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2019, Número 2

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Rev Cuba Endoc 2019; 30 (2)


Resistencia a la insulina en mujeres con síndrome de ovario poliquístico

Monteagudo PG, González SR, Gómez AM, Ovies CG, Menocal AA, Rodríguez MK, Puentes CJ, Bell HYM

Idioma: Español
Referencias bibliográficas: 57
Paginas: 1-22
Archivo PDF: 649.98 Kb.


RESUMEN

Introducción: La resistencia a la insulina es frecuente en el síndrome de ovario poliquístico, con diferencias entre fenotipos y discrepancias sobre cómo medirla.
Objetivo: Identificar trastornos de la sensibilidad y resistencia a la insulina en mujeres con síndrome de ovario poliquístico, y determinar si es mayor en el fenotipo clásico.
Métodos: Incluyó 152 mujeres: 45 sin síndrome de ovario poliquístico (Grupo I); 46 con síndrome de ovario poliquístico clínico (Grupo II); 61 con síndrome de ovario poliquístico clásico (Grupo III). Se realizó prueba de tolerancia a la glucosa oral, se calcularon índices de sensibilidad o resistencia a la insulina en ayunas (HOMA-IR, I0/G0, FIRI, ISI, Belfiore, Bennet, Quicki, Raynaud) y en la prueba de tolerancia a la glucosa oral (Belfiore2, Ribel, Ins2glu2, ATI, IITotal, DATI/DATG, Matsuda, BetaHOMA). Se emplearon las pruebas de Kruskal-Wallis, Mann-Whitney y Chi cuadrado.
Resultados: Las mujeres con síndrome de ovario poliquístico tenían más obesidad global y central (p < 0,05), más nivel de glucemia a los 30, 120 y 180 minutos de la prueba de tolerancia a la glucosa oral (p < 0,05) y de insulinemia a los 30, 60 y 120 (p < 0,0001), lo que fue mayor en el grupo III. Se diagnosticó intolerancia en ayunas en una mujer de cada grupo y tolerancia alterada en una del II y III. No hubo diferencias significativas entre grupos para los índices de sensibilidad o resistencia a la insulina en ayunas; ni del HOMA entre mujeres normopeso vs. sobrepeso-obesidad (p > 0,05). La mediana de los índices de la prueba de tolerancia a la glucosa oral fue menor para los de sensibilidad (Belfiore2, Ribel) y mayor para los de resistencia a la insulina (Ins2glu2, ATI, IITotal) en el Grupo III. El DATI/DATG, Matsuda y BetaHOMA no tuvieron diferencias significativas.
Conclusiones: Las mujeres con síndrome de ovario poliquístico tienen mayor respuesta glucémica, resistencia a la insulina e hiperinsulinismo postsobrecarga de glucosa que las mujeres con función ovárica normal, más manifiesta en el fenotipo clásico. Los índices de ayuno son menos sensibles, independientemente del peso corporal. Tienen mayor utilidad: insulinemia a los 60 minutos de la prueba de tolerancia a la glucosa oral, Belfiore2, ATI e IITotal.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Teede HJ, Misso ML, Costello MF, Dokras A, Laven J, Moran L, et al. International PCOS Network. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Hum Reprod. 2018;33(9):1602-18. doi: 10.1093/humrep/dey256

  2. Lizneva D, Kirubakaran R, Mykhalchenko K, Suturina L, Chernukha G, Diamond MP, et al. Phenotypes and body mass in women with polycystic ovary syndrome identified in referral versus unselected populations: systematic review and meta-analysis. Fertil Steril. 2016;106(6):1510-20.

  3. Vázquez AK, Delgado AA, Fuentes C, Monroy F. Síndrome de ovario poliquístico. Rev Med Clin. 2018;2(2):75-86.

  4. McCartney CR, Marshall JC. Polycystic Ovary Syndrome. N Engl J Med. 2016;375(1):54-64. doi:10.1056/NEJMcp1514916.

  5. Huang R, Zheng J, Li S, Tao T, Ma J, Liu W. Characteristics and contributions of hyperandrogenism to insulin resistance and other metabolic profiles in polycystic ovary syndrome. Acta Obstet Gynecol Scand. 2015;94:494-500.

