不同表型PCOS患者血清皮质醇水平及其影响因素的研究  

The levels of basal serum cortisol and its influence factors in different phenotypes of polycystic ovary syndrome

作　　者：廖鑫[1] 李豪鹏 邓凡曲 张晗[1] 高琳[1] 张开羽 张琳[1] 章莹[1] LIAO Xin;LI Haopeng;DENG Fanqu;ZHANG Han;GAO Lin;ZHANG Kaiyu;ZHANG Lin;ZHANG Ying(Department of Endocrinology,Affiliated Hospital of Zunyi Medical College,Zunyi,Guizhou 563099,China;Department of Nursing,Zunyi Medical andPharmaceutical College,Zunyi,Guizhou 563006,China)

机构地区：[1]遵义医学院附属医院内分泌科,贵州遵义563099 [2]遵义医药高等专科学校护理系,贵州遵义563006

出　　处：《重庆医学》2019年第9期1509-1512,共4页Chongqing medicine

基　　金：国家自然科学基金资助项目(81660142);贵州省科学技术基金项目(黔科合SY字[2013]3003号);贵州省科技计划项目(黔科合LH字[2017]7096号)

摘　　要：目的探讨不同表型多囊卵巢综合征(PCOS)患者血清皮质醇(COR)水平与糖脂代谢及性激素指标的相关性。方法纳入就诊于遵义医学院附属医院内分泌科及妇科PCOS患者150例,其中稀发排卵或无排卵(OA)+高雄激素血症(HA)临床表现和(或)HA+卵巢多囊样改变(PCO)患者66例(OHP组)、OA+HA患者42例(OH组)、OA+PCO患者40例(OP组)、HA+PCO患者2例(数量偏少未纳入研究);另选44例健康体检者作为对照组。检测各组对象空腹血糖(FPG,)、血脂谱、空腹胰岛素(FINS)、性激素、COR,并计算体质量指数(BMI)、腰臀比(WHR)、胰岛素抵抗指数(HOMA-IR)及黄体生成素/促卵泡素(LH/FSH)比值。结果各组间年龄、血糖比较差异无统计学意义(P>0.05)。3组PCOS患者腰围、三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、FINS、HOMA-IR均明显高于对照组(P<0.05),雌二醇(E2)低于对照组(P=0.036)。OHP组患者COR、血清总睾酮(TEST)、脱氢表雄酮(DHEA-S)、LH、LH/FSH比值均明显高于对照组(P<0.05),OHP组患者COR、TEST、DHEA-S均明显高于OP组(P<0.01);OH组患者BMI、TEST、DHEA-S均明显高于对照组(P<0.01),且OH组患者TEST、DHEA-S明显高于OP组(P<0.01);OP组BMI明显高于对照组(P=0.001)。相关性分析显示,PCOS患者血清基础COR与BMI呈负相关(r=-0.288,P<0.05),与LH、TEST、DHEA-S均呈正相关(r=0.257、0.231、0.323,P<0.05);多元线性回归显示,BMI、LH、DHEA-S是PCOS患者血清基础COR升高的独立危险因素。结论 PCOS患者OHP亚型血清基础COR水平明显高于其他亚组,而BMI、LH、DHEA-S可能是COR增高的独立影响因素。Objective To investigate the cowelation between serum cortisol(COR)levels and glycolipid metabolism and sex hormonesmetabolic indexes in different phenotypes of polycystic ovary syndrome(PCOS)women.Methods A total of 150 PCOS patients were divided into three groups including group OHP [oligoanovulation(OA)+hyperandrogenism(HA)+ polycystic ovary morphology(PCO)]with 66 patients,group OH(OA+HA)with 42 patients and group OP(OA+PCO)with 40 patients.44 healthy subjects served as the control group.The levels of fasting plasma glucose(FPG),blood lipid profile,fasting insulin(FINS),sex hormones and COR were detected.Body mass index(BMI),waist-hip ratio(WHR),homeostasis model assessment for insulin resistance index(HOMA-IR)and ratio of luteinizing hormone/follicle-stimulating hormone(LH/FSH)were calculated.Results There was no statistically significant difference in age and blood glucose between the groups(P>0.05).The waist circumference,triglyeride(TG),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),FINS and HOMA-IR of PCOS patients in three groups were significantly higher than those in control group(P<0.05),estradiol(E2)was lower than that in control group(P=0.036).COR,total testosterone(TEST),dehydroepiandrosterone sulfate(DHEA-S),LH,LH/FSH ratios in group OHP were significantly higher than those in the contrl group(P<0.05),COR,TEST,DHEA-S in group OHP were significantly higher than those in group OP(P<0.01);BMI,TEST and DHEA-S in OH group were significantly higher than those in the group contrl(P<0.05),and serum TEST and DHEA-S in OH group were significantly higher than those in group OP(P<0.01);BMI in group OP was significantly higher than that in the group contrl(P=0.001).The correlation analysis showed that the COR levels has a negative correlation with the body mass index(r=-0.288,P<0.05)and has a positive correlation with LH,TEST and DHEA-S(r=0.257,0.231,0.323,P<0.05).In the multiple stepwise regression analysis,BMI,LH and DHEA-S were the independent risk factors of the COR levels increasing in

关 键 词：多囊卵巢综合征 表型 皮质醇 促黄体生成素 

分 类 号：R588.6[医药卫生—内分泌]