ins180 [ 24.01(8.355,39.57)vs 56.6(22.2,67.475)] were statistically significant(P < 0.05).FPG [4.81(4.14,5.10)vs 5.055(4.608,5.375)],Glu30(6.117±1.603 vs 6.649±1.342),Glu60(7.112±1.162 vs 7.868±1.571)、Glu120(6.075±1.345 vs 6.755±1.310)、Glu180[ 5.11(4.365,6.475)vs 5.715(5.03,6.14)].There was no significant difference(P > 0.05).4.Value analysis of PCOS insulin resistance reflected by different insulin resistance indexes: HOMA-IR,QUICKI and Li Guangwei index showed the best value of PCOS insulin resistance(AUC=0.820)among different insulin resistance indexes.5.Compared with the control group,changes in blood lipid in PCOS group: compared with the control group,TG and LDL-C in PCOS group were increased,the difference was statistically significant(P < 0.05);There was no statistical significance in the increase of TC and the decrease of HDL-C(P > 0.05).TG [0.79(0.600,0.935)vs S1.46(0.710,1.795)] and LDL-C(1.496±0.264 vs 2.736±0.856)were significantly different(P < 0.05).There was no statistical significance in TC [4.36(3.950,4.690)vs4.595(3.4225,5.5975)] and HDL-C [1.94(1.475,2.275)vs 1.33(1.220,2.035)](P > 0.05).Conclusion:1.Most patients with PCOS were associated with insulin resistance.Among v arious insulin resistance and sensitivity indexes,HOMA-IR,QUICKI and Li Guan gwei indexes showed that PCOS patients had the best insulin resistance and sensit ivity.2.Under the condition of normal blood glucose in PCOS patients,insulin secr etion has been compensatory increased.3.PCOS patients may be accompanied by abnormal lipid metabolism,which i s mainly characterized by increased TG and LDL,which is closely related to insu lin resistance.4.PCOS patients are often accompanied by obesity,mostly with increased wai st circumference and WHR,and the body type is mainly characterized by central obesity. |
