不同表型多囊卵巢综合征患者糖脂代谢差异分析  

Analysis of endocrine and metabolic characteristics of different phenotypes of patients with polycystic ovary syndrome

作　　者：高审祥 王芳[1] 陈晨[1] GAO Shen-xiang;WANG Fang;CHEN Chen(Department of Obstetrics ＆ Gynecology,Rui J in Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 20002)

机构地区：[1]上海交通大学医学院附属瑞金医院妇产科,上海200025

出　　处：《生殖医学杂志》2018年第10期952-956,共5页Journal of Reproductive Medicine

基　　金：上海浦江人才计划(11PJ1406600)

摘　　要：目的探讨不同表型多囊卵巢综合征(PCOS)患者的糖脂代谢指标差异。方法选取2016年10月至2017年9月来在我院妇科门诊就诊,按照鹿特丹标准结合我国标准诊断为PCOS的112例患者作为实验组,对照组为我院内分泌科招募的月经规则、否认多毛及痤疮、且否认糖尿病家族史的生育期女性100例。将PCOS患者按表型分为3组:稀发排卵或无排卵(OA)+高雄激素血症或高雄的临床表现(HA)+多囊卵巢样改变(PCO)组,OA+HA组,OA+PCO组。所有患者均检测临床内分泌及代谢相关参数[抗苗勒管激素(AMH)、性激素、血糖、血脂、甲状腺功能等]。结果 OA+HA表型组糖代谢受损最严重,OA+HA+PCO表型组次之,OA+PCO表型组最轻。OA+HA表型组的总胆固醇(TC)、甘油三酯(TG)显著高于OA+PCO表型组及对照组(P<0.05)。三个表型组空腹血糖均在正常范围,OA+HA糖脂代谢程度受累程度最严重,其120min、180min血糖均高于OGTT诊断标准。结论相较PCOS其他表型,OA+PCO表型的糖脂代谢受累较轻,OA+HA糖脂代谢程度受累程度最严重,OA+HA型PCOS患者初诊均应该行口服葡萄糖耐量试验、胰岛素释放试验、血脂检查,了解其血糖血脂受损情况。将PCOS患者进行不同表型的分类,能较好地指导临床PCOS患者的个体化治疗。Objective： To analyze the endocrine and metabolic characteristics of different phenotypes of the patients with polycystic ovary syndrome（PCOS）. Methods： A total of 112 patients were diagnosed as PCOS based on the 2003 Rotterdam criteria and 100 women with regular menstrual cycle without hyperandrogenism and acne were recruited as control group in our hospital from October 2016 to September 2017. The PCOS patients were divided into three subgroups： oligo anovulation （OA） ＋ hyperandrogenism （HA） ＋ polycystic ovary morphology （PCO）, OA＋HA,and OA ＋ PCO. Endocrine hormonal and metabolic parameters （AMH, sex hormones, blood glucose, blood lipid, thyroid function, etc. ） were evaluated in all patients. Results： The OA＋HA phenotype group had the most severe damage to glucose metabolism,followed by the OA＋HA＋PCO phenotype group and the OA＋PCO phenotype group. Total cholesterol（TC）and triglyceride（TG）in the OA＋HA phenotype group were significantly higher than those in the OA＋PCO phenotype group and the control group（P^0.05）. The fasting blood glucose of the three phenotype groups was in the normal range,and the degree of glycolipid metabolism in OA＋HA group was the most serious,and the blood glucose at 120 min and 180 min was higher than the OGTT diagnostic criteria. Conclusions.- Compared with other phenotypes of PCOS, the glycolipid metabolism in OA ＋ PCO phenotype is lighter and the degree of OA ＋ HA glycolipid metabolism is the most serious. The PCOS patients with OA＋HA type should undergo oral glucose tolerance test（OGTT）,insulin release test（IRT） and lipid test to understand the damage of glycolipid metabolism. The classification of different phenotypes in patients with PCOS can better guide the individualized treatment in clinic practice.

关 键 词：多囊卵巢综合征 表型 糖脂代谢 

分 类 号：R711.75[医药卫生—妇产科学]