基于改善胰岛素抵抗治疗多囊卵巢综合征的研究进展

doi:10.12280/gjfckx.20250829

摘要/Abstract

摘要：

胰岛素抵抗（insulin resistance，IR）是多囊卵巢综合征（polycystic ovary syndrome，PCOS）的关键病理生理驱动因素，56.3%的中国PCOS患者存在IR。虽然高胰岛素-正常葡萄糖钳夹试验是诊断IR的金标准，但基于临床可行性，稳态模型评估胰岛素抵抗指数（homeostasis model assessment of insulin resistance，HOMA-IR）等替代指标更为常用。生活方式干预是治疗的基石，高强度间歇训练通过增强骨骼肌葡萄糖代谢，显著改善胰岛素敏感性与生殖结局；限时进食和生酮饮食能够增强胰岛素敏感性，独立于减重效应之外改善内分泌及代谢指标。针对心理共病进行身心干预，亦有助于改善代谢，提升生活质量。药物治疗方面，除传统的胰岛素增敏药物二甲双胍外，亦有噻唑烷二酮类药物（如吡格列酮）在改善PCOS代谢水平方面展现出潜力。合理使用代谢补充剂亦可帮助PCOS患者恢复月经规律性并改善代谢指标。

关键词: 多囊卵巢综合征, 胰岛素抵抗, 生活方式干预, 胰岛素增敏药物, 代谢补充剂

Abstract:

Insulin resistance (IR) is a key pathophysiological driving factor for polycystic ovary syndrome (PCOS). Approximately 56.3% of Chinese PCOS patients have IR. Although the hyperinsulinemic-euglycemic clamp test is the gold standard for diagnosing IR, alternative indicators such as the homeostasis model assessment of insulin resistance (HOMA-IR) are more commonly used based on clinical feasibility. Lifestyle intervention is the cornerstone of treatment. High-intensity interval training can significantly improve insulin sensitivity and reproductive outcomes by enhancing skeletal muscle glucose metabolism. Time-restricted eating and ketogenic diet can enhance insulin sensitivity and improve endocrine and metabolic indicators independently of weight loss effects. Psychophysical interventions targeting psychological comorbidities also contribute to improving metabolism and enhancing the quality of life. In terms of drug therapy, apart from the traditional insulin-sensitizing drug metformin, thiazolidinediones (such as pioglitazone) have also shown potential in improving the metabolic level of PCOS. The rational use of metabolic supplements can also help PCOS patients restore menstrual regularity and improve metabolic indicators.

Key words: Polycystic ovary syndrome, Insulin resistance, Lifestyle intervention, Insulin-sensitizing drugs, Metabolic supplements

刘音, 宋殿荣. 基于改善胰岛素抵抗治疗多囊卵巢综合征的研究进展[J]. 国际妇产科学杂志, 2025, 52(6): 601-605.

LIU Yin, SONG Dian-rong. Research Progress on the Treatment of Polycystic Ovary Syndrome Based on Improving Insulin Resistance[J]. Journal of International Obstetrics and Gynecology, 2025, 52(6): 601-605.

