北京地区多囊卵巢综合征病人内分泌代谢特征分析

doi:10.3969/j.issn.1006-7795.2017.04.003

首都医科大学学报 ›› 2017, Vol. 38 ›› Issue (4): 498-503.doi: 10.3969/j.issn.1006-7795.2017.04.003

北京地区多囊卵巢综合征病人内分泌代谢特征分析

殷冬梅¹, 阮祥燕^1,2, 赵越¹, Alfred O. Mueck²

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内分泌与绝经中心, 图宾根 D-72076, 德国

收稿日期:2017-06-05 出版日期:2017-07-21 发布日期:2017-07-20
通讯作者: 阮祥燕 E-mail:ruanxiangyan@163.com
基金资助:
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）

Analysis of endocrine and metabolic characteristics in patients with polycystic ovary syndrome in Beijing

Yin Dongmei¹, Ruan Xiangyan^1,2, Zhao Yue¹, Alfred O. Mueck²

1. Department of Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China;
2. Section of Endocrinology and Menopause, Department of Women's Health, University of Tubingen, Tubingen D-72076, Germany

Received:2017-06-05 Online:2017-07-21 Published:2017-07-20
Supported by:
This study was supported by Foreign Technical and Administrative Talent Introduction Project in 2017, State Administration of Foreign Experts Affairs, China (20171100004); Capital Characteristic Clinical Project of China(Z161100000516143); Beijing Capital Foundation for Medical Science Development and Research(2016-2-2113); Clinical Technique Innovation Project of Beijing Municipal Administration of Hospitals (XMLX201710);Beijing Municipality Health System High-Level Health Technical Talents (Academic Leaders)(2014-2-016)

摘要/Abstract

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（P<0.05）；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，ApoB）浓度、ApoB/ApoA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，ApoA）浓度低于对照组，差异有统计学意义（P<0.05）。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（P<0.05）；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（P>0.05）。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。

关键词: 多囊卵巢综合征, 亚型, 脂代谢, 腹型肥胖, 胰岛素抵抗

Abstract: Objective To analyze the clinical characteristics, sex hormones and lipid metabolism in patients with polycystic ovary syndrome (PCOS) in Beijing. Methods Totally 142 untreated PCOS patients were enrolled, and 48 age-matched healthy women were included as control group. Patients were diagnosed and grouped using the Rotterdam 2003 criteria. Based on the National Institutes of Health (NIH) guidelines, patients with PCOS were classified as: subtype-1, androgen excess+ ovulatory dysfunction (AE+OD)(n=40); subtype-2, androgen excess + polycystic ovarian morphology (AE+PCO)(n=10); subtype-3, ovulatory dysfunction + polycystic ovarian morphology (OD+PCO) (n=32); subtype-4, androgen excess + ovulatory dysfunction + polycystic ovarian morphology (AE+OD+PCO)(n=60). The screening panel consisted of a physical examination, weight and height measurement, ultrasonography of the ovaries, and measurements of hormone, glucose, lipid, and insulin resistance. Besides, endocrine and metabolic parameters were measured in all patients. Results In the PCOS group, body mass index (BMI), waist and hip ratio (WHR), total testosterone (T), luteinizing hormone (LH), LH/follicle stimulating hormone(FSH) ratio were higher than that of the control group with statistically significant difference (P<0.05). Total cholesterol (TC), low density lipoprotein-cholesterol (LDL-C), triglycerides (TG), apolipoprotein B (ApoB) levels, fasting insulin (INS), homeostatic model assessment of insulin resistance (HOMA-IR) and the ratio of ApoB to ApoA were significantly higher than those in the control group (P<0.05). Meanwhile, high density lipoprotein-cholesterol (HDL-C) and apolipoprotein A (ApoA) level were lower than the control group with statistically significant difference (P<0.05). The BMI, WHR, T and LDL-C of subtype-1 were higher compared to subtype-3, and TC and LDL-C were higher than subtype-2; the BMI, T and LDL-C of 4 subtypes were higher than the three other subtypes and T, LH and LH/FSH were higher than subtype-2 with statistically significant difference (P<0.05). There was no significant difference between subtype-2 and subtype-3 (P>0.05). Conclusion The incidence of central obesity, lipid metabolism disorders, insulin resistance and hyperinsulinemia in PCOS patients in Beijing was significantly higher than that in healthy women. Among the four subtypes of PCOS patients, this phenomenon maybe is most significant in subtypes 1 and 4 subgroups with both ovulation abnormality and hyperandrogenism, while subtypes with normal menstrual cycle or non-hyperandrogenic have more moderate metabolic changes, Distinction of the four subtypes should be made during clinical treatment and targeted therapy should be applied correspondingly.

Key words: polycystic ovary syndrome, subtype, lipid metabolic, abdominal obesity, insulin resistance

中图分类号:

R711.75

殷冬梅, 阮祥燕, 赵越, Alfred O. Mueck. 北京地区多囊卵巢综合征病人内分泌代谢特征分析[J]. 首都医科大学学报, 2017, 38(4): 498-503.

Yin Dongmei, Ruan Xiangyan, Zhao Yue, Alfred O. Mueck. Analysis of endocrine and metabolic characteristics in patients with polycystic ovary syndrome in Beijing[J]. Journal of Capital Medical University, 2017, 38(4): 498-503.

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北京地区多囊卵巢综合征病人内分泌代谢特征分析

Analysis of endocrine and metabolic characteristics in patients with polycystic ovary syndrome in Beijing

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