Page 31 - 2023-08-中国全科医学

·928· http: //www.chinagp.net E-mail: zgqkyx@chinagp.net.cn March 2023, Vol.26 No.8

Objective To explore the correlation of adiponectin（ADPN）with FAI and insulin resistance at different testosterone
concentrations in PCOS patients，and to further investigate the clinical value of adiponectin in PCOS. Methods From October
2017 to April 2020，116 patients with PCOS and 45 healthy women of normal reproductive age （control group） who were
treated in outpatient or inpatient hospital of Zunyi Medical University Affiliated Hospital were selected as the research objects. The
general data of the research subjects were collected，and laboratory index examinations were conducted：on the 3rd to 5th day
of the menstrual cycle of regular menstruation or when there was no dominant follicle in the B-ultrasound examination of irregular
menstruation，and the patient's cubital venous blood was collected on an empty stomach after fasting for 12 hours to detect fasting
blood glucose（FPG），fasting insulin（FINS），Glycated hemoglobin（HbA 1c ），triacylglycerol（TG），total cholesterol（TC），
low density lipoprotein （LDL），high density lipoprotein（HDL），follicle stimulating hormone（FSH），luteinizing hormone（LH），
progesterone，testosterone（TEST），sex hormone binding globulin（SHGB），dehydroepiandrosterone sulfate （DHEA-S），
ADPN. The homeostasis model-assessed insulin resistance index（HOMA-IR） and FAI were calculated. PCOS patients were
divided into PCOS with hyperandrogenemia group （HA group，n=65） and PCOS without hyperandrogenemia group（non-HA
group，n=51） according to whether they had hyperandrogenism（TEST ≥ 2.44 nmol/L）. The HA and non-HA groups were
further divided into 4 subgroups according to the quartile values of TEST levels. The correlation between ADPN and other indicators
and the influencing factors of FAI and ADPN were analyzed. Results Compared with the control group，the body mass，BMI，
waist circumference，hip circumference，WHR，FPG，FINS，HOMA-IR，HbA 1c ，TG，LDL，FSH，TEST，FAI were
increased，and HDL was decreased in the non-HA and HA group of PCOS patients （P<0.05）. Compared with the non-HA
group，the TG，HOMA-IR，TEST and FAI of the HA group were increased，while the HDL，FSH，progesterone，SHBG
and ADPN of the HA group were decreased （P<0.05）. There were significant differences in ADPN between HA group and non-
HA group with different TEST level subgroups（P<0.05）. After adjustment for BMI，ADPN in PCOS patients was negatively
correlated with HOMA-IR，FAI，and TEST（P<0.001）. In the HA group，ADPN was negatively correlated with HOMA-IR，
FAI，and TEST （P<0.05）；in the non-HA group，ADPN in the group was negatively correlated with HOMA-IR，FAI （P<0.05），
and had no correlation with TEST（P=0.061）. In the non-HA group，ADPN and BMI were the influencing factors of FAI，
and HOMA-IR，FAI and BMI were the influencing factors of ADPN （P<0.05）. In the HA group，ADPN was the influencing
factor of FAI and HOMA-IR，and FAI were the influencing factors of ADPN （P<0.05）. Conclusion ADPN is negatively
correlated with and mutually affects free testosterone index，and this relationship is not affected by TEST concentrations，and by
measuring serum ADPN levels can simultaneously reflect the high androgen levels and the degree of insulin resistance in PCOS
patients，ADPN is expected to be an important reference index for the diagnosis and condition evaluation.
【Key words】 Polycystic ovary syndrome；Adiponectin；Testosterone；Free testosterone index；Insulin resistance；
Androgens

多 囊 卵 巢 综 合 征（polycystic ovary syndrome， 可以通过影响促黄体生成素受体基因的表达使卵泡膜细
PCOS）是一种以高雄激素血症、无排卵症（常表现为 胞雄激素的生成减少 ［5］ 。同时 PCOS 患者血清 ADPN
月经稀发、闭经、不孕等）及卵巢多囊样改变为主要表 表达水平与胰岛素抵抗呈负相关，检测血清 ADPN 水平
现的综合征 ［1］ 。既往有研究表明，PCOS 患者血液雄激 可对患者胰岛素抵抗的程度进行预测 ［7］ 。
素水平和胰岛素水平存在相关性，血液中较高的胰岛素 本研究通过对 PCOS 患者游离睾酮指数（free
水平会促进雄激素合成增加，影响正常的卵泡发育过程， androgen index，FAI）和胰岛素抵抗与 ADPN 相关性进
导致多毛、月经紊乱甚至不孕 ［2-3］ 。此外血液中雄激素 行初步研究，旨在探究 ADPN 是否可以作为一个同时评
水平的增加还会从多方面影响体内各靶细胞对胰岛素的 估 PCOS 患者高雄激素血症和胰岛素抵抗程度的指标。
敏感性，从一定程度上加重了胰岛素抵抗，导致患者患 1 对象与方法
高血压、高脂血症、心血管疾病及 2 型糖尿病的风险较 1.1 研究对象 选取 2017 年 10 月至 2020 年 4 月就诊
正常人明显增高 ［4］ 。 于遵义医科大学附属医院门诊或住院的 116 例 PCOS 患
脂联素（adiponectin，ADPN）是一种蛋白质类激素， 者及 45 例体检健康的正常育龄期妇女（对照组）为研
在人体中的生理作用包括调控能量代谢、抗炎、促进卵 究对象。
泡发育、诱导排卵、促进宫内胎儿生长发育等方面 ［5］ 。 纳入标准：参照鹿特丹标准 ［7］ 诊断为 PCOS。在
ADPN 主要由脂肪细胞分泌，可明显影响 PCOS 患者血 排除其他已知内分泌系统相关的性腺疾病（如先天性肾
清中性激素及胰岛素的水平 ［6］ 。动物实验表明，ADPN 上腺皮质增生，分泌雄激素的肿瘤和库欣综合征）后，