多囊卵巢综合征卵巢储备功能降低患者肥胖及糖脂代谢特征

doi:10.3969/j.issn.1006-7795.2018.04.005

首都医科大学学报 ›› 2018, Vol. 39 ›› Issue (4): 505-511.doi: 10.3969/j.issn.1006-7795.2018.04.005

多囊卵巢综合征卵巢储备功能降低患者肥胖及糖脂代谢特征

金婧¹, 阮祥燕^1,2, 华琳³, 李杨璐¹, 王利娟¹, 王虎生¹, 赵越¹, Alfred O. Mueck^1,2

1. 首都医科大学附属北京妇产医院内分泌科, 北京 100026;
2. 德国图宾根大学妇产医院妇女健康部与妇女健康研究中心, 图宾根 D-72076, 德国;
3. 首都医科大学生物信息学教研室, 北京 100069

收稿日期:2018-05-31 出版日期:2018-07-21 发布日期:2018-07-21
通讯作者: 阮祥燕 E-mail:ruanxiangyan@163.com
基金资助:
北京市自然科学基金（Y181004），北京市属医院科研培育计划（PX2017053），北京市科学技术委员会首都临床特色应用研究课题（Z161100000516143），北京市医院管理局"登峰"计划专项（DFL20181401），北京市卫生系统高层次卫生技术人才（2014-2-016）。

Characteristics of obesity and glycolipid metabolism in polycystic ovary syndrome patients with diminished ovarian reserve

Jin Jing¹, Ruan Xiangyan^1,2, Hua Lin³, Li Yanglu¹, Wang Lijuan¹, Wang Husheng¹, Zhao Yue¹, Alfred O. Mueck^1,2

1. Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China;
2. Department for Women's Health, University Women's Hospital and Research Center for Women's Health, University of Tuebingen, Tuebingen D-72076, Germany;
3. Department of Bioinformatics, Capital Medical University, Beijing 100069, China

Received:2018-05-31 Online:2018-07-21 Published:2018-07-21
Supported by:
This study was supported by Natural Science Foundation of Beijing(Y181004), Beijing Municipal Administration of Hospitals Incubating Program(PX2017053), Beijing Municipal Science & Technology Commission (Z161100000516143),Beijing Municipal Administration of Hospitals ‘Ascent’ Plan(DFL20181401), Beijing Municipality Health Technology High-level Talent(2014-2-016).

摘要/Abstract

摘要： 目的探讨中国多囊卵巢综合征（polycystic ovary syndrome，PCOS）合并卵巢储备功能降低（diminished ovarian reserve，DOR）患者肥胖及糖脂代谢特征。方法选取2015年1月至2017年1月在首都医科大学附属北京妇产医院内分泌科就诊的多囊卵巢综合征患者338名（包括PCOS合并DOR功能降低患者57名及单纯PCOS患者281名）及同期就诊的正常对照组70名，记录研究对象的年龄、月经情况，测量其身高、体质量、腰围、臀围，测定基础血清卵泡刺激素（follicle stimulating hormone，FSH）、黄体生成素（luteinizing hormone，LH）、雌二醇（estradiol，E₂）、睾酮（testosterone，T）、抗苗勒管激素（anti-Müllerian hormone，AMH）、空腹血糖（fasting plasma glucose，FPG）、空腹胰岛素（fasting insulin，FINS）、三酰甘油（triglyceride，TG）、总胆固醇（total cholesterol，TC）、高密度脂蛋白胆固醇（high density lipoprotein-cholesterol，HDL-C）、低密度脂蛋白胆固醇（low density lipoprotein-cholesterol，LDL-C），测量基础窦卵泡数（baseline antral follicle count，bAFC）。对多囊卵巢综合征合并卵巢储备功能低下患者、单纯多囊卵巢综合征及正常对照组的各指标进行比较，并对各组AMH与其他指标进行相关性分析。结果（1）单纯PCOS患者、PCOS合并DOR患者及正常对照组全身型肥胖（≥ 25 kg/m²）的发生率分别为38.1%、40.4%及22.9%，腹型肥胖[腰臀比（waist hip ratio，WHR）≥ 0.85]的发生率分别为46.6%、21.1%及28.6%。PCOS合并DOR患者全身型肥胖率与单纯PCOS患者及正常对照组间的差异均无统计学意义（P>0.05），而腹型肥胖率低于单纯PCOS患者（P<0.05）。（2）PCOS合并DOR患者FPG、FINS、自我平衡模型分析法（homeostasis model assessment，HOMA）-计算胰岛素抵抗（insulin resistivity，IR）与单纯PCOS患者的差异均无统计学意义（P>0.05），而FPG、HOMA-IR均高于正常对照组（P<0.05）。（3）单纯PCOS患者、PCOS合并DOR患者TC、HDL-C及LDL-C均高于正常对照组（P<0.05），PCOS合并DOR患者TC、TG、HDL-C及LDL-C与单纯PCOS患者的差异均无统计学意义（P>0.05）。（4）单纯PCOS患者，AMH与FPG、HOMA-IR呈负相关关系（P<0.05），与HDL-C呈正相关关系（P<0.01）；PCOS合并DOR患者AMH与肥胖及糖脂代谢指标均无相关关系（P>0.05）；正常对照组AMH仅与HDL-C呈正相关关系（P<0.01）。结论 PCOS合并DOR患者腹型肥胖率低于单纯PCOS患者，其糖脂代谢特征与单纯PCOS患者相似，但AMH与糖脂代谢指标的相关性不同于单纯PCOS患者及正常对照组。