参考文献 35

[1]	Huddleston HG, Dokras A. Diagnosis and Treatment of Polycystic Ovary Syndrome[J]. JAMA, 2022, 327(3):274-275. doi: 10.1001/jama.2021.23769. pmid: 35040896
[2]	Li W, Chen Q, Xie Y, et al. Prevalence and degree of insulin resistance in Chinese Han women with PCOS: Results from euglycemic-hyperinsulinemic clamps[J]. Clin Endocrinol(Oxf), 2019, 90(1):138-144. doi: 10.1111/cen.13860.
[3]	Tosi F, Bonora E, Moghetti P. Insulin resistance in a large cohort of women with polycystic ovary syndrome: a comparison between euglycaemic-hyperinsulinaemic clamp and surrogate indexes[J]. Hum Reprod, 2017, 32(12):2515-2521. doi: 10.1093/humrep/dex308.
[4]	Chang KJ, Chen JH, Chen KH. The Pathophysiological Mechanism and Clinical Treatment of Polycystic Ovary Syndrome: A Molecular and Cellular Review of the Literature[J]. Int J Mol Sci, 2024, 25(16):9037. doi: 10.3390/ijms25169037.
[5]	Sadeghi HM, Adeli I, Calina D, et al. Polycystic Ovary Syndrome: A Comprehensive Review of Pathogenesis, Management, and Drug Repurposing[J]. Int J Mol Sci, 2022, 23(2):583. doi: 10.3390/ijms23020583.
[6]	Chen F, Liao Y, Chen M, et al. Evaluation of the Efficacy of Sex Hormone-Binding Globulin in Insulin Resistance Assessment Based on HOMA-IR in Patients with PCOS[J]. Reprod Sci, 2021, 28(9):2504-2513. doi: 10.1007/s43032-021-00535-0. pmid: 33721297
[7]	Teede HJ, Tay CT, Laven J, et al. Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome[J]. Eur J Endocrinol, 2023, 189(2):G43-G64. doi: 10.1093/ejendo/lvad096.
[8]	Lee SH, Park SY, Choi CS. Insulin Resistance: From Mechanisms to Therapeutic Strategies[J]. Diabetes Metab J, 2022, 46(1):15-37. doi: 10.4093/dmj.2021.0280.
[9]	Richter EA, Bilan PJ, Klip A. A comprehensive view of muscle glucose uptake: regulation by insulin, contractile activity, and exercise[J]. Physiol Rev, 2025, 105(3):1867-1945. doi: 10.1152/physrev.00033.2024. pmid: 40173020
[10]	Koçak S, Çalışkan H, Ömercioğlu G, et al. The impact of high-intensity interval training on insulin resistance, oxidative stress, and muscle function in a PCOS rat model[J]. Physiol Behav, 2025, 291:114794. doi: 10.1016/j.physbeh.2024.114794.
[11]	Kiel IA, Lionett S, Parr EB, et al. High-Intensity Interval Training in Polycystic Ovary Syndrome: A Two-Center, Three-Armed Randomized Controlled Trial[J]. Med Sci Sports Exerc, 2022, 54(5):717-727. doi: 10.1249/MSS.0000000000002849.
[12]	Manoogian E, Chow LS, Taub PR, et al. Time-restricted Eating for the Prevention and Management of Metabolic Diseases[J]. Endocr Rev, 2022, 43(2):405-436. doi: 10.1210/endrev/bnab027.
[13]	唐露, 胡丽平, 李情姣, 等. 晨间限时进食法对超重/肥胖多囊卵巢综合征患者维生素D及糖脂代谢的影响[J]. 实用临床医药杂志, 2023, 27(18):127-132. doi: 10.7619/jcmp.20232294.
[14]	Velissariou M, Athanasiadou CR, Diamanti A, et al. The impact of intermittent fasting on fertility: A focus on polycystic ovary syndrome and reproductive outcomes in Women-A systematic review[J]. Metabol Open, 2025, 25:100341. doi: 10.1016/j.metop.2024.100341.
[15]	Paoli A, Bianco A, Moro T, et al. The Effects of Ketogenic Diet on Insulin Sensitivity and Weight Loss, Which Came First: The Chicken or the Egg?[J]. Nutrients, 2023, 15(14):3120. doi: 10.3390/nu15143120.
[16]	Cannarella R, Rubulotta M, Leonardi A, et al. Effects of ketogenic diets on polycystic ovary syndrome: a systematic review and meta-analysis[J]. Reprod Biol Endocrinol, 2025, 23(1):74. doi: 10.1186/s12958-025-01411-1.
[17]	Rossetti R, Strinati V, Caputi A, et al. A Ketogenic Diet Followed by Gradual Carbohydrate Reintroduction Restores Menstrual Cycles in Women with Polycystic Ovary Syndrome with Oligomenorrhea Independent of Body Weight Loss: Results from a Single-Center, One-Arm, Pilot Study[J]. Metabolites, 2024, 14(12):691. doi: 10.3390/metabo14120691.
