瘦素与妊娠期糖尿病胰岛素抵抗的关系

目的　探讨瘦素与妊娠期糖尿病 (GDM)胰岛素抵抗 (IR)关系及在GDM发病机制中的作用。方法　应用放射免疫法测量 32例GDM妇女、 30例正常糖耐量妊娠妇女 (NGT)的空腹瘦素、C肽水平及空腹胰岛素和 75g葡萄糖耐量试验 (OGTT)后 2h的胰岛素水平。应用稳态模型胰岛素抵抗指数 (HOMA -IR)及胰岛分泌功能指数 (HBCI) ,比较两组HOMA -IR及HBCI的差异 ,分析两组空腹瘦素与IR之间的关系。结果　①GDM组HOMA -IR (2 3± 0 3)高于NGT组 (1 4± 0 4 ) ,差异有显著性 (P <0 0 1) ;两组间HBCI比较差异无显著性 (P >0 0 5 )。②GDM组血清瘦素水平 (2 4 7± 2 2 )ng ml高于NGT组 (2 0 3± 1 5 )ng ml,两组之间比较差异有显著性 (P <0 0 5 )。相关分析表明 ,在GDM组瘦素与HOMA -IR呈正相关 (rLeptin =0 5 4 8,P <0 0 0 1) ,在NGT组二者之间无相关性 (rNGT =0 2 2 1P >0 0 5 )。结论　妊娠期IR程度增加 ,可能是GDM主要的发病机制之一。瘦素与GDM胰岛素抵抗有关 ,可能参与GDM的发病     

糖代谢异常孕妇胰岛素抵抗程度与巨大儿的关系

目的探讨糖代谢异常孕妇中胰岛素抵抗（IR）和胰岛β细胞功能的关系,以及胰岛素抵抗程度与巨大儿发生的关系。方法测定35例妊娠期糖耐量异常孕妇（GIGT）和12例妊娠期糖尿病孕妇（GDM）的空腹血糖、胰岛素,采用稳态模型评估法（HOMA）计算GIGT和GDM的胰岛素抵抗指数（HOMA-IR）和胰岛β细胞功能指数（HBCI）。结果GIGT、GDM两组孕妇HBCI无统计学差异（P〉0.05）,而HOMA-IR差异有统计学意义（P〈0.05）;HOMA-IR与巨大胎儿的发生没有显著相关性。结论GDM较GIGT孕妇存在更为明显的胰岛素抵抗,没有发现胰岛素抵抗指数与巨大儿的发生相关。     

BMI正常的糖代谢异常孕妇胰岛素抵抗与分泌的研究

目的:探讨BMI正常的糖代谢异常孕妇胰岛素抵抗与分泌的关系。方法:选择2005年1月1日至2007年1月1日在我院进行正规产检、孕前BMI正常孕妇538例。于孕24~28周行50g葡萄糖筛查和75g葡萄糖耐量试验(oral glucose tolerance test,OGTT),根据检查结果将产妇分为:血糖正常孕妇组(NGT)178例、50g葡萄糖筛查(glucose challengetest,GCT)(+)组94例、妊娠期糖耐量减低(gestational impaired glucose tolerance,GIGT)组100例、妊娠期糖尿病(gestational diabetes mellitus,GDM)166例,同期测定空腹血胰岛素及空腹血糖。用稳态模型评估法(HOMA)计算各组胰岛素抵抗指数(HOMA-IR)和胰岛素β细胞功能指数(HBCI),比较各组胰岛素抵抗和胰岛素分泌能力的差别。结果:(1)GDM组与NGT、GCT(+)、GIGT组孕妇相比,空腹血糖、空腹胰岛素、HBCI差异有统计学意义(P<0.01)。HOMA-IR在各组间差异无统计学意义(P>0.05)。(2)NGT、GIGT组孕妇的HOMA-IR与HBCI呈正相关关系(P<0.01)。GCT(+)、GDM组孕妇的HOMA-IR则与HBCI无关(r=0.123,P>0.05)。结论:孕中期BMI正常的GDM妇女胰岛素抵抗与NGT、GCT(+)、GIGT孕妇相比无增高,但胰岛β细胞分泌能力明显降低。     