关键词: 多囊卵巢综合征, 卵巢储备功能降低, 抗苗勒管激素, 肥胖, 胰岛素抵抗

Abstract: Objective To explore the characteristics of obesity and glycolipid metabolism in polycystic ovary syndrome (PCOS) patients with diminished ovarian reserve (DOR). Methods Totally 338 PCOS patients (including 57 PCOS with DOR patients and 281 simple PCOS patients) and 70 healthy women (control group), who came to Department of Gynecological Endocrinology in Beijing Obstetrics and Gynecology Hospital between January 2015 and January 2017, were recruited. Age and menstruation of these patients were recorded. Body height, body weight, waist circumference, hip circumference, basel follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E₂), testosterone (T), anti-Müllerian hormone (AMH), fasting plasma glucose (FPG), fasting insulin (FINS), total cholesterol (TC), triglyceride (TG), high density lipoprotein-cholesterol (HDL-C), low density and lipoprotein-cholesterol (LDL-C) and baseline antral follicle count of these patients were measured. The indices between PCOS with DOR, simple PCOS and control group were compared, and the correlations between AMH and other indices in each group were analyzed. Results (1) The prevalence of central obesity (≥ 25 kg/m²) in simple PCOS, PCOS with DOR and control group was 38.1%, 40.4% and 22.9%, respectively. And the prevalence of abdominal obesity waist hip ratio (WHR) ≥ 0.85 in simple PCOS, PCOS with DOR and control group was 46.6%, 21.1% and 28.6%, respectively. The prevalence of central obesity in PCOS with DOR patients had no significant difference with simple PCOS patients and control group (P>0.05), but the prevalence of abdominal obesity was lower than simple PCOS patients (P<0.05). (2) The level of FPG, FINS and homeostasis model assessment (HOMA)-insulin resistivity (IR) in PCOS with DOR patients had no significant differences from simple PCOS patients(P>0.05), while the level of FPG and HOMA-IR was higher than control group (P<0.05). (3) The levels of TC, HDL-C and LDL-C in both simple PCOS and PCOS with DOR patients were higher than control group (P<0.05). The levels of TC, triglyceride (TG), HDL-C and LDL-C in PCOS with DOR patients had no significant difference with simple PCOS patients (P<0.05). (4) In simple PCOS patients, AMH had a negative correlation with FPG and HOMA-IR (P<0.05), while had a positive correlation with HDL-C (P<0.01). In PCOS with DOR patients, AMH had no correlation with obesity and glycolipid metabolic indices (P>0.05). In control group, AMH had a positive correlation with HDL-C (P<0.01). Conclusion The prevalence of abdominal obesity in PCOS with DOR patients is lower than simple PCOS patients. The characteristic of glycolipid metabolism in PCOS with DOR patients is similar to simple PCOS patients. But the correlation between AMH and glycolipid metabolic indices in PCOS with DOR patients is different from both simple PCOS patients and control group.

Key words: polycystic ovary syndrome, diminished ovarian reserve, anti-Müllerian hormone, obesity, insulin resistance

中图分类号:

R711.77

金婧, 阮祥燕, 华琳, 李杨璐, 王利娟, 王虎生, 赵越, Alfred O. Mueck. 多囊卵巢综合征卵巢储备功能降低患者肥胖及糖脂代谢特征[J]. 首都医科大学学报, 2018, 39(4): 505-511.

Jin Jing, Ruan Xiangyan, Hua Lin, Li Yanglu, Wang Lijuan, Wang Husheng, Zhao Yue, Alfred O. Mueck. Characteristics of obesity and glycolipid metabolism in polycystic ovary syndrome patients with diminished ovarian reserve[J]. Journal of Capital Medical University, 2018, 39(4): 505-511.

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多囊卵巢综合征卵巢储备功能降低患者肥胖及糖脂代谢特征

Characteristics of obesity and glycolipid metabolism in polycystic ovary syndrome patients with diminished ovarian reserve

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