目的：探讨胰岛素抵抗与多囊卵巢综合征(PCOS)育龄妇女生育功能的关系。方法以2015年1月至2016年6月我院妇产科门诊收治的145例PCOS患者为研究对象，按照病史将其分为正常妊娠组（48例），流产组(51例)和不孕组（46例），选择同期因其他因素或男方因素不孕的30例正常育龄妇女作为对照组。比较各组间的空腹血糖、空腹血浆胰岛素及胰岛素抵抗指数(HOMA-IR)水平。结果四组受检者的空腹血糖水平比较差异无统计学意义（P>0.05）；空腹血浆胰岛素组间比较差异有统计学意义(P<0.05)，其中流产组与不孕组的空腹血浆胰岛素水平高于正常妊娠组与对照组，差异均有统计学意义(P<0.05)；四组受检者间胰岛素抵抗水平比较差异有统计学意义(P<0.05)，其中两两比较结果显示，流产组、不孕组的空腹血浆胰岛素≥20 mIU/L及G：I<4.5的发生率均高于对照组育龄妇女(P<0.05)，但与正常妊娠组间比较差异无统计学意义(P>0.05)；流产组HOMA-IR＞4.5发生率明显高于正常妊娠与对照组(P<0.05)，不孕组HOMA-IR＞4.5发生率与正常妊娠组及对照组间比较差异均无统计学意义(P>0.05)。结论胰岛素抵抗在多囊卵巢综合征患者的不孕和流产发生中具有重要作用，临床可通过改善多囊卵巢综合征患者的胰岛素抵抗程度，以纠正患者高雄激素状态和改善卵巢排卵功能，提高促排卵治疗的效果，进而达到提高患者妊娠率的目的。%Objective To investigate the relationship between insulin resistance and fertility of polycystic ova-ry syndrome (PCOS) women of childbearing age. Methods A total of 145 cases of PCOS patients, who admitted to Department of Obstetrics and Gynecology of our hospital from January 2015 to June 2016, were selected and divided into the normal pregnancy group (48 cases), abortion group (51 cases) and infertility group (46 cases) according to their disease history. At the same time, 30 cases of normal women of childbearing age who couldn’t have children due to other factors or male factor infertility were selected as the control group. The indexes of fasting blood glucose, fast-ing plasma insulin and homeostasis model assessment-estimated insulin resistance (HOMA-IR) were compared among the groups. Results There was no significant difference in fasting blood glucose between the four groups (P>0.05). There were significant differences in fasting plasma insulin between the four groups (P<0.05);the fasting plasma insulin levels of the abortion group and the infertility group were significantly higher than those of the normal pregnancy group and the control group (P<0.05). There were significant differences in HOMA-IR among the four groups (P<0.05);The results of pairwise comparison showed that the incidence of fasting plasma insulin≥20 mIU/L and G:I<4.5 of the abor-tion group and the infertility group were significantly higher than those of the control group (P<0.05), but there was no statistically significant difference from the normal pregnancy group (P>0.05). The incidence of HOMA-IR>4.5 in the in-fertile group was significantly higher than that in the normal pregnancy group (P<0.05), while there was no significant difference in the incidence of HOMA-IR>4.5 between the normal pregnancy group and the control group (P>0.05). Conclusion Insulin resistance plays an important role in infertility and abortion in patients with PCOS. To improve the degree of insulin resistance in patients with PCOS can correct the state of hyperandrogenism and improve the ovarian function, which can improve the effectiveness of ovulation induction therapy, and thus achieve the purpose of improving the rate of pregnancy.
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