妊娠期糖尿病患者与正常孕妇妊娠中晚期胰岛素抵抗及胰岛B细胞功能观察

目的前瞻性纵向观察中期妊娠诊断为妊娠期糖尿病(GDM)患者及血糖正常孕妇在妊娠中晚期胰岛素抵抗及胰岛B细胞功能变化,并比较两者之间的差别。方法 2009年2月至2010年3月在中山大学孙逸仙纪念医院产前检查的82例孕妇于妊娠20～24周行葡萄糖耐量试验(OGTT)及胰岛素释放试验,诊断为GDM43例为GDM组,血糖正常的39例为对照组。于32～36周复查OGTT及胰岛素释放试验,纵向观察两组孕妇胰岛素抵抗及胰岛B细胞功能的变化。结果两组的胰岛B细胞分泌指数(HOMA-β)晚期妊娠均高于中期妊娠,时间主效应有统计学意义(F=7.863,P=0.007);GDM组的早期胰岛素分泌指数(△I30/△G30)中期妊娠及晚期妊娠均低于对照组,组间主效应差异有统计学意义(F=6.052,P=0.018),但GDM组从中期妊娠到晚期妊娠有所升高,而对照组逐渐下降。GDM组的血糖曲线下面积(AUCG)在中期妊娠及晚期妊娠均大于对照组(分别为P<0.0001,P=0.001),同时对照组的AUCG晚期妊娠显著高于中期妊娠(P=0.001);稳态模式胰岛素抵抗指数(HOMA-IR)及混合胰岛素敏感度的时间及组间主效应差异均无统计学意义。结论中晚期妊娠正常孕妇及GDM患者胰岛素抵抗均增加,后者胰岛素抵抗程度高于前者,胰岛B细胞代偿功能两者均增强;GDM组的早期胰岛素分泌功能较正常妊娠组下降。胰岛素抵抗和胰岛素分泌代偿不足是GDM发生、发展的重要机制。     

妊娠期糖耐量异常妇女胰岛功能与胰岛素抵抗的相关研究

目的:研究妊娠期糖耐量异常与胰岛β细胞功能、胰岛素抵抗等的关系。方法:对孕24~36周上海市孕妇共4568例(孕前有糖尿病或糖尿病家族史者排除),先行50g葡萄糖筛查试验,异常者再行75g口服葡萄糖耐量试验(OGTT)-胰岛素释放试验,选取OG-TT异常者318例作为试验组,OGTT正常者中随机选取320例作为对照组,获取各阶段的血糖值及血清胰岛素值,通过计算,用胰岛素敏感指数(ISI)、稳态评估模式、胰岛素储备能力/血糖最大升高值(ΔPI/ΔPG)了解胰岛β细胞功能及外周胰岛素抵抗情况。结果:OGTT异常组的OGTT后1h血清胰岛素(PI1)、胰岛素释放曲线下面积较OGTT正常组显著增高(P<0·05),而胰岛素敏感指数、ΔPI/ΔPG及HOMA-β细胞较OGTT正常组降低(P<0.05)。糖尿病(GDM)组与妊娠期糖耐量减退(GIGT)组相比:GDM组的BMI高于GIGT组,而胰岛素敏感指数、HOMA-β细胞低于GIGT组(P<0.05)。其它指标均无明显差异。结论:妊娠期糖耐量异常形成的主要原因为胰岛素抵抗而非胰岛分泌功能降低。     

