不同表型多囊卵巢综合征患者代谢综合征患病特点及风险研究  

Morbidity and risk factors of metabolic syndrome in different phenotypes of polycystic ovary syndrome

作　　者：陶弢[1] 刘伟[1] 赵爱民[2] 李圣贤[1] 郑俊[1] 王丽华[1] 周佳雯[1] 黄融[1] 张萍[1] 

机构地区：[1]上海交通大学医学院附属仁济医院内分泌代谢科,200127 [2]上海交通大学医学院附属仁济医院妇产科,200127

出　　处：《中华内分泌代谢杂志》2013年第3期200-205,共6页Chinese Journal of Endocrinology and Metabolism

基　　金：国家自然基金项目（81270875）,国家自然基金青年项目（81200628）,上海市自然基金项目（12ZR1417800）

摘　　要：目的多囊卵巢综合征（PCOS）患者表型的高度异质性决定了其合并代谢异常及预后的不同，故本研究调查不同表型的PCOS患者的代谢综合征（MS）患病率，并探讨代谢紊乱发生的危险因素。方法比较305例PCOS患者及123例非PCOS女性的MS及其组分的患病率。PCOS的诊断根据2003年鹿特丹标准，将其分为高雄激素PCOS和无高雄激素PCOS两个亚组。MS诊断根据2005年国际糖尿病联盟（IDF）标准。结果（1）无高雄激素PCOS组及高雄激素PCOS组的MS患病率分别为12．3％和22．9％．高雄激素PCOS组的Ms患病率显著高于非PCOS对照组的6．5％（P〈0．05），除空腹血糖和血压外，其他的MS组分在高雄激素PCOS组和无高雄激素PCOS组均高于非PCOS对照组（P〈0．05）。在血脂异常谱中．无高雄激素PCOS组高甘油三酯组分出现率显著高于高雄激素PCOS组及非PCOS对照组（均P〈0．01）．而在高雄激素PCOS组低高密度脂蛋白胆固醇组分出现率最高。（2）无高雄激素PCOS组及高雄激素PCOS组的葡萄糖处置指数（DI）及全身胰岛素敏感性（MatsudaIndex）均明显低于正常对照组（均P〈0．01），校正体重指数后差异仍有统计学意义。但无高雄激素PCOS组与高雄激素PCOS组的DJ及全身胰岛素敏感性之间差异无统计学意义。（3）多元逐步回归分析显示全身胰岛素敏感性和体重指数是MS的独立预测因素（均P〈0．01）。结论肥胖和全身胰岛素敏感性是Ms的独立危险因素，高雄激素PCOS患者Ms风险显著增加，而不同表型PCOS之间MS的组分有所差异。Objective To test the hypothesis that different phenotypes Chinese women with polycystic ovary syndrnme（PCOS） have various risk of metabolic syndrome（MS） and different metabolic phenotypes. Methods This was a prospective case-control study. A total of 305 women were diagnosed as PCOS based on the 2003 Rotterdam criteria. 123 women with regular menstrual cycles and without hyperandrogenism were recruited and served as controls. PCOS patients were divided into two subgroups： aceording to their phenotypes with and without hyperandrogenism. The diagnosis of MS was based on 2005 modified International Diabetes Federation criteria. Results The prevalence of MS was 12. 3% in PCOS without hyperandrogenism, 22. 9% in PCOS with hyperandrogenism, both significantly higher than 6.5% in control group （ P〈0.05 ）. The rates of MS components, except for the fasting glucose level and blood pressure, all were significantly higher in both PCOS groups than those in control group（ both P〈0. 05 ）. Furthermore, the triglyeeride level was significantly higher in PCOS women without hyperandrogenism than that in PCOS women with hyperandrogenism as well as control women （ both P〈0. 05 ）. The incidence of lowered high density lipoprotein-cholesterol （ HDL-C ） level was the highest in PCOS women with hyperandrogenism. The disposition index（DI） and Matsuda Index in PCOS women with and without hyperandrogenism were significantly lower compared with the control subjects after adjustment for body mass index （BMI, all P 〈 0.05 ） . However, there was no significant difference in DI and Matsuda Index between PCOS women with and without hyperandrogenism. The results of logistic regression analysis revealed that Matsuda Index and BMI were the independent predictors of MS （both P 〈 0.05 ）. Conclusion Obesity and Matsuda Index are the independentpredictors of MS in PCOS women. PCOS women with hyperandrogenism have high risk of MS. The rates of MS components in PCOS women with and without hyperandrogenism

关 键 词：多囊卵巢综合征 表型 代谢综合征 肥胖 

分 类 号：R711.75[医药卫生—妇产科学]