多囊卵巢综合征患者代谢特征与胰岛素抵抗的相关性分析

发布时间：2018-07-03 07:59

本文选题：多囊卵巢综合征 + 胰岛素抵抗　；参考：《吉林大学》2015年硕士论文

【摘要】：背景多囊卵巢综合征（polycystic ovary syndrome, PCOS）作为女性无排卵性不孕最常见的病因，是育龄期妇女最为常见的生殖紊乱疾病，发病率逐年增加［1］。PCOS在临床表现上具有高度的异质性，主要表现为严重的代谢紊乱及激素水平失调，其中肥胖在PCOS的临床症状中影响显著，且与PCOS患者的不孕存在相关性，也增加了PCOS患者发生代谢综合征（MS）和心血管疾病的风险［2］。目前已有研究指出脂肪分布模式是心血管及代谢性疾病独立存在的危险因素，脂肪含量可影响女性内分泌代谢，使育龄期妇女生殖功能减低，从而增加妇科疾病发生的危险［3］。目的分析PCOS患者糖、脂、激素水平、骨代谢特征及脂肪分布，探究PCOS患者中脂肪分布、骨代谢与胰岛素抵抗的关系，为PCOS临床治疗提供理论依据。方法选取PCOS患者56例，健康育龄期妇女39例，在月经周期的第3-5天或者月经不规律者在B超检查未见优势卵泡时，清晨空腹采集静脉血。同时测量体重、身高、腰围、臀围，计算体重指数（body mass index，，BMI）及腰臀比，并以BMI为标准将PCOS组分为18例正常体重组，38例超重及肥胖组。测定空腹血糖（FPG）、甘油三酯（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、空腹胰岛素（FINS）、促黄体生成素（LH）、促卵泡激素(FSH)、孕酮（P）、睾丸酮(T)、泌乳素(PRL)、雌二醇(E2)，计算出稳态模型胰岛素抵抗指数（HOMA-IR=（FPG×FINS）/22.5）和LH/FSH。应用双能X线骨密度仪（DXA）进行全身扫描，测量全身及局部的骨密度（BMD）、骨矿物质含量（BMC）、表示骨密度水平的T值及Z值；双上肢、躯干、双下肢、腹部、臀部及全身的脂肪重量（Fat mass）、无脂肪重量（Lean mass+BMC）、腹部脂肪/臀部及大腿脂肪比率（Android/Gynoid）、各部分及全身的脂肪率（Fat%）等。使用SPSS19.0统计软件进行分析统计，以P0.05判定为有统计学差异。结果 1、PCOS组与健康对照组相比，PCOS组体重、BMI、腰围（WC）、腰臀比（WHR）、FPG、FINS、HOMA-IR、TG、TC、LDL-C、LH、LH/FSH、T均明显高于健康对照组（P＜0.05）；健康对照组HDL-C明显高于PCOS组（P＜0.05），差异均有统计学意义。 2、PCOS组左上肢的BMC、右上肢的BMC及BMD、全身BMC及BMD和表示骨密度水平的Z值较健康对照组高（P＜0.05），差异均有统计学意义。 3、PCOS组全身、右上肢、躯干及腹部脂肪重量、无脂肪重量及脂肪率均显著高于健康对照组（P＜0.05），差异有统计学意义。两组双下肢及臀部脂肪重量无差异；PCOS组双下肢及臀部无脂肪重量高于健康对照组（P＜0.05）、臀部脂肪率低于健康对照组（P＜0.05）、Android/Gynoid脂肪含量的比率高于健康对照组（P＜0.01），差异均有统计学意义。 4、PCOS超重及肥胖组全身BMD与BMI、HOMA-IR呈正相关（r分别为0.530、0.456，（P＜0.01））。PCOS正常体重组全身BMC与T呈负相关（r=-0.688，P＜0.01）；PCOS超重及肥胖组全身BMC与BMI、HOMA-IR呈正相关（r分别为0.352、0.560，（P＜0.05））。 5、健康对照组全身脂肪重量与BMI、HOMA-IR和WC呈正相关（r分别为0.827、0.322、0.726，（P＜0.05））；PCOS超重及肥胖组全身脂肪重量与BMI、HOMA-IR和WC呈正相关（r分别为0.579、0.377、0.513，（P＜0.05））。 6、健康对照组腹部脂肪重量与BMI、HOMA-IR和WC呈正相关（r分别为0.775、0.400、0.674，（P＜0.05））；PCOS正常体重组腹部脂肪重量与BMI、HOMA-IR和WC呈正相关（r分别为0.511、0.500、0.483，（P＜0.05））；PCOS超重及肥胖组腹部脂肪重量与BMI、HOMA-IR和WC呈正相关（r分别为0.530、0.358、0.329，（P＜0.05））。 7、PCOS超重及肥胖组全身骨密度与全身无脂肪重量呈正相关（r=0.344，P＜0.05）。结论 1、PCOS患者多肥胖，伴胰岛素抵抗，出现糖、脂代谢异常，存在不同程度的高LH及高雄激素血症等代谢紊乱征象，表现出代谢综合征的某些特征。 2、PCOS患者具有较高的骨密度水平，胰岛素抵抗或高胰岛素水平可能在骨量的维持中起到了保护作用。维持一定的体重，尤其是增加无脂肪重量，对于骨量的增加与维持是有利的。 3、PCOS患者脂肪主要堆积于腹部，多呈男性特征型脂肪分布特点，腹部脂肪重量与胰岛素抵抗、肥胖的关系密切，全身肥胖程度及腹型肥胖均影响胰岛素抵抗。 4、控制体重、减少腹部脂肪量、降低胰岛素抵抗可对PCOS的治疗提供依据，对疾病远期并发症防治有着重大意义。
[Abstract]:background
Polycystic ovary syndrome (PCOS) is the most common cause of anovulatory infertility in women. It is the most common reproductive disorder in women of childbearing age. The incidence of the disease is increasing year by year [1].PCOS is highly heterogeneous in clinical manifestations, mainly characterized by severe metabolic disorder and hormone imbalance. Obesity is significantly affected by the clinical symptoms of PCOS, and is associated with infertility in PCOS patients, and increases the risk of metabolic syndrome (MS) and cardiovascular disease in PCOS patients [2]. Secretory metabolism reduces reproductive function in women of childbearing age, thereby increasing the risk of gynecological diseases [3].
objective
Analysis of PCOS patients sugar, lipid, hormone levels, bone metabolism and fat distribution, explore the relationship between fat distribution, bone metabolism and insulin resistance in PCOS patients, and provide a theoretical basis for the clinical treatment of PCOS.
56 cases of PCOS patients, 39 healthy childbearing age women, in the 3-5 day of the menstrual cycle, or irregular menstrual cycles, when no dominant follicle was detected in the B-mode ultrasound examination, the venous blood was collected on the morning empty stomach. The body weight, height, waist circumference, hip circumference were measured and the body mass index (body mass index, BMI) and waist hip ratio were calculated, and the group of PCOS was divided into 18 cases in the PCOS group. FPG, triglyceride (TG), triglyceride (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), low density lipoprotein cholesterol (FINS), luteinizing hormone (LH), follicle stimulating hormone (FSH), progesterone (P), testosterone (T), prolactin (PRL) and estradiol (E2) were calculated. The model insulin resistance index (HOMA-IR= (FPG x FINS) /22.5) and LH/FSH. with double energy X-ray bone densitometer (DXA) were used to scan the whole body. The bone mineral density (BMD) and bone mineral content (BMC) were measured, and the T value and Z value of bone mineral density (BMC); the weight of the fat (Fat mass) of the two upper limbs, trunk, lower limbs, abdomen, hip and whole body (Fat mass). Fat weight (Lean mass+BMC), abdominal fat / hip and thigh fat ratio (Android/Gynoid), all parts and body fat rate (Fat%). The SPSS19.0 statistical software was used for analysis and statistics, and the statistical difference was determined by P0.05.