妊娠期糖尿病胰岛素分泌模式与胰岛功能评估的探讨

目的建立妊娠期胰岛素分泌模式,探讨不同胰岛素分泌模式与胰岛功能的关系。方法回顾性分析从2010年12月至2017年1月在上海交通大学附属上海市第六人民医院正规产检并住院分娩的2432例孕妇资料,按75g葡萄糖耐量试验(OGTT)及胰岛素分泌试验结果分为两组:妊娠期糖尿病(GDM)组及糖耐量正常(NGT)组;据胰岛素分泌试验结果建立胰岛素分泌模式曲线。利用稳态模型计算胰岛素抵抗指标:胰岛素抵抗指数(HOMA-IR)、混合胰岛素敏感度(ISIcomp)及胰岛素分泌指标:即刻胰岛B细胞功能(HOMA-β)、修正的胰岛B细胞功能指数(MBCI)、第一时相胰岛素分泌指数(Stumvoll1)、第二时相胰岛素分泌指数(Stumvoll2)、即刻胰岛素分泌指数(ΔI30/ΔG30)进行统计学分析。结果 (1)建立了P1～P6 6种胰岛素分泌模式曲线。(2)NGT组胰岛素分泌模式主要表现为P3(51.45%),而GDM组为P4(51.83%)。GDM为P4、P5模式时,主要表现为服糖后1h及2h血糖均异常。(3)NGT中,P3、P4、P5的ISIcomp、MBCI均较P1降低(P0.05),不同胰岛素分泌模式下HOMA-β差异无统计学意义。GDM中,P3、P4和P5的MBCI、Stumvoll1、Stumvoll2均小于P1和P2模式(P0.05),各分泌模式的ISIcomp差异无统计学意义。结论 GDM患者的胰岛素分泌模式主要表现为峰值延迟至服糖后2h。随着胰岛素分泌延迟,胰岛素分泌功能降低,餐后血糖异常增加。     

妊娠期糖尿病血清脂联素与胰岛素抵抗和分泌的相关性研究

目的　探讨不同糖耐量孕妇血清脂联素与胰岛素抵抗和胰岛 β细胞分泌功能的关系。 方法　 2 0 0 3年1月至 2 0 0 4年 1月广东省妇幼保健院和佛山市妇幼保健院采用稳态模型评估法 (HOMA)分别评估正常糖耐量孕妇 (NGT)、糖耐量减低孕妇 (GIGT)和妊娠期糖尿病患者 (GDM)的胰岛素抵抗指数 (HOMA IR)和胰岛 β细胞功能指数 (HBCI) ;利用放免法检测三组孕妇的血清脂联素水平。结果　 (1)GDM组HOMA IR显著高于GIGT组 (P <0 0 5 )和NGT组 (P <0 0 0 1) ,三组的HBCI则差异无显著性。 (2 )血清脂联素水平由NGT、GIGI到GDM呈逐步下降态势 (P <0 0 0 1) ;多元回归分析提示HOMA IR、孕晚期体重、孕晚期BMI是影响血清脂联素水平的最显著因素(r2 =0 4 84 ,P <0 0 0 1)。结论　GDM和GIGT患者血清脂联素显著降低 ,并以GDM降低最为明显 ;其脂联素水平的改变与胰岛素敏感性高度相关。     

以妊娠预后评估妊娠期糖耐量受损异质性

目的 从妊娠预后角度，探讨不同时点妊娠期糖耐量受损（gestational impaired glucose tolerance，GIGT）之间是否存在异质性。方法 选取2000年至2006年在上海交通大学附属第一医院行50g糖筛查异常的孕妇1145例为研究对象，进行75g葡萄糖耐量试验，同时进行胰岛素释放试验，计算血糖曲线下面积及胰岛素敏感性指数，并随访至妊娠终止。比较1145例孕妇中，OGTT 1h异常（68例）及2h／3h异常（40例）两种糖耐量受损患者之间预后的差异，并与妊娠期糖尿病（gestational diabetes mellitus，GDM）患者（38g例）及糖代谢正常（normal glucose tolerance，NGT）孕妇（655例）进行比较。结果 1h GIGT孕妇巨大儿和新生儿低血糖发生率（10．29％和13．24％）与2h／3h糖耐量受损孕妇（5．00％和5．00％）及NGT患者（4．42％和4．73％）比较明显升高（P〈0．01），而2h／3h糖耐量受损孕妇巨大儿及新生儿低血糖发生率显著低于GDM组（11．26％和17．80％）（P〈0．01）。结论 妊娠期糖耐量受损孕妇存在异质性。     

