多囊卵巢综合征合并非酒精性脂肪性肝病相关风险因素探讨  

Analysis of related factors for polycystic ovary syndrome patients complicated non-alcoholic fatty liver disease

作　　者：李忆昆 沈山梅[1] 杨佳苗 乔程程 邵飞 张冰洁 王静[3] 毕艳[2] 朱大龙[2] Li Yikun;Shen Shanmei;Yang Jiamiaoiao;Chengcheng;Shao Fei;Zhang Bingjie;Wang Jing;Bi Yan;Zhu Dalong(Department of Endocrinology,Medical School of Southeast University Nanjing Drum Tower Hospital,Nanjing 210008,China;Department of Endocrinology,Drum Tower Hospital Affiliated to Nanjing University Medical School,Nanjing 210008,China;Health Manager Center,Drum Tower Hospital Affiliated to Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]东南大学医学院南京鼓楼医院内分泌科,210008 [2]:南京大学医学院附属南京鼓楼医院内分泌科,210008 [3]南京大学医学院附属南京鼓楼医院体重管理中心,210008

出　　处：《中华生殖与避孕杂志》2020年第3期201-206,共6页Chinese Journal of Reproduction and Contraception

基　　金：江苏省医学重点学科(XK201105)。

摘　　要：目的评估多囊卵巢综合征(PCOS)患者非酒精性脂肪性肝病(NAFLD)的患病率,并探究PCOS和NAFLD之间的关联。方法本横断面研究选取2016年2月至2018年4月期间在南京大学医学院附属南京鼓楼医院内分泌科就诊的122例PCOS患者(PCOS组)及年龄、体质量指数(BMI)匹配的107例对照(对照组),收集所有受试者的一般资料并测定肝酶、血脂、糖耐量、性激素指标,同时行肝脏彩色超声检查,比较PCOS组和对照组的临床特征、实验室指标和NAFLD患病率,并对PCOS和NAFLD之间的相关因素以及胰岛素抵抗、高雄激素血症在其中的作用进行分析。结果PCOS组的NAFLD患病率(62.6%)高于对照组(76.2%,P=0.025)。Logistic回归提示PCOS患者中稳态模型的胰岛素抵抗指数(HOMA-IR)和游离雄激素指数(FAI)水平与NAFLD的风险显著相关(OR=1.686,95%CI=1.279~2.223;OR=1.167,95%CI=1.039~1.311),将HOMA-IR纳入模型后,FAI水平与NAFLD的相关性无统计学意义(P>0.05)。结论NAFLD在PCOS患者中非常普遍。PCOS患者的NAFLD与胰岛素抵抗和高雄激素血症有关,其中胰岛素抵抗是PCOS合并NAFLD的独立危险因素,而高雄激素血症通过介导胰岛素抵抗而影响NAFLD的发生。Objective To compare the prevalence of non-alcoholic fatty liver disease(NAFLD)in women with or without polycystic ovary syndrome(PCOS),and to evaluate association between PCOS and NAFLD.Methods A cross-sectional study was performed including 122 PCOS patients(PCOS group)and 107 age,and body mass index(BMI)-matched women(control group).Anthropometric parameters,liver enzyme,lipid profile,glucose and insulin levels,sex hormones and hepatic ultrasonography were measured in all subjects.The clinical features,laboratory parameters and prevalence of NAFLD were compared between PCOS group and control group.The related factors were evaluated between PCOS and NAFLD,finally the role of insulin resistance(IR)and hyperandrogenism(HA)was analysed.Results Women with PCOS had a significantly higher prevalence of NAFLD than those without PCOS(62.6%vs.76.2%,P=0.025).Logistic regression found that HOMA-IR and FAI were associated with NAFLD in PCOS women(OR=1.686,95%CI=1.279-2.223;OR=1.167,95%CI=1.039-1.311),however,there was no significant correlation between FAI and NAFLD after adjustment for HOMA-IR(P>0.05).Conclusion NAFLD is more prevalent in women with PCOS than in those without.Insulin resistance and HA drive risk of NAFLD in young female with PCOS.IR may be an independent risk factor for NAFLD,and the association between HA and NAFLD is not independent but is mediated by IR.

关 键 词：多囊卵巢综合征 非酒精性脂肪性肝病 胰岛素抵抗 高雄激素血症 

分 类 号：R575[医药卫生—消化系统] R711[医药卫生—内科学]