[18]	Lin H, Liu M, Zhong D, et al. The Prevalence and Factors Associated With Anxiety-Like and Depression-Like Behaviors in Women With Polycystic Ovary Syndrome[J]. Front Psychiatry, 2021, 12:709674. doi: 10.3389/fpsyt.2021.709674.
[19]	Greenwood EA, Pasch LA, Cedars MI, et al. Insulin resistance is associated with depression risk in polycystic ovary syndrome[J]. Fertil Steril, 2018, 110(1):27-34. doi: 10.1016/j.fertnstert.2018.03.009. pmid: 29908775
[20]	Martin H, Bullich S, Martinat M, et al. Insulin modulates emotional behavior through a serotonin-dependent mechanism[J]. Mol Psychiatry, 2024, 29(6):1610-1619. doi: 10.1038/s41380-022-01812-3.
[21]	Carr A, Finneran L, Boyd C, et al. The evidence-base for positive psychology interventions: a mega-analysis of meta-analyses[J]. J Posit Psychol, 2024, 19(2):191-205. doi: 10.1080/17439760.2023.2168564.
[22]	Zhao K, Nie L, Ye X, et al. Effects of mind-body interventions on polycystic ovary syndrome: a comprehensive meta-analysis[J]. J Ovarian Res, 2024, 17(1):154. doi: 10.1186/s13048-024-01477-2. pmid: 39054488
[23]	Verma A, Upadhyay V, Saxena V. Effect of Yoga Therapy on Health Outcomes in Women With Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis[J]. Am J Lifestyle Med, 2023, 17(1):73-92. doi: 10.1177/15598276211029221.
[24]	Abdalla MA, Shah N, Deshmukh H, et al. Impact of metformin on the clinical and metabolic parameters of women with polycystic ovary syndrome: a systematic review and meta-analysis of randomised controlled trials[J]. Ther Adv Endocrinol Metab, 2022, 13:20420188221127142. doi: 10.1177/20420188221127142.
[25]	郑荔子, 彭占东, 刘丽丽. 二甲双胍联合低分子肝素钙对多囊卵巢综合征不孕症患者子宫内膜容受性和促甲状腺激素水平的影响[J]. 中国妇幼保健, 2024, 39(17):3347-3350. doi: 10.19829/j.zgfybj.issn.1001-4411.2024.17.030.
[26]	Sanoee MF, Neghab N, Rabiee S, et al. Metformin therapy decreases hyperandrogenism and ovarian volume in women with polycystic ovary syndrome[J]. Iran J Med Sci, 2011, 36(2):90-95. doi: 10.4236/ojemd.2015.54005.
[27]	Xu Y, Wu Y, Huang Q. Comparison of the effect between pioglitazone and metformin in treating patients with PCOS:a meta-analysis[J]. Arch Gynecol Obstet, 2017, 296(4):661-677. doi: 10.1007/s00404-017-4480-z. pmid: 28770353
[28]	Baillargeon JP, Jakubowicz DJ, Iuorno MJ, et al. Effects of metformin and rosiglitazone, alone and in combination, in nonobese women with polycystic ovary syndrome and normal indices of insulin sensitivity[J]. Fertil Steril, 2004, 82(4):893-902. doi: 10.1016/j.fertnstert.2004.02.127.
[29]	Liu Y, Li J, Yan Z, et al. Improvement of Insulin Sensitivity Increases Pregnancy Rate in Infertile PCOS Women: A Systemic Review[J]. Front Endocrinol(Lausanne), 2021, 12:657889. doi: 10.3389/fendo.2021.657889.
[30]	Zhao Q, He J. Efficacy and safety of metformin in pregnant women with polycystic ovary syndrome: a systematic review with meta-analysis of randomized and non-randomized controlled trials[J]. Gynecol Endocrinol, 2022, 38(7):558-568. doi: 10.1080/09513590.2022.2080194.
[31]	Unanyan A, Pivazyan L, Krylova E, et al. Effectiveness of inositol, metformin and their combination in women with PCOS undergoing assisted reproduction: systematic review and meta-analysis[J]. Gynecol Endocrinol, 2022, 38(12):1035-1046. doi: 10.1080/09513590.2022.2136160.
[32]	Wild RA, Carmina E, Diamanti-Kandarakis E, 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]. J Clin Endocrinol Metab, 2010, 95(5):2038-2049. doi: 10.1210/jc.2009-2724. pmid: 20375205
[33]	多囊卵巢综合征诊治路径专家共识编写组. 多囊卵巢综合征诊治路径专家共识[J]. 中华生殖与避孕杂志, 2023, 43(4):337-345. doi: 10.3760/cma.j.cn101441-20220927-00417.
[34]	张国忠, 胡艳梅, 伍学一. D-手性肌醇治疗多囊卵巢综合征患者的有效性Meta分析[J]. 四川医学, 2022, 43(1):11-19. doi: 10.16252/j.cnki.issn1004-0501-2022.01.003.
[35]	Greff D, Juhász AE, Váncsa S, et al. Inositol is an effective and safe treatment in polycystic ovary syndrome: a systematic review and meta-analysis of randomized controlled trials[J]. Reprod Biol Endocrinol, 2023, 21(1):10. doi: 10.1186/s12958-023-01055-z.