妊娠期糖尿病患者血清瘦素肿瘤坏死因子与胰岛素抵抗的关系

目的探讨妊娠期糖尿病患者血清瘦素(Leptin)与胰岛素抵抗水平、肿瘤坏死因子的关系。方法2002年1月至2005年2月解放军181医院对32例妊娠期糖尿病患者(GDM)为观察组,随机选择同期门诊及住院36例糖耐量正常妊娠妇女为对照组,均进行75g葡萄糖耐量试验(OGTT),同时测定空腹血清瘦素(leptin)、肿瘤坏死因子(INFα)、胰岛素(FINS),稳态模型(HOMA)计算胰岛素抵抗指数(HOMAIR),并应用pearson分析妊娠期糖尿病患者胰岛素抵抗与瘦素、INFα、空腹胰岛素、体重指数(BMI)的关系。结果观察组血清瘦素、INFα、FINS及胰岛素抵抗指数均明显高于对照组(P<0.05或P<0.01);血清瘦素、INFα、FINS、BMI与HOMAIR呈正相关(P<0.01)。结论瘦素、肿瘤坏死因子是影响妊娠期糖尿病患者胰岛素抵抗的重要因素之一。     

胰岛素受体底物1表达及其酪氨酸磷酸化与妊娠期糖尿病患者胰岛素抵抗的关系

目的探讨骨骼肌组织中胰岛素受体底物1（IRS-1）表达及其酪氨酸磷酸化与妊娠期糖尿病发生胰岛素抵抗的关系。方法采用蛋白印迹法（western blot）及免疫沉淀法检测22例妊娠期糖尿病患者（妊娠期糖尿病组）、22例正常妊娠妇女（正常妊娠组）及13例正常非孕妇女（正常非孕组）骨骼肌组织中IRS-1蛋白表达水平及其酪氨酸磷酸化程度；采用放射免疫法及葡萄糖氧化酶法检测各组妇女空腹胰岛素（FINS）及空腹血糖（FPG）水平，并采用稳态模型法计算胰岛素抵抗指数（HOMA—IR）。结果（1）妊娠期糖尿病组FPG、FINS、HOMA—IR分别为（5．6±0．8）mmol／L、（15．4±5．1）mU／L、1．2±0．5，正常妊娠组分别为（4．4±0．5）mmol／L、（10．6±3．1）mU／L、0．8±0．3，两组间各指标分别比较，差异均有统计学意义（P〈0．01）；正常非孕组FINS、HOMA—IR分别为（7．6±2．3）mU／L、0．5±0．3，分别与正常妊娠组比较，差异均有统计学意义（P〈0．01）。（2）妊娠期糖尿病组IRS．1蛋白表达水平为0．64±0．11，明显低于正常妊娠组的0．81±0．13，两组分别比较，差异均有统计学意义（P〈0．01）；正常非孕组IRS-1蛋白表达水平为0．83±0．12，与正常妊娠组比较，差异无统计学意义（P〉0．05）。（3）妊娠期糖尿病组基础及胰岛素刺激后的IRS-1酪氨酸磷酸化程度分别为0．35±0．12及0．48±0．14，均低于正常妊娠组的0．38±0．13及0．66±0．12，两组分别比较，差异均有统计学意义（P〈0．01）；正常妊娠组胰岛素刺激后的IRS．1酪氨酸磷酸化程度明显低于正常非孕组的0．85±0．09（P〈0．01）。（4）妊娠期糖尿病组IRS-1蛋白表达水平和胰岛素刺激后的酪氨酸磷酸化程度与HOMA-IR呈明显负相关（r=-0．613，-0．632；P〈0．01）；正常妊娠组胰岛素刺激后酪氨酸磷酸化程度与HOMA—IR呈明显负相关（r=-0．526，P〈0．05）。结论骨骼肌组织中IRS-1蛋白表达及其酪氨酸磷酸化程度异常，是妊娠期糖尿病患者发生胰岛素抵抗的分子机制之一。     

