·胰岛素抵抗及其相关疾病·

　　李昌林 张木勋 喻晶 帅红霞 刘永健 桂书彦

　　作者单位：431700湖北省天门市第一人民医院内分泌科(李昌林);华中科技大学同济医学院附属同济医院内分泌科(张木勋、喻晶、帅红霞、刘永健、桂书彦)

　　通讯作者：张木勋，E-mail：zhangmuxun@medmail.com.cn

　　【摘要】  目的  探讨对氧磷酯酶1(PON-1)活性、氧化应激在多囊卵巢综合征(PCOS)患者发生胰岛素抵抗(IR)中的作用。  方法  41例PCOS患者分为肥胖组17例和非肥胖组24例，另有20名健康女性纳入正常对照组。所有研究对象均行口服糖耐量试验(OGTT)和胰岛素释放试验，使用稳态模型评价IR及胰岛β细胞分泌功能，空腹静脉取血检测丙二醛(MDA)、超氧化物歧化酶(SOD)活性及PON-1活性。  结果(  1) PCOS非肥胖组和PCOS肥胖组的空腹胰岛素、餐后2小时血糖及胰岛素、HOMA-IR及HOMA-β均高于正常组(P<0.05)，且PCOS肥胖组的空腹胰岛素、餐后2小时血糖及胰岛素、HOMA-IR均高于PCOS非肥胖组(P<0.05)。(2) PCOS非肥胖组和PCOS肥胖组的MDA、SOD及PON-1与正常组比较差异有统计学意义(P<0.05);PCOS肥胖组的SOD显著低于PCOS非肥胖组(P<0.01)，而MDA及PON-1两组之间差异无统计学意义(P>0.05)。(3) 相关分析显示：在PCOS非肥胖组，SOD与PON-1正相关(r=0.417, P<0.05)，SOD与IR负相关(r=-0.492, P<0.05)。  结论 　PCOS患者无论肥胖与否，均存在餐后血糖升高、PON-1活性降低、氧化应激、IR，且肥胖患者更为严重;PCOS患者的氧化应激与IR相关。

　　【关键词】多囊卵巢综合征;胰岛素抵抗;氧化应激;对氧磷酯酶1

　　doi:12.3969/j.issn.1006-6187.2011.02.004

　　The correlation of serum paraoxonase-1 and oxidative stress with insulin resistance in patients with polycystic ovary syndrome

　　LI Chang-lin, ZHANG Mu-xun，YU Jing， et al. Department of Endocrinology, The First People′s Hospital of Tianmen city, Hubei Tianmen 431700, China

　　Corresponding author: ZHANG Mu-xun, E-mail: zhangmuxun@medmail.com.cn

　　【Abstract】 Objective T o observe the role of paraoxonase-1 and oxidative stress in pathogenesis of insulin resistance in patients with polycystic ovary syndrome (PCOS).  Methods 41 PCOS patients divided into obese group and non-obese group with 20 healthy volunteers as a control. The 75g oral glucose tolerance test (OGTT) and insulin releasing test (IRT) were performed. The insulin resistance and β-cell function were estimated with homeostasis model assessment (HOMA). The fasting serum concentration of malondialdehyde (MDA), and the activities of superoxide dismutase (SOD) and paraoxonase-1 (PON-1) were assayed.   Results  (1) The levels of fasting plasma insulin, 2 hour plasma glucose and insulin, the index of insulin resistance (HOMA-IR) and β-cell function (HOMA-β) were significantly higher in PCOS patients of both non-obese group and obese group than in healthy controls(all P<0.05). HOMA-β was not different between non-obese group and obese group in PCOS patients(P>0.05), while the the levels of BMI, 2hPG, FIns, 2hIns, and HOMA-IR were significantly higher in obese group than in non-obese group(all P<0.05). (2)The PCOS patients in both non-obese group and obese group showed higher MDA and lower SOD and PON-1 than in healthy controls(P<0.05). The serum concentration of MDA and the activity PON-1 showed no differences between non-obese group and obese group in PCOS patients (both, P>0.05), but The activity of SOD was significantly lower in obese group than in non-obese group(P<0.01).　　(3) SOD had a positive correlation with PON-1(r=0.417, P=0.043), and a negative correlation with HOMA IR(r=-0.492, P=0.015)in non-obese PCOS group.  Conclusion  The PCOS patients has an increased postprandial plasma glucose, impared PON-1 activity, oxidative stress, insulin resistance, and high level of plasma insulin in non-obese and especially in obese subgroup. Insulin resistance is related to oxidative stress in patients with PCOS.

　　【Key words】Polycystic ovary syndrome;Insulin resistance;Oxidative stress;Paraoxonase-1