  6. Goodman NF, Cobin RH, Futterweit W, Glueck JS, Legro RS, Carmina E. American Association of Clinical Endocrinologists, American College of Endocrinology, and Androgen Excess And PCOS Society Disease State Clinical Review: Guide to the best practices in the evaluation and treatment of Polycystic Ovary Syndrome Part 1. Endocr Pract. 2015; 21(11):1291-300.

  7. Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Futterweit W, et al. Criteria for defining polycystic ovary syndrome as a predominantly hyperandrogenic syndrome: an Androgen Excess Society guideline. J Clin Endocrinol Metab. 2006;91:4237-45.

  8. Lewandowski KC, Skowrońska E, Łukasiak K, Gałuszko K, Dukowicz A, Cedro M, et al. How much insulin resistance in polycystic ovary syndrome? Comparison of HOMA-IR and insulin resistance (Belfiore) index models. Arch Med Sci. 2019 [acceso: 17 Dic 2019];15(3):613-8. Disponible en: https://doi.org/10.5114/aoms.2019.82672

  9. Szosland K, Lewiński A. In quest for method of insulin resistance assessment in everyday clinical practice – insulin resistance indices. Diabetes Metab Syndr Clin Res Rev. 2016;10S:S120-5.

  10. Aziz M, Sidelmann JJ, Faber J, Wissing ML, Naver KV, Mikkelsen AL, et al. Polycystic ovary syndrome: cardiovascular risk factors according to specific phenotypes. Acta Obstet Gynecol Scand. 2015;94:1082-9.

  11. The Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril. 2004;81:19-25.

  12. Trout KK, Homko C, Tkacs NC. Methods of Measuring Insulin Sensitivity. Biol Res Nurs. 2007;8:305-9.

  13. Belfiore F, Iannello S, Volpicelli G: Insulin sensitivity indices calculated from basal and OGTT-induced insulin, glucose, and FFA levels. Mol Genet Metab. 1998;63:134-14.

  14. Raynaud E, Perez-Martin A, Brun JF, Benhaddad AA, Mercier J: Revised concept for the estimation of insulin sensitivity from a single sample. Diabetes Care. 1999;22:1003-4.

  15. González R, Arranz C. Evaluación de la secreción de insulina y la sensibilidad a la insulina por medio de la prueba de tolerancia a la glucosa por vía oral. Estudio en sujetos con tolerancia a la glucosa normal. Rev Cubana Endocrinol. 2000;11:23-30.

  16. Glintborg D, Andersen M. Morbidity in polycystic ovary síndrome. Eur J Endocrinol. 2017;176:R53-R65.

  17. Orio F, Muscogiuri G, Nese C, Palomba S, Savastano S, Tafuri D, et al. Obesity, type 2 diabetes mellitus and cardiovascular disease risk: an update in the management of polycystic ovary syndrome. Eur J Obstet Gynecol. 2016;207:214-9.

  18. Hart R, Doherty DA. The potential implications of a PCOS diagnosis on a woman's long-term health using data linkage. J Clinical Endocrinol Metabol. 2015;3:911-9.

  19. Glintborg D, Hass RK, Nybo M, Abrahamsen B, Andersen M. Morbidity and medicine prescriptions in a nationwide Danish population of patients diagnosed with polycystic ovary syndrome. Eur J Endocrinol. 2015;5:627-38.

  20. Lim SS, Davies MJ, Norman RJ, Moran LJ. Overweight, obesity and central obesity in women with polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update. 2012;6:618-37.

  21. Alberti KGMM, Zimmet P, Shaw J. International Diabetes Federation: a consensus on type 2 diabetes prevention. Diabet Med. 2007;24:451-63.

  22. Escobar-Morreale HF, Roldán-Martín MB. Type 1 Diabetes and Polycystic Ovary Syndrome: Systematic Review and Meta-analysis. Diabetes Care. 2016;39:639-48. doi: 10.2337/dc15-2577

  23. Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale H, Futterweit W, et al. The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report. Fertil Steril. 2009;91(2):456-88.

  24. Facio A, Pérez-Palacio M, Molina J, Martínez-Sánchez M. Síndrome de ovario poliquístico y complicaciones metabólicas: más allá del exceso de andrógenos. Rev Chil Obstet Ginecol. 2015;80(6):515-9.