Inositol’s and other nutraceuticals’ synergistic actions counteract insulin resistance in polycystic ovarian syndrome and metabolic syndrome: state-of-the-art and future perspectives

The incidence of metabolic syndrome (MetS), type II diabetes (T2D) and polycystic ovarian syndrome (PCOS) has been progressively increasing. Insulin resistance (InsR) seems to play a key role in a majority of phenotypes of these conditions, altering metabolic homeostasis, within muscle, liver, adipose and other tissues. Hyperinsulinemia is often associated with InsR and causes hormonal imbalances especially within ovaries and adrenals. Inositol is a polyalcohol, naturally occurring as nine stereoisomers, including D-chiro-inositol (DCI) and myo-inositol (MI), which have prominent roles in the metabolism of glucose and free fatty acids. MI and DCI have been classified as insulin-sensitizers and seem to adequately counteract several InsR-related metabolic alterations with a safe nutraceutical profile. Based on our analysis of selected studies that investigated MI and/or DCI, we conclude that supplementation with MI and/or DCI complement each other in their metabolic actions and act in synergy with other insulin sensitizing drugs and/or nutraceuticals. Nevertheless, considering the possible severe bias due to different methodologies across published studies, we conclude that there is a need for further studies on larger cohorts and with greater statistical power. These should further clarify outcomes and suitable therapeutic dosages of MI and DCI, possibly based on each patient’s clinical status.     

The potential for the use of insulin lispro in pregnancy complicated by diabetes

The target of improved perinatal outcome in diabetic pregnancies may be achieved by new insulin preparations that more closely mirror the physiological response of insulin and not exclusively the traditional means of strict adherence to diet and frequent blood glucose testing.

No insulin preparation has been systematically tested in pregnancy; it is a responsibility of all clinicians who look after pregnant diabetic women to record the outcomes of IL-treated pregnancies.

More data is needed before this preparation can be either recommended in pregnancy or alternatively avoided.     

胰岛素受体α、β及胰岛素受体底物-1在子宫内膜癌的表达及其临床意义

目的 探讨胰岛素受体α（IRα）、β（IRβ）及胰岛素受体底物-1（IRS-1）在子宫内膜癌的表达及其临床意义。方法 用免疫组织化学法检测10例正常子宫内膜：18例子宫内膜增生及57例子宫内膜癌组织中IRα、IRβ及IRS-1蛋白的表达。结果 IRα、IRβ、IRS-1的表达在10正常子宫内膜表达分别为80．00％（8／10）、60．00％（6／10）及70．00％（7／10）；在18例子宫内膜增生组织中分别为77．78％（14／18）、61．11％（11／18）及77．78％（14／18）；在子宫内膜癌组织中分别为47．37％（27／57）、54．39％（31／57）及63．16％（36／57）。IRα的表达在子宫内膜癌组织与正常子宫内膜组及子宫内膜增生比较差异有显著性（P〈0．05），其余差异无统计学意义（P〉0．05）；Ⅰ期子宫内膜癌组织中IRα的阳性表达率明显低于Ⅱ～Ⅳ期者（P〉0．05）；IRβ及IRS-1各组间的阳性表达率与Ⅱ～Ⅳ期者相近（P〉0．05）；IRS-1的阳性表达率Ⅰ期明显低于Ⅱ～Ⅳ期者（P〉0．05）；IRα、β、IRS-1蛋白的表达在子宫内膜癌G1—2与G3差异有显著性（P〈0．05），与肌层浸润深度及淋巴结转移与否差异无显著性（P〉0．05）。结论 IRα及IRS-1的表达与子宫内膜癌的期别有关，提示其表达的改变可能是子宫内膜腺癌发生的早期事件。     

Accurate screening for insulin resistance in PCOS women using fasting insulin concentrations

