摘要目的 探讨多囊卵巢综合征(PCOS)患者肾上腺源性雄激素水平与胰岛素抵抗的关系.方法 对22名正常女性和85例PCOS患者行促肾上腺皮质激素(ACTH)兴奋试验,将PCOS患者分为高反应组(HR-PCOS)和正常反应组(NR-PCOS).用放射免疫分析法检测血清促黄体生成素与卵泡刺激素(LH/FSH)比值、雌二醇、睾酮、孕酮,测定ACTH兴奋试验前后(0 min和60 min)血清17-羟孕酮(17-OHP)、硫酸脱氢表雄酮(DHEAS)、雄烯二酮(AD)、皮质醇,测定稳态模型下胰岛素抵抗指数(HOMA-IR),测量体质量指数(BMI)、腰臀围比.结果 在85例PCOS患者中,有20例的17-OHP水平高于正常,为HR-PCOS组,其余65例反应正常,为NR-PCOS组.基本情况比较:HR-PCOS组和NR-PCOS组的MBI及腰臀围比均显著高于对照组(MBI:x2=13.874,14.512,腰臀围比:x2=12.607,15.153,P均＜0.05),HR-PCOS组和NR-PCOS组间差异无统计学意义(x2=4.801,5.362,P＞0.05)；激素水平比较:HR-PCOS组和NR-PCOS组的LH/FSH比值、雌二醇显著高于对照组(LH/FSH:x2=18.226,16327,雌二醇:x2=17334,19.261,P均＜0.01),HR-PCOS组和NR-PCOS组间差异无统计学意义；HR-PCOS组血清总睾酮显著高于NR-PCOS组(x2=12.274,P＜0.05),HR-PCOS组和NR-PCOS组均高于对照组(x2=20.314,18.492,P均＜0.01)；ACTH兴奋试验前后HR-PCOS组17-OHP和DHEAS显著高于NR-PCOS组和对照组(17-OHP:x2=18.063,19.214,D HE AS:x2=17.358,19.355,P均＜0.01),而NR-PCOS组与对照组间差异无统计学意义(x2=4.109,4.362,P均＞0.05)；AD在ACTH兴奋试验前后HR-PCOS组和NR-PCOS组均高于对照组(x2=14.062,16.549,P均＜0.05),而HR-PCOS组和NR-PCOS组间差异无统计学意义(x2=5.541,P＞0.05)；血清皮质醇在ACTH兴奋试验前后各组间差异无统计学意义；HR-PCOS组和NR-PCOS组的HOMA-IR均显著高于对照组(x2=19.263,21.482,P均＜0.01),且HR-PCOS组显著高于NR-PCOS组(x2=13.582,P均＜0.05).结论 部分PCOS患者存在肾上腺雄激素亢进并对ACTH反应性增强,其肾上腺雄激素的水平可能与胰岛素抵抗有关.

abstractsObjective To investigate the relationship between adrenal androgen level and insulin resistance in polycystic ovary syndrome(PCOS)patients.Method Twenty-two healthy women and 85 PCOS patients were underwent adrenocorticptropic hormone(ACTH)stimulation test,and 85 PCOS patients were divided into high response-polycystic ovary syndrome(HR-PCOS)group and normal response-polycystic ovary syndrome(NR-PCOS)group.The ratio of serum luteinizing hormonetofolliclestimulating hormone(LH/FSH),estradiol(E2),testosterone(T)and progestin(P)were tested by radioimmunoassay method.17-hydroxy-progesterone(17-OHP),dehydroepiandros-teronesulfate(DHEAS)and androsterone(AD)was tested at 0 and 60 min after an ACTH stimulation test.Body mass index(BMI),waist-to-hip-circumference radio(WHR)and homeostasis modes of assessment for insulin resistence index(HOMA-IR)were also measured.Results There were 20 cases that 17-OHP levels were higher than normal(HR-PCOS),the other 65 cases were NR-PCOSgroup.MBI and WHR(MBI:x2=13.874,14.512,WHR:x2=12.607,15.153,P all＜0.05)of HR-PCOS group and NR-PCOS group were significantly higher than control group,but there had no significant difference between the two PCOS groups(x2=4.801,5.326,P all＞0.05).HR-PCOS group and NR-PCOS group were significantly higher than the control group for LH/FSH and estradiol(LH/FSH:x2=18.226,16.327,E2:x2=17.334,19.261,P all＜0.05),but there had no significant difference between the two PCOS groups.Serum T of HR-PCOS group was significantly higher than control group(x2=12.274,P ＜0.01),HR-PCOS group and NR-PCOS group were higher than control group(x2=20.314,18.492,P all＜0.01).17-OHP and DHEAS of HR-PCOS group were significantly higher than NR-PCOS group and control group before and after ACTH stimulation test(17-OHP:x2=18.063,19.214,DHEAS:x2=17.358,19.355,P all＜0.01).But there had no differences between NR-PCOS group and control group(x2=4.109,4.362,P all＞0.05).AD of HR-PCOS group and NR-PCOS group were higher than control group before and after the ACTH stimulation test(x2=14.062,16.549,Pall＜0.05).However,there had no differences(x2=5.541,P＞0.05)between the two PCOS groups.Serum cortisol was no difference between HR-PCOS,NR-PCOS and control groups before and after stimulation test.HOMA-IR of HR-PCOS group and NR-PCOS group were higher than control group(x2=19.263,21.482,P all＜0.01),and HR-PCOS group is higher than NR-PCOS group(x2=13.582,P＜0.05).Conclusions There have significantly higher basal and ACTH-stimulated level of adrenal androgen hyperresponsiveness in PCOS patients.Adrenal androgen level appears to be closely associated with insulin resistance in PCOS patients.