  25. Wild R, Carmina E, Diamanti-Kandarakis E, Dokras A, Escobar-Morreale HF, Futterweit W, et al. Assessment of Cardiovascular Risk And Prevention of Cardiovascular Disease In Women With The Polycystic Ovary Syndrome: A Consensus Statement By The Androgen Excess And Polycystic Ovary Syndrome (Ae-Pcos) Society. J Clin Endocrinol Metab. 2010;95(5):2038-49.

  26. Barber TM, Dimitriadis GK, Andreou A, Franks S. Polycystic ovary syndrome: insight into pathogenesis and a common association with insulin resistance. Clin Med (Northfield Il). 2015;15(S6):s72-6. doi:10.7861/clinmedicine.15-6-s72.

  27. Hurd WW, Abdel-Rahman MY, Ismail SA, Abdellah MA, Schmotzer CL, Sood A. Comparison of diabetes mellitus and insulin resistance screening methods for women with polycystic ovary syndrome. Fertil Steril. 2011;96(4):1043-7. doi:10.1016/j.fertnstert.2011.07.002

  28. Diamanti-Kandarakis E, Kouli CH, Alexandraki K, Spina G. Failure of mathematical indices to accurately assess insulin resistance in lean, overweight, or obese women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2004;89:1273-76.

  29. Gutch M, Kumar S, Razi SM, Gupta JJ, Gupta A. Assessment of insulin sensitivity/resistance. Indian J Endocrinol Metab. 2015;19:160-4

  30. Wallace TM, Levy JC, Matthews DR. Use and abuse of HOMA modeling. Diabetes Care. 2004;27:1487-95

  31. Quon MJ. Limitations of the fasting glucose to insulin ratio as an index of insulin sensitivity. J Clin Endocrinol Metab. 2001; 86:4615-17.

  32. American Association of Clinical Endocrinologists Polycystic Ovary Syndrome Writing Committee. American Association of Clinical Endocrinologists position statement on metabolic and cardiovascular consequences of polycystic ovary syndrome. Endocr Pract. 2005;11:126-34.

  33. Lewandowski KC, Płusajska J, Horzelski W, Bieniek E, Lewiński A. Limitations of insulin resistance assessment in polycystic ovary syndrome. Endocrine Connections. 2018;7:403-12.

  34. Polak K, Czyzyk A, Simoncini T, Meczekalski B. New markers of insulin resistance in polycystic ovary syndrome. J Endocrinol Invest. 2017;40:1-8. DOI 10.1007/s40618-016-0523-8

  35. Ciampelli M, Leoni F, Cucinelli F, Mancuso S, Panunzi S, De Gaetano A. Assessment of insulin sensitivity from measurements in the fasting state and during an oral glucose tolerance tests in polycystic ovary syndrome and menopausal patients. J Clin Endocrinol Metab. 2005;90:1398-406.

  36. Cobin RH, Nestler JE, Jellinger PS, Redmond GP. American Association of Clinical Endocrinologist Posistion Statement on Metabolic and Cardiovascular Consequences of Polycystic Ovary Syndrome. Endocrine Practice. 2005;11(2):125-35.

  37. Vrblková J, Cibula D, Dvosakova K, Stanicka S, Sindelka G, Hill M, et al. Insulin Sensitivity in Woman with Polycystic Ovary Syndrome. J Clin Endocrinol Metabol. 2004;89(6):2942-5.

  38. Dumesic DA, Oberfield SE, Stener-Victorin E, Marshall JC, Laven JS, Legro RS. Scientific Statement on the Diagnostic Criteria, Epidemiology, Pathophysiology, and Molecular Genetics of Polycystic Ovary Syndrome. Endocr Rev. 2015;36(5):487-525. doi: 10.1210/er.2015-1018

  39. Federação Brasileira das Associações de Ginecologia e Obstetrícia (FEBRASGO). Síndrome dos ovários policísticos. São Paulo, Série, Orientações e Recomendações FEBRASGO, no.4, 2018. 103p.

  40. Milewicz A, Kudła M, Spaczyński RZ, Dębski R, Męczekalski B, Wielgoś M, et al. The polycystic ovary syndrome: a position statement from the Polish Society of Endocrinology, the Polish Society of Gynaecologists and Obstetricians, and the Polish Society of Gynaecological Endocrinology. Endokrynol Pol 2018;69(4):328-6. DOI: 10.5603/EP.2018.0046

  41. Meyer BP. McGrath F, Teede HJ. Overweight Women with Polycystic Ovary Syndrome Have Evidence of Subclinical Cardiovascular Disease. J Clin Endocrinol Metab. 2005;90:5711-6.