Abstract

The aims of this cross-sectional study were to evaluate the relative agreement of both static and dynamic methods of diagnosing IR in women with polycystic ovary syndrome (PCOS) and to suggest a simple screening method for IR. All participants underwent serial blood draws for hormonal profiling and lipid assessment, a 3?h, 75?g load oral glucose tolerance test (OGTT) with every 15?min measurements of glucose and insulin, and an ACTH stimulation test. The prevalence of IR ranged from 12.2% to 60.5%, depending on the IR index used. Based on largest area under the curve on receiver operating curve (ROC) analyses, the dynamic indices outperformed the static indices with glucose to insulin ratio and fasting insulin (fInsulin) demonstrating the best diagnostic properties. Applying two cut-offs representing fInsulin extremes (<7 and >13?mIU/l, respectively) gave the diagnosis in 70% of the patients with high accuracy. Currently utilized indices for assessing IR give highly variable results in women with PCOS. The most accurate indices based on dynamic testing can be time-consuming and labor-intensive. We suggest the use of fInsulin as a simple screening test, which can reduce the number of OGTTs needed to routinely assess insulin resistance in women with PCOS.     

PCOS患者卵巢胰岛素抵抗的发生机理探讨

目的:探讨胰岛素抵抗/高胰岛素血症在PCOS生殖功能障碍中的作用。方法:收集行IVF-ET治疗的11例PCOS患者(PCOS组)和15例排卵正常的输卵管性不孕患者(对照组)促排卵后卵巢黄素化颗粒细胞,行体外培养,分别用不同浓度胰岛素处理细胞48h,采用RT-PCR和Westernblot检测黄素化颗粒细胞胰岛素受体底物(IRS)-1和IRS-2mRNA及蛋白的表达。采用放射免疫法检测血清性激素及空腹血清胰岛素(FIN)水平;采用葡萄糖氧化酶法测定空腹血糖(FPG)水平;计算胰岛素抵抗指数(HOMA-IR)。结果:①PCOS患者血清LH、LH/FSH、T、FIN及HOMA-IR均明显高于对照组(P<0.05);②0mU/ml胰岛素时,PCOS组黄素化颗粒细胞IRS-1mRNA及蛋白的表达水平明显高于对照组(P<0.05),而IRS-2mRNA及蛋白的表达水平较对照组明显降低(P<0.05);③10mU/ml胰岛素对二组患者黄素化颗粒细胞IRS-1和IRS-2mRNA及蛋白的表达均无影响(P>0.05);④100mU/ml或1000mU/ml胰岛素作用后,二组患者IRS-1mRNA及蛋白的表达水平均明显增高(P<0.05),而IRS-2mRNA及蛋白的表达水平均明显降低(P<0.05)。结论:PCOS患者胰岛素抵抗/高胰岛素血症通过提高卵巢颗粒细胞IRS-1的表达,降低IRS-2的表达参与患者卵巢生殖功能障碍的发生。     

N-acetyl-cysteine treatment improves insulin sensitivity in women with polycystic ovary syndrome

Objective: To evaluate the effect of N-acetyl-cysteine (NAC) on insulin secretion and peripheral insulin resistance in subjects with polycystic ovary syndrome (PCOS).

Design: Prospective data analysis.

Setting: Volunteer women in an academic research environment.

Patient(s): Six lean and 31 obese subjects, aged 19–33 years.

Intervention(s): Patients were treated for 5–6 weeks with NAC at a dose of 1.8 g/day orally. A dose of 3 g/day was arbitrarily chosen for massively obese subjects. Six of 31 obese patients with PCOS were treated with placebo and served as controls.

Main Outcome Measure(s): Before and after the treatment period, the hormonal and lipid blood profile and insulin sensitivity, assessed by an hyperinsulinemic euglycemic clamp, were evaluated and an oral glucose tolerance test (OGTT) was performed.

