生殖医学杂志

目的 探究多囊卵巢综合征（PCOS）患者肠道菌群水平与糖代谢的关系及对PCOS伴胰岛素抵抗（IR）的预测价值。方法 选取南通市妇幼保健院在2022年7月至2024年7月间收治的102例PCOS患者为研究组，另选取同期在我院健康体检女性105例为对照组，所有受试者均进行肠道菌群检测。根据研究组患者是否伴有IR将其分为IR组（n=61）和非IR组（n=41）两个亚组，进行糖代谢指标测定，分析研究组患者肠道菌群水平与糖代谢指标的相关性、PCOS伴IR的影响因素和肠道菌群水平对PCOS伴IR的预测效能。结果 研究组体质量指数（BMI）、肠球菌、肠杆菌水平显著高于对照组（P<0.05），而双歧杆菌、乳酸杆菌水平显著低于对照组（P<0.05）。研究组中IR亚组的肠杆菌水平、糖化血红蛋白、空腹血糖、空腹胰岛素（FINS）、BMI、甘油三酯（TG）和睾酮（T）水平显著高于非IR亚组，而双歧杆菌、乳酸杆菌和高密度脂蛋白胆固醇（HDL-C）水平显著低于非IR亚组（P<0.05）。Logistic分析显示，肠杆菌水平[OR=2.754,95%CI(1.693,4.478)]）、双歧杆菌水平[OR=0.265,95%CI(0.128,0.561)]、乳酸杆菌水平[OR=0.251,95%CI(0.134,0.469)]、FINS水平[OR=4.046,95%CI(2.369,6.908)]和HDL-C水平[OR=0.203,95%CI(0.074,0.557)]是PCOS患者伴IR的独立影响因素（P<0.05）。ROC曲线显示，肠杆菌、双歧杆菌、乳酸杆菌及三者联合预测PCOS伴IR的曲线下面积（AUC）分别为0.786、0.797、0.800和0.912(P<0.05)。Pearson法分析显示，PCOS患者双歧杆菌、乳酸杆菌水平与FINS水平呈负相关（P<0.05），肠杆菌水平与FINS呈正相关（P<0.05）。结论 PCOS患者肠道菌群水平与糖代谢水平有关，肠杆菌、双歧杆菌、乳酸杆菌水平对PCOS伴IR有一定预测效能，联合检测效能较高。

Objectives:To explore the relationship between gut microbiota levels and glucose metabolism in patients with polycystic ovary syndrome(PCOS)and its predictive value for PCOS with insulin resistance(IR).Methods:A total of 102 patients with PCOS admitted to Nantong Maternal and Child Health Hospital from July 2022 to July 2024 were selected as the study group,and 105 healthy subjects in the same hospital during the same period were selected as the control group.All subjects were tested for gut microbiota level.According to whether the patients in the study group were accompanied by IR,they were divided into two subgroups as IR group(n=61)and non-IR group(n=41).The glucose metabolism indexes were measured,and the correlation between the level of gut microbiota and glucose metabolism indexes in the study group,the influencing factors of PCOS with IR,and the predictive efficacy of gut microbiota level for PCOS with IR were analyzed.Results:The body mass index(BMI),Enterococcus and Enterobacterin the study group were higher than those in the control group(P<0.05),and the levels of Bifidobacteriumand Lactobacillus were lower than those in the control group(P<0.05).The levels of Enterobacter,glycated hemoglobin,fasting blood glucose,fasting insulin(FINS),BMI,triglycerides(TG)and testosterone(T)in the IR group were higher than those in the non-IR group,while the levels of Bifidobacterium,Lactobacillus and high-density lipoprotein cholesterol(HDL-C)were lower than those in the non-IR group(P<0.05).The logistic results showed that the levels of Enterobacter [OR=2.754,95%CI(1.693,4.478)],Bifidobacterium[OR=0.265,95%CI(0.128,0.561)]and Lactobacillus [OR=0.251,95%CI(0.134,0.469)],FINS[OR=4.046,95%CI(2.369,6.908)]and HDL-C [OR =0.203,95%CI(0.074,0.557)]were independent influencing factors of IR in PCOS patients(P<0.05).The receiver operating characteristic curve showed that the area under the curve(AUC)of Enterobacterium,Bifidobacterium,Lactobacillus and the combination of the above three to predict PCOS with IR was 0.786,0.797,0.800 and 0.912,respectively(P<0.05).Pearson analysis showed that the FINS level in PCOS patients was negatively correlated with Bifidobacteriumand Lactobacillus levels,while positively correlated with Enterobacterium level(P<0.05).Conclusions:The level of gut microbiota in PCOS patients is related to the level of glucose metabolism.The levels of Enterobacter,Bifidobacteriumand Lactobacillus have a certain predictive value for PCOS with IR,and the detection efficiency of combination of the above three is high.