血清性激素结合球蛋白、雄激素和胰岛素抵抗对多囊卵巢综合征孕妇的影响研究

摘要

Objective Toinvestigatethechangesofserumlevelsofsexhormonebindingglobulin(SHBG),freetestosteroneindex ( FTI)and insulin resistance,and to investigate the relationship among them and prevalence of gestation diabetes mellitus( GDM)and hyperten-sivedisordercomplicatingpregnancy(HDP)inpolycysticovariansyndrome(PCOS)womenduringpregnancy.Methods Serumsamplesof50P-COS women and 50 non-PCOS women with comparable age and body mass index( BMI)were collected during their gestational age from 12 to l6 weeks. Serum levels of total testosterone(TT),SHBG,total cholesterol(TC),triglyceride(TG)and fasting insulin(FINS)were detected. Free testosterone index( FTI)and homeostasis model assessment for insulin resistance( HOMA-IR)were calculated. Risk factors of GDM and HDPwereanalyzedbybinarylogisticregression.Results SerumTC,FINS,FTI,HOMA-IRlevelsandTTwerehigherinPCOSgroupthan those of control group. SHBG level was lower in PCOS group than that of control group( P <0. 05). Cesarean section rate,premature delivery rate,GDM and HDP incidence were higher in PCOS group than those of control group(84. 0% vs. 50. 0%,P <0. 01;22. 0% vs. 6. 0%,P <0. 05;20. 0% vs. 4. 0%,P <0. 05;26. 0% vs. 4. 0%,P <0. 01,respectively). Binary logistic regression analysis showed that high SHBG was the risk factor of GDM(OR=0. 97,95% CI:0. 95~1. 00,P <0. 05). FTI was the risk factor of HDP in PCOS women(OR=5. 47,95%CI:2.20~24.32,P<0.05).Conclusion FTIandSHBGlevelscouldbepredictorsforGDMandHDPinPCOSwomenduringtheirpregnan-cies.%目的：评估多囊卵巢综合征（ PCOS）患者妊娠期血清性激素结合球蛋白（ SHBG）、游离睾酮指数（ FTI）、胰岛素抵抗水平变化及与妊娠期糖尿病（GDM）、妊娠期高血压疾病（HDP）的关系。方法50例孕前诊断为PCOS的孕妇于妊娠12~16周检测血清总睾酮（ TT）、SHBG、总胆固醇（ TC）、甘油三酯（ TG）、空腹胰岛素（ FINS）水平，计算FTI，稳态模型评估法评定胰岛素抵抗指数（ HOMA-IR）。采用二元Logistic回归分析GDM和HDP的影响因素，以同期年龄和体重指数（BMI）相匹配的50例非PCOS孕妇作为对照组。结果 PCOS组血清TC、FINS、FTI、HOMA-IR及TT水平均高于对照组，而SHBG水平低于对照组，差异均有统计学意义（ P <0.05），PCOS组的剖宫产率、早产率、GDM及HDP发生率均高于对照组（分别为84.0% vs.50.0%，P <0.01；22.0% vs.6.0%，P <0.05；20.0% vs.4.0%，P <0.05；26.0%vs.4.0%，P <0.01）。二元Logistic回归分析显示，较高水平的SHBG是GDM发生的影响因素（OR=0.97，95% CI：0.95~1.00，P<0.05），较高水平的FTI是HDP发生的危险因素（OR=5.47，95%CI：2.20~24.32，P<0.05）。结论 SHBG与FTI可作为预测PCOS孕妇发生GDM及HDP的指标。