  42. Cascelle T, Palomba S, De Sio I, Manguso F, Giallauria F, De Simone B, et al.Visceral fat is associated with cardiovascular risk in women with polycystic ovary syndrome. Hum Reprod. 2008;23:153-9.

  43. García Y, Monteagudo G, Padrón RS, González R. Evaluación de la sensibilidad a la insulina en el síndrome de ovarios poliquísticos. Rev. Cubana Endocrinol. 2009 [acceso 20 Mar 2018];20(3) Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S1561-29532009000300006

  44. Azziz R. Polycystic ovary syndrome, insulin resistance and molecular defects of insulin signaling. J Clin Endocrinol Metab. 2002; .87:4085-7.

  45. Dunaif A, Wu X, Lee A, Diamanti-Kandarakis E. Defects in insulin receptor signaling in vivo in the polycystic ovary syndrome (PCOS). Am J Physiol Endocrinol Metab. 2001;281(2):E392–9.

  46. Escobar-Morreale HF, San Millán JL. Abdominal adiposity and the polycystic ovary syndrome. Trends Endocrinol Metab. 2007;18:266-72.

  47. Saxena P, Prakash A, Nigam A, Mishra A. Polycystic ovary syndrome: is obesity a sine qua non? A clinical, hormonal, and metabolic assessment in relation to body mass index. Indian J Endocrinol Metab. 2012;16:996-9.

  48. Franik G, Bizoń A, Włoch S, Pluta D, Blukacz L, Milnerowicz H, Madej P. The effect of abdominal obesity in patients with polycystic ovary syndrome on metabolic parameters. Eur Rev Med Pharmacol Sci. 2017; 21:4755-61.

  49. Corbould A, Kim YB, Youngren JF, Pender C, Kahn BB, Lee A, et al. Insulin resistance in the skeletal muscle of women with PCOS involves intrinsic and acquired defects in insulin signaling. Am J Physiol Endocrinol Metab. 2005;288(5):E1047-54.

  50. Carmina E, Lobo RA. Use of fasting blood to assess the prevalence of insulin resistance in women with polycystic ovary syndrome. Fertil Steril. 2004; 82:661-5.

  51. Diamanti-Kandarakis E, Dunaif A. Insulin resistance and the polycystic ovary syndrome revisited: an update on mechanisms and implications. Endocr Rev. 2012;33:981-1030.

  52. Nölting M, Lana M. Pautas para el diagnóstico y tratamiento de los grandes síndromes endocrino-ginecológicos. Estados hiperandrogénicos. 3ra ed. Buenos Aires, Argentina: Ed. Ascune; 2016. p. 119-42.

  53. Fauser BC, Tarlatzis BC, Rebar RW, Legro RS, Balen AH, Lobo R, et al. Consensus On Women's Health Aspects of Polycystic Ovary Syndrome (PCOS): the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group. Fertil Steril. 2012;97:28-38.

  54. Çelik E, Türkçüoğlu I, Ata B, Karaer A, Kırıcı P, Eraslan S, et al. Metabolic and carbohydrate characteristics of different phenotypes of polycystic ovary syndrome. J Turk Ger Gynecol Assoc. 2016;17(4):201-8.

  55. Gameza JM, Abruzzeseb G, Cerronec G, Lioyd G, Mormandia E, Oteroa P, el al. Síndrome de ovario poliquístico: fenotipos y enfermedad cardiovascular. Rev Argent Endocrinol Metab. 2016;53(4):149-56

  56. Jamil AS, Alalaf SK, Al-Tawil NG, Al-Shawaf T. A case–control observational study of insulin resistance and metabolic syndrome among the four phenotypes of polycystic ovary syndrome based on Rotterdam criteria. Reproductive Health 2015 [acceso 20 Mar 2018)];12:7. Disponible en: http://www.reproductive-health-journal.com/content/12/1/7

  57. Panidis D, Macut D, Tziomalos K, Papadakis E, Mikhailidis K, Kandaraki EA, et al. Prevalence of metabolic syndrome in women with polycystic ovary syndrome. Clinical Endocrinology. 2013;78:586-92. doi:10.1111/cen.12008




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