北京地区多囊卵巢综合征病人内分泌代谢特征分析

发布时间：2018-04-18 12:07

本文选题：多囊卵巢综合征 + 亚型　；参考：《首都医科大学学报》2017年04期

【摘要】：目的分析北京地区不同亚型多囊卵巢综合征(polycystic ovary syndrome,PCOS)病人临床特征及性激素、糖脂代谢特征。方法选择190例来自北京地区的女性,其中142例未经治疗的PCOS病人作为研究组,48例年龄匹配的健康女性作为对照组;根据2003鹿特丹PCOS诊断标准及美国国立卫生院(National Institute of Health,NIH)指南推荐将PCOS组病人分为4个亚型:亚型1,高雄激素+排卵异常(androgen excess+ovulatory dysfunction,AE+OD)40例;亚型2,高雄激素+卵巢多囊泡改变(androgen excess+polycystic ovarian morphology,AE+PCO)10例;亚型3,排卵异常+卵巢多囊泡改变(ovulatory dysfunction+polycystic ovarian morphology,OD+PCO)32例;亚型4,高雄激素+排卵异常+卵巢多囊泡改变(androgen excess+ovulatory dysfunction+polycystic ovarian morphology,AE+OD+PCO)60例。测量所有受试者的临床特征;测定血清性激素浓度及糖、脂代谢指标。结果 PCOS组病人的体质量指数(body mass index,BMI)、腰臀比(waist and hip ratio,WHR)、血清总睾酮(total testosterone,T)、黄体生成素(luteinizing hormone,LH)、LH/卵泡刺激素(follicle stimulating hormone,FSH)比值均高于对照组,差异有统计学意义(P0.05);血清总胆固醇(total cholesterol,TC)、低密度脂蛋白胆固醇(low density lipoprotein-cholesterol,LDL-C)、三酰甘油(triglycerides,TG)及载脂蛋白B(apolipoprotein B,Apo B)浓度、Apo B/Apo A比值及空腹胰岛素(fasting insulin,INS)、胰岛素抵抗指数(homeostatic model assessment of insulin resistance,HOMA-IR)高于对照组,高密度脂蛋白胆固醇(high density lipoprotein-cholesterol,HDL-C)和载脂蛋白A(apolipoprotein A,Apo A)浓度低于对照组,差异有统计学意义(P0.05)。亚型1的BMI、WHR、T及LDL均高于亚型3,TC及LDL较亚型2增高;亚型4的BMI、T及LDL高于亚型3,T、LH及LH/FSH较亚型2增高,差异有统计学意义(P0.05);亚型2和亚型3之间各个临床特征及糖脂代谢参数的差异无统计学意义(P0.05)。结论北京地区PCOS病人中向心性肥胖、脂代谢紊乱及胰岛素抵抗和高胰岛素血症的发病率较健康女性明显升高;同时具备排卵异常和高雄的亚型1和亚型4这2个亚型的脂代谢紊乱及胰岛素抵抗可能比较严重,而月经正常的亚型2和无高雄的亚型3其代谢变化相对比较温和,临床应加以区分并强调个体化治疗。
[Abstract]:Objective to analyze the clinical characteristics of polycystic ovary syndromes (PCOS) patients with different subtypes of polycystic ovary syndrome (PCOS) in Beijing.Methods A total of 190 women from Beijing were selected, including 142 untreated PCOS patients as the study group and 48 age-matched healthy women as the control group.According to the 2003 Rotterdam PCOS diagnostic criteria and the National Institute of HealthNIH guidelines, the patients in the PCOS group were divided into four subtypes: subtype 1, androgen excess ovulatory dysfunctional AE OD)40;Subtype 2, androgen excess polycystic ovarian morphologyae PCO)10; subtype 3, ovulatory dysfunction polycystic ovarian morphologyOD PCO)32; subtype 4, androgen excess ovulatory dysfunction polycystic PCO)60.The clinical characteristics of all subjects were measured, and the serum sex hormone concentration and metabolic indexes of sugar and lipid were measured.Results in PCOS group, the body mass index (BMI), waist hip ratio (WHR), total testosterone (T), total testosterone (T), luteinizing hormone (LH) / follicle stimulating hormone (FSH) were higher than those in control group.There were significant differences in serum total cholesterol (total cholesterol), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), low density lipoprotein cholesterol (LDL-C), triglyceridesl (TGG), apolipoprotein (B(apolipoprotein), apolipoprotein (Apolipoprotein), apolipoprotein (B(apolipoprotein), B(apolipoprotein B/Apo A ratio, fasting insulin insulin insulin resistance index (HOMA-IRR), serum total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), triglycerides (TG) and apolipoprotein (B(apolipoprotein), and fasting insulin insulin (ins), insulin resistance index (ISR) was higher than that in control group (P < 0.05).High density lipoprotein cholesterol (HDL-C) and apolipoprotein A(apolipoprotein apo A (high density lipoprotein cholesterol) were significantly lower than those in the control group (P 0.05).In subtype 1, BMIT and LDL were higher than those in subtype 3TC and LDL, and the levels of BMIT and LDL in subtype 4 were higher than those in subtype 3, Th, LH and LH/FSH were higher than those in subtype 2.The difference was statistically significant (P 0.05), but there was no significant difference between subtype 2 and subtype 3 in the clinical characteristics and the metabolic parameters of glucose and lipid.Conclusion the incidence of concentric obesity, lipid metabolism disorder, insulin resistance and hyperinsulinemia in PCOS patients in Beijing area is significantly higher than that in healthy women.The dyslipidemia and insulin resistance of subtypes 1 and 4 with abnormal ovulation and Kaohsiung subtype 4 may be more serious, but the metabolic changes of subtype 2 with normal menstruation and subtype 3 without Kaohsiung are relatively mild.Clinical treatment should be differentiated and individualized.
【作者单位】：首都医科大学附属北京妇产医院内分泌科;德国图宾根大学妇产医院内分泌与绝经中心;
【基金】：首都临床特色应用研究与成果推广(Z161100000516143) 首都卫生发展科研专项项目(2016-2-2113) 北京市医院管理局临床技术创新项目(XMLX201710) 北京市卫生系统高层次卫生技术人才(学科带头人)(2014-2-016) 国家外国专家局2017年度北京市引进国外技术、管理人才项目(20171100004)~~
【分类号】：R711.75

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