摘要
目的分析总结肥胖型多囊卵巢综合征(PCOS)患者的临床及内分泌代谢特征。方法对象为肥胖型PCOS(A组)70例、非肥胖型(B组)122例以及同期就诊的输卵管因素不孕症患者104例(其中单纯肥胖25例,C组;正常体重79例,D组)作为对照。对上述对象进行临床体征评分,内分泌、代谢指标测定。采用雄激素指数(FAI)评估雄激素增多症,用稳态模型指数(HOMA IR)、胰岛素曲线下面积(IAUC)评估胰岛素敏感性,HOMA-IS、ΔI30/ΔG30评估胰岛β细胞功能。结果(1)A组患者的FAI(3.40±1.84)高于B组(1.75±1.20)和C组(1.65±0.90),P均<0.01。B组黄体生成素(LH)/卵泡刺激素(FSH)比值(2.41±1.13)高于A、C、D组,P均<0.01。(2)192例患者总的胰岛素抵抗发生率为43.23%,A、B组分别为82.86%及20.49%。A组黑棘皮症发生率、空腹胰岛素、IAUC、HOMA IR及甘油三酯水平均高于B组(P均<0.01)。A、B、D组间HOMA IS、ΔI30/ΔG30差异无统计学意义(P>0.05)。(3)人体质量指数、腰臀比与FAI、HOMA-IR均呈正相关(P均<0.01);与LH/FSH比值呈负相关(r=-0.345、-0.260,P<0.01)。结论肥胖型PCOS患者较非肥胖型存在更严重的内分泌及代谢紊乱,胰岛β细胞功能处于代偿期,其远期并发症的防治应受到高度重视。
Objective To investigate and analyze the clinical presentation, hormonal profile, and metabolic abnormalities of obese women with polycystic ovary syndrome （PCOS）. Methods The data of the anthropometric measurements, clinical manifestations of hyperandrogenism, serum levels of luteininzing hormone （LH）, follicle stimulating hormone （FSH）, estradiol （E2 ）, testosterone （T）, prolactin （PRL）, dehydro-epiandrosterone sulfate （ DHEAS ） , sex-hormone-binding globulin （ SGBG ） , and 17- oxyhydroprogesterone （17-OHP） , fasting plasma glucose （FPG） and fasting insulin （FINS） detected after oral glucose tolerance test （OGTY） , serum lipid levels, including total cholesterol （ Chol ） , triglycerides （TG） , high-density lipoprotein （HDL） , and low-density lipoprotein （LDL） , homeostasis model assessment （HOMA） and area under curve （AUC） so as to assess the insulin resistance （IR） , free androgen index （FAI） to estimate the extent of hyperandrogenism, HOMA IS and AI30/AG30 used to assess the function of islet 13 cells, were collected from 192 women with PCOS, aged 24 ± 6, that were divided into 2 groups according to the body mass index （BMI） ： Group A （n = 70） with the BMI≥25 kg · m^-2 and Group B （n = 122） with the BMI 〈 2 5 kg · m^-2, and 65 age-matched bilateral tubal block factor infertile women served as controls that were divided into 2 groups as well： Group C （n =25） with the BMI≥25 kg · m^-2; and Group D （ n = 79） with the BMI 〈 25 kg · m ^-2, and underwent a cross-sectional study. Results （ 1 ） Clinical phenotype： The presence of obesity was 36.46% （70/192） of which 80. 00% （56/70） was central obesity. The incidence of acanthosis nigricans was 17. 18% （33/192）, 35.71% in Group A and 6.56% in Group B. （P 〈0. 01 ） Groups A and C showed increased frequency of acanthosis nigricans compared with Group B. The value of FAI of Group A was 3.40 ± 1.84, significantly higher than those of Group B （ 1.75 ± 1.20） and GroupC （1.65±0.90）, （bothP〈0.01）. The LH/FSH ratio of Group Bwas2.41＋l. 13, significantly higher than those of Groups A, C, and D （all P 〈0. 01 ）. （2） Hormonal profile： The IR rate was 43.23% in the 192 patients, 82.86% in Group A and 20. 49% in Group B. The LH and LH/FSH ratio were significantly higher in Group B than in Groups A, C, and D （ all P 〈 0. 01 ） ; T level was higher in Groups A and B than in Group C and D （all P〈0.05）. SHBGwas lower in Group A （108.70±81.35 nmol· L^-1） and Group C （150.34± 106.23 nmol · L^-1） compared with Group B （192.49 ± 98.30 nmol · L^-1） and Group D （231.84 ±90.09 nmol · L^-1） （P 〈0.01 and P〈0.05）. FAI level was3.40 ± 1.84 in Group A, significantly higher than those of Groups B （ 1.75 ± 1.20） , C （ 1.65±0.90） , and D （0.84±0.45） （all P 〈0.01）. The FINS, TG, and HOMA IR of Groups A and C were all significantly higher than those of Groups B and D （all P 〈 0. 01 ）/The OGTY GAUC was significantly higher than those of Groups B, C, and D （ P = 0. 006, 0. 028, and 0. 031 respectively）. （3） Metabolic profile ： The prevalence of IR was 43.23% （83/192） with a higher prevalence rate in Group A （82. 76%, 58/70） compared with Group B （20. 49% , 25/122）. The values of FINS, HOMA IR, GAUC, IAUC, and TG were all higher in Group A than in Group B （ all P 〈 0. 01 ）. BMI and WHR were positively correlated with FAI and HOMA-IR （ all P 〈 0. 01 ）, whereas negatively correlated with LH/FSH ratio （ r = - 0. 345, - 0. 260, P 〈0. 01 ） There were no significant differences in HOMA-IS and ΔI30/ΔG30 among these groups （all P 〉 0.05 ）. Conclusion Obese PCOS women have more severe hyperandrogenism, IR and hyperinsulinism than normal-weight PCOS women, which may have some health implications later in life.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2005年第46期3266-3271,共6页
National Medical Journal of China
基金
上海市医学重点学科建设项目(05-3-016)