Result(s): Fasting glucose, fasting insulin, and glucose area under curve (AUC) were unchanged after treatment. Insulin AUC after OGTT was significantly reduced, and the peripheral insulin sensitivity increased after NAC administration, whereas the hepatic insulin extraction was unaffected. The NAC treatment induced a significant fall in T levels and in free androgen index values (P<.05). In analyzing patients according to their insulinemic response to OGTT, normoinsulinemic subjects and placebo-treated patients did not show any modification of the above parameters, whereas a significant improvement was observed in hyperinsulinemic subjects.

Conclusion(s): NAC may be a new treatment for the improvement of insulin circulating levels and insulin sensitivity in hyperinsulinemic patients with polycystic ovary syndrome.     

Beta cell function and insulin sensitivity in women with polycystic ovary syndrome: Influence of the family history of type 2 diabetes mellitus

Aim.?To study the impact of family history (FH) of type 2 diabetes mellitus on β-cell compensatory mechanism in women with polycystic ovary syndrome (PCOS).

Subjects and methods.?A total of 70 women with PCOS, 14 with first-degree relative with type 2 diabetes mellitus (T2DM) (FH+), 56 with negative FH of T2DM (FH?) and 72 age and BMI matched control healthy women (CNT) underwent oral glucose tolerance test (OGTT). Insulin resistance was evaluated as oral glucose index (OGIS); insulin and C-peptide secretion as the insulinogenic index in 30th min of OGTT.

Results.?Fasting blood glucose levels were significantly higher in FH+ than in FH? (p < 0.05). Fasting insulin was higher in FH+ than in CNT (p < 0.05). Fasting C-peptide was significantly higher in both FH? and FH+ than in CNT (p < 0.05 and p < 0.01, respectively). OGIS was lower in FH+ than in FH? or in CNT (p < 0.05). Insulinogenic index calculated from C-peptide values (II-Cp) was lower in FH+ than in CNT (p < 0.05). Adaptation index calculated from the values of OGIS and insulinogenic index was significantly lower in FH+ than in CNT or in FH? (p < 0.0001 and p < 0.01, respectively).

Conclusions.?Insulin resistance and defective early-phase insulin secretion is present only in those PCOS-affected subjects who had positive FH of T2DM.     

多囊卵巢综合征患者胰岛素抵抗和高胰岛素血症的诊治

胰岛素抵抗(IR)是多囊卵巢综合征(PCOS)的重要病理生理改变。IR及高胰岛素血症是PCOS患者代谢异常的基本特征,也是PCOS患者内分泌代谢紊乱的主要特征之一。肥胖型PCOS患者高胰岛素血症发生率高达75％,非肥胖型PCOS患者约为30％ 。流行病学调查显示PCOS患者发生2型糖尿病、高血压、冠心病等疾病的风险明显增加,胰岛素抵抗可能在PCOS的发生 中起着重要作用。生活方式改变和胰岛素增敏剂是治疗的有效方法。     

Comparison of two insulin sensitizers,metformin and myo-inositol,in women with polycystic ovary syndrome (PCOS)

Insulin resistance (IR) plays a pivotal role in PCOS. Insulin-sensitizer agents such as metformin and inositols have been shown to improve the endocrine and metabolic aspects of PCOS. The purpose of this study is to compare their effects on the clinical and metabolic features of the women with PCOS. Fifty PCOS women with IR and/or hyperinsulinemia were randomized to treatment with metformin (1500?mg/day) or myo-inositol (4?g/day). IR was defined as HOMA-IR >2.5, while hyperinsulinemia was defined as a value of AUC for insulin after a glucose load over the cutoff of our laboratory obtained in normal women. The Matsusa Index has been calculated. The women have been evaluated for insulin secretion, BMI, menstrual cycle length, acne and hirsutism, at baseline and after 6 months of therapy. The results obtained in both groups were similar. The insulin sensitivity improved in both treatment groups. The BMI significantly decreased and the menstrual cycle was normalized in about 50% of the women. No significant changes in acne and hirsutism were observed. The two insulin-sensitizers, metformin and myo-inositol, show to be useful in PCOS women in lowering BMI and ameliorating insulin sensitivity, and improving menstrual cycle without significant differences between the two treatments.