摘要
目的比较多囊卵巢综合征(PCOS)患者不同体质量指数(BMI)组间内分泌激素水平、糖脂代谢参数及临床表现的差异,探讨抗苗勒管激素(AMH)与BMI等指标的相关性。方法选取2020年1月至2022年10月在扬州市妇幼保健院确诊并治疗的167例PCOS患者为研究对象。根据患者不同的BMI分为3组:18.5 kg/m^(2)<BMI<24.0 kg/m^(2)为正常体重组(n=14)、24.0 kg/m^(2)≤BMI<28.0 kg/m^(2)为超重组(n=25)、BMI≥28.0 kg/m^(2)为肥胖组(n=128),比较3组患者的一般情况、内分泌激素水平、糖脂代谢相关参数及临床表现。采用Pearson相关性分析,分析BMI与内分泌激素水平及糖脂代谢指标之间的关系;分析AMH对PCOS患者卵巢多囊样改变的影响。结果肥胖组患者的臀围(HC)、腰围(WC)、腰臀比(WHR)等显著高于正常体重组(P<0.05)。肥胖组患者的血清LH/FSH、LH、AMH和性激素结合球蛋白(SHBG)水平均显著低于正常体重组(P<0.05)。肥胖组血清总胆固醇(TC)、低密度脂蛋白(LDL)和空腹血糖(FPG)水平显著高于其他两组(P<0.05);正常体重组高密度脂蛋白(HDL)和25-羟维生素D_(3)(25-OH-D_(3))水平显著高于其他两组(P<0.05),而甘油三酯(TG)、尿酸(UA)、空腹胰岛素(FINS)和稳态模型胰岛素抵抗指数(HOMA-IR)显著低于其他两组(P<0.05)。肥胖组临床表现中黑棘皮、糖耐量受损和代谢综合征的发生率显著高于其他两组(P<0.05)。Pearson相关性分析结果显示,PCOS患者的BMI与AMH、FPG、FINS、HOMA-IR、TG、TC、HDL、LDL均存在统计学相关性(P<0.05),PCOS患者血清AMH和25-OH-D_(3)存在显著负相关(r=-0.245,P=0.005)。卵巢多囊样改变PCOS患者的AMH水平显著高于无多囊样改变的患者[(6.78±2.74)ng/ml vs.(5.68±2.37)ng/ml,P<0.05]。结论肥胖PCOS患者更易出现内分泌紊乱和糖脂代谢异常。BMI值越高者,其内分泌紊乱更加明显,更容易导致代谢综合征;AMH水平越高者,更易发生卵巢多囊样改变。
Objective:To explore the endocrine hormone levels,glycolipid metabolism parameters and clinical features of PCOS patients with different body mass indices(BMI),and to investigate the correlation of anti-Müllerian hormone(AMH)levels and BMI.Methods:A total of 167 PCOS patients diagnosed and treated in Yangzhou Maternal and Child Care Service Center from January 2020 to October 2022 were recruited.The patients were divided into three groups based on their BMI:normal group(18.5 kg/m^(2)<BMI<24.0 kg/m^(2),n=14),the overweight group(24.0 kg/m^(2)≤BMI<28.0 kg/m^(2),n=25)and the obesity group(BMI≥28.0 kg/m^(2),n=128).Basic characteristics,endocrine hormone levels,glucose and lipid metabolism parameters and clinical manifestations were compared among the three groups.Pearson correlation analysis was used to analyze the relationship between BMI and endocrine hormone levels,glucose and lipid metabolism parameters.The relationship between AMH and polycystic changes in the ovaries was analyzed.Results:The hip circumference(HC),waist circumference(WC)and waist to hip ratio(WHR)in the obesity group were significantly higher than those of the normal group(P<0.05).The serum levels of LH/FSH,LH,AMH and sex hormone-binding globulin(SHBG)in the obesity group were significantly lower than those in the normal group(P<0.05).The serum levels of total cholesterol(TC),low-density lipoprotein(LDL)and fasting blood glucose(FPG)in obesity group were significantly higher than those of other two groups(P<0.05).The serum levels of high-density lipoprotein(HDL)and 25-OH-D_(3)in the normal group were significantly higher than those in other two groups,while the serum levels of triglycerides(TG),uric acid(UA),fasting insulin(FINS)and homeostasis model assessment of insulin resistance(HOMA-IR)were significantly lower(P<0.05).The incidence of clinical manifestations of acanthosis nigricans,impaired glucose tolerance and metabolic syndrome was significantly higher in the obesity group than those in other two groups(P<0.05).Pearson correlation analysis showed significant correlations between BMI and the levels of AMH,FPG,FINS,HOMA-IR,TG,TC,HDL and LDL(P<0.05).The AMH level had a significantly negative correlation with 25-OH-D_(3)level in PCOS patients(r=-0.245,P=0.005).The level of AMH in patients with polycystic ovarian changes was significantly higher than that in patients without polycystic ovarian changes[(6.78±2.74)ng/ml vs.(5.68±2.37)ng/ml,P<0.05].Conclusions:PCOS patients in the obesity group were more likely to have endocrine disorders and abnormal glucose and lipid metabolism.The higher the BMI,the more severe the endocrine disorders,which was prone to metabolic syndrome.The higher the AMH,the more severe polycystic ovarian changes for PCOS patients.
作者
蒋荣
徐扬
JIANG Rong;XU Yang(Yangzhou University Medical College,Yangzhou 225001;Suzhou Hospital of Integrated Traditional Chinese and Western Medicine,Suzhou 215101;Yangzhou Maternal and Child Health Care Hospital in Jiangsu Province,Yangzhou 225001;Yangzhou Maternal and Child Health Care Hospital Affiliated to Yangzhou University Medical College,Yangzhou 225001)
出处
《生殖医学杂志》
CAS
2024年第8期1038-1044,共7页
Journal of Reproductive Medicine
基金
江苏省妇幼保健科研项目(F202324)
扬州市科技计划基金资助项目(YZ2023110)。
关键词
多囊卵巢综合征
体质量指数
抗苗勒管激素
糖代谢
脂代谢
Polycystic ovary syndrome
Body mass index
Anti-Müllerian hormone
Carbohydrate metabolism
Lipid metabolism