Result
1, compared with the healthy control group, the body weight, BMI, waist circumference (WC), waist to hip ratio (WHR), FPG, FPG, FINS, HOMA-IR, TG, TC, LDL-C, LH, PCOS were all significantly higher than those in the healthy control group, and the health control group was significantly higher than the healthy control group (0.05), the difference was statistically significant.
2, the BMC of the left upper limb of the group PCOS, the BMC and BMD of the right upper limb, the whole body BMC and BMD and the Z value representing the bone density level were higher than those of the healthy control group (P < 0.05), the difference was statistically significant.
3, PCOS group, right upper limb, trunk and abdominal fat weight, fat free weight and fat rate were significantly higher than the healthy control group (P < 0.05), the difference was statistically significant. Two groups of lower limbs and hip fat weight was no difference in group PCOS, the fat free weight of lower limbs and buttocks was higher than that of the healthy control group (P < 0.05), the fat rate of the buttocks was lower than that of the health group. According to the group (P < 0.05), the ratio of Android/Gynoid fat content was higher than that of the healthy control group (P < 0.01), and the difference was statistically significant.
4, the whole body BMD in the overweight and obese group was positively correlated with BMI and HOMA-IR (r was 0.530,0.456, (P < 0.01)). There was a negative correlation between BMC and T in the normal body weight group of.PCOS (r=-0.688, P < 0.01), and there was a positive correlation between the overweight and obesity group.
5, there was a positive correlation between the body fat weight of the healthy control group and BMI, HOMA-IR and WC (R 0.827,0.322,0.726, respectively (P < 0.05)). The body fat weight of the overweight and obese PCOS groups was positively correlated with BMI, HOMA-IR and WC (r was 0.579,0.377,0.513, (0.05)).
6, there was a positive correlation between the weight of abdominal fat in the healthy control group and BMI, HOMA-IR and WC (R respectively 0.775,0.400,0.674, (P < 0.05)). The abdominal fat weight of the normal weight group of PCOS was positively correlated with BMI, HOMA-IR and WC respectively (r was 0.511,0.500,0.483, (0.05)). For 0.530,0.358,0.329, (P < 0.05)).
7, there was a positive correlation between BMD and body fat weight in PCOS overweight and obesity group (r=0.344, P < 0.05).
conclusion
1, PCOS patients are more obese, with insulin resistance, sugar, lipid metabolism abnormalities, the presence of different levels of high LH and Kaohsiung hormone metabolism disorder signs, showing some characteristics of the metabolic syndrome.
2, PCOS patients have a high level of bone density, insulin resistance or high insulin levels may play a protective role in the maintenance of bone mass. Maintaining a certain weight, especially the increase of fat free weight, is beneficial to the increase and maintenance of bone mass.
3, the fat accumulation in the PCOS patients mainly in the abdomen, most of the male characteristic fat distribution characteristics, abdominal fat weight and insulin resistance, obesity is closely related, the degree of obesity and abdominal obesity all affect insulin resistance.
4, controlling body weight, reducing abdominal fat and reducing insulin resistance can provide evidence for the treatment of PCOS, and it is of great significance for prevention and treatment of long-term complications.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R711.75

【共引文献】