A fasting glucose to insulin ratio is a useful measure of insulin sensitivity in women with polycystic ovary syndrome
A fasting glucose to insulin ratio is a useful measure of insulin sensitivity in women with polycystic ovary syndrome
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DOI：
10.1210/jc.83.8.2694
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发表时间：
1998-08-01
影响因子：
5.8
通讯作者：
Dunaif, A
中科院分区：
文献类型：
--
作者：
Legro, RS;Finegood, D;Dunaif, A
患有多囊卵巢综合征（PCOS）的女性具有严重的胰岛素抵抗，并且由此产生的高胰岛素血症加剧了该综合征的生殖异常。改善胰岛素抵抗和降低循环胰岛素水平的药物可能为PCOS提供新的治疗模式。因此，确定胰岛素抵抗最严重的PCOS妇女子集可能有助于选择对这种治疗有反应的妇女。我们研究了基础和口服葡萄糖刺激的葡萄糖和胰岛素水平以及空腹和刺激的葡萄糖/胰岛素（G：I）比值与胰岛素敏感性参数的相关性，这些参数是通过频繁采样的静脉葡萄糖耐量试验（FSIGT）获得的，以评估是否有一个简单的筛选试验来检测PCOS患者的胰岛素抵抗。40名PCOS妇女（年龄18-40岁，体重指数>26 kg/m2）和15名年龄、体重和种族相匹配的对照妇女进行了75 g口服葡萄糖耐量试验（OGTT）和FSIGT。胰岛素敏感性指数（S-I）通过应用葡萄糖动力学的最小模型来计算FSIGT期间血浆葡萄糖和胰岛素水平的动态。PCOS患者S-I与空腹血糖水平的相关性最好的是空腹G：I比值（r = 0.73; P < 0.0001）。与空腹胰岛素水平的相关性较低，但有显著性（r = 0.50; P < 0.001），与空腹血糖水平无显著相关性（r = 0.24; P = NS）。在OGTT期间，空腹G：I与SI的相关性比与综合葡萄糖和胰岛素反应的相关性更强。唯一较强的相关性是与OGTT 2 h G：I比值（r = 0.74; P < 0.001）。以S-I作为因变量，以空腹血糖和胰岛素水平、血糖和胰岛素曲线下面积以及空腹G：I比值进行逐步回归分析，结果显示，在模型中，只有空腹G：I比值对S-I具有显著预测作用（F去除值= 38.1; P < 0.001）。当被视为PCOS胰岛素抵抗的筛查试验时，将空腹G：I比值小于4.5设定为异常（使用低于我们对照人群第10百分位数的S-I值作为胰岛素抵抗的证据），空腹G：I比值的敏感性为95%，特异性为84%，阳性预测值为87%，阴性预测值为94%。接受者操作曲线分析表明，空腹G：I比值是检测胰岛素抵抗的最佳筛选指标。我们的结论是，空腹G：I比值可能是有用的，作为一个筛选测试胰岛素抵抗的肥胖非西班牙裔白色PCOS妇女。这可能是一个临床上有用的参数，选择PCOS妇女最有可能响应的治疗干预措施，提高胰岛素敏感性。
Women with polycystic ovary syndrome (PCOS) are profoundly insulin resistant, and the resultant hyperinsulinemia exacerbates the reproductive abnormalities of the syndrome. Agents that ameliorate insulin resistance and reduce circulating insulin levels could provide a new therapeutic modality for PCOS. Identifying the subset of PCOS women who are most insulin resistant may therefore be useful for selecting women who will respond to this therapy. We examined the correlation of basal and oral glucose-stimulated glucose and insulin levels and fasting and stimulated glucose/insulin (G:I) ratios with parameters of insulin sensitivity obtained by frequently sampled iv glucose tolerance test (FSIGT) to assess whether there is a simple screening test for insulin resistance in PCOS. Forty PCOS women (aged 18-40 yr; body mass index, >26 kg/m(2)) and 15 control women matched for age, weight, and ethnicity underwent both a 75-g oral glucose tolerance test (OGTT) and a FSIGT. The insulin sensitivity index (S-I) was calculated by application of the minimal model of glucose kinetics to the dynamics of plasma glucose and insulin levels during the FSIGT. The best correlation in PCOS between S-I and a fasting level was found with fasting G:I ratios (r = 0.73; P < 0.0001). A less substantial, but significant, correlation was found with fasting insulin levels (r = 0.50; P < 0.001), and no significant correlation was found with fasting glucose levels (r = 0.24; P = NS). The fasting G:I was more strongly correlated with SI than with integrated glucose and insulin responses during the OGTT. The only stronger correlation was with the OGTT 2 h G:I ratio (r = 0.74; P < 0.001). Stepwise regression analysis with S-I as the dependent variable and fasting glucose and insulin levels, area under the curve for glucose and insulin, and a fasting G:I ratio showed that only the fasting G:I ratio was significantly predictive of S-I in the model (F to remove value = 38.1; P < 0.001). When viewed as a screening test for insulin resistance in PCOS, setting a value of the fasting G:I ratio of less than 4.5 as abnormal (using an S-I value below the 10th percentile of our control population as evidence for insulin resistance), the sensitivity of a fasting G:I ratio was 95%, the specificity was 84%, the positive predictive value was 87%, and the negative predictive value was 94%. Receiver operator curve analysis showed that this fasting G:I ratio was the single best screening measure for detecting insulin resistance. We conclude that a fasting G:I ratio may be useful as a screening test for insulin resistance in obese non-Hispanic white PCOS women. This may be a clinically useful parameter for selecting PCOS women most likely to respond to therapeutic interventions that improve insulin sensitivity.