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/jcem.83.8.5054
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发表时间：
1998-08
期刊：
影响因子：
--
通讯作者：
R. Legro;D. Finegood;A. Dunaif
中科院分区：
文献类型：
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作者：
R. Legro;D. Finegood;A. Dunaif
患有多囊卵巢综合征(PCOS)的女性存在严重的胰岛素抵抗，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多囊卵巢综合征提供一种新的治疗方式。因此，确定最具胰岛素抵抗的多囊卵巢综合征妇女亚群可能有助于选择对该疗法有反应的妇女。我们研究了基础和口服葡萄糖刺激的血糖和胰岛素水平以及空腹和刺激后的葡萄糖/胰岛素(G：I)比值与频繁静脉注射获得的胰岛素敏感性参数的相关性。糖耐量试验(FSIGT)评估PCOS是否有一种简单的胰岛素抵抗筛查试验。40名PCOS妇女(年龄18-40岁；体重指数，26公斤/平方米)和15名年龄、体重和种族匹配的对照组妇女接受了75克口服葡萄糖耐量试验(OGTT)和FSIGT。应用葡萄糖动力学最小模型计算胰岛素敏感指数(S(I))。S(I)与空腹血糖与多囊卵巢综合征的相关性最好，与空腹G：I比值相关(r=0.73P&0.0001)。与空腹胰岛素水平的相关性不是很显著(r=0.5；P<；0.001)，与空腹血糖水平没有明显的相关性(r=0.24；P=NS)。空腹血糖：I与S(I)的相关性要强于与糖耐量试验期间的血糖和胰岛素反应的相关性。唯一较强的相关性是OGTT2 h G：I比值(r=0.74；P<；0.001)。以S(I)为因变量，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表明，在模型中，只有空腹G：I比值对S(I)有显著预测作用(F=38.1；P<；0.001)。以空腹G/I<4.5值作为PCOS胰岛素抵抗的筛查指标(以S(I)<10百分位数作为胰岛素抵抗的证据)，其敏感性为95%，特异性为84%，阳性预测值为87%，阴性预测值为94%。受试者操作员曲线分析显示，空腹G：I比值是检测胰岛素抵抗的最佳筛查指标。我们得出结论，空腹G：I比率可作为肥胖的非西班牙裔白人PCOS妇女胰岛素抵抗的筛查试验。这可能是一个临床上有用的参数，用于选择最有可能对改善胰岛素敏感性的治疗干预有效的多囊卵巢综合征患者。
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 i.v. 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/m2) 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 S(I) 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.