基于人体成分分析的生活方式干预在非肥胖型多囊卵巢综合征患者治疗作用的初步研究  

Life-style intervention improves insulin resistance and ovulation in non-obese polycystic ovary syndrome patients based on the body composition analysis:a pilot study

作　　者：苏椿淋[1] 唐玉珠 林金芳[1] Su Chunlin;Tang Yuzhu;Lin Jinfang(Obstetrics and Gynecology Hospital of Fudan University,Shanghai 200032,China;Eden Outpatient,Shanghai 200040,China)

机构地区：[1]复旦大学附属妇产科医院,上海200011 [2]爱丁互联网连锁门诊,上海200040

出　　处：《中华生殖与避孕杂志》2020年第9期716-722,共7页Chinese Journal of Reproduction and Contraception

基　　金：上海市科学技术委员会课题(170H190400)。

摘　　要：目的探讨生活方式干预对非肥胖型多囊卵巢综合征(PCOS)患者的治疗作用。方法本研究为前瞻性自身前后对照研究,收集2017年5月至2018年3月期间在复旦大学妇产科医院就诊的非肥胖[18.5 kg/m2≤体质量指数(BMI)<24.0 kg/m2]PCOS患者43例,通过体成分测定结果制定以增肌及或增肌减脂为目标的个体化的饮食和运动生活干预方案。12周后分析患者体成分数据变化与胰岛素抵抗及生殖激素改善情况与排卵恢复情况的相关性。结果干预前,43例非肥胖型PCOS患者中,21例体脂率正常,22例(51.2%)体脂率高于正常;17例患者骨骼肌重量标准占比正常(90%~110%),26例(60.5%)骨骼肌重量标准占比低于正常。相关性分析显示,空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)与患者体脂率呈正相关(r=-0.442,P=0.003;r=0.395,P=0.010),与骨骼肌重量标准占比呈负相关(r=-0.492,P=0.001;r=-0.536,P<0.001)。经12周的生活方式干预后,非肥胖型PCOS患者的体脂率较干预前明显降低(P<0.001);骨骼肌标准占比及骨骼肌重量较干预前明显升高(P<0.001);HOMA-IR较前明显降低(P<0.001);黄体生成素(LH)和总睾酮较干预前均明显降低(P=0.005,P=0.004);12周后70%(31例)的患者恢复自发排卵,较治疗前明显升高(P<0.001)。相关性分析显示,①治疗后患者骨骼肌重量标准占比与HOMA-IR呈负相关(r=-0.512,P=0.001),与胰岛素曲线下面积呈负相关(r=-0.421,P=0.007);②治疗后患者的体脂率与LH、总睾酮呈正相关(r=0.455,P=0.003;r=0.377,P=0.015);治疗后患者的骨骼肌重量标准占比与治疗后总睾酮呈负相关(r=-0.307,P=0.048);③治疗后的LH与治疗后HOMA-IR呈正相关(r=0.39,P=0.011);④回归性分析显示,自发排卵的恢复与体质量的下降、骨骼肌标准占比的升高、胰岛素曲线下面积的下降密切相关(P=0.016,P=0.004,P=0.003)。结论正常体质量的非肥胖型PCOS患者的胰岛素抵抗与其体脂率的增加、骨骼肌重量标准占Objective To explore the effect of life-style intervention on non-obese polycystic ovary syndrome(PCOS)patients.Methods This was a prospective self-control study.Forty-three cases of non-obese[18.5 kg/m^2≤body mass index(BMI)<24.0 kg/m^2]PCOS patients were enrolled from May 2017 to March 2018 in Obstetrics and Gynecology Hospital of Fudan University.The individualized dietary and exercise lifestyle intervention was formulated based on the body composition.After 12 weeks,the correlations among body composition data,insulin resistance,reproductive hormone improvement,and ovulation recovery were analyzed.Results Before intervention,21 of 43 non-obese PCOS patients had normal body fat rate,22 patients(51.2%)had higher body fat rate than normal,17 patients had normal standard proportion of skeletal muscle weight(90%-110%),and 26 patients(60.5%)had lower standard proportion of skeletal muscle weight.Correlation analysis showed that fasting insulin(FINS)and homeostasis model assessment-insulin resistance(HOMA-IR)were positively correlated with body fat rate(r=0.442,P=0.003;r=0.395,P=0.010,respectively),and negatively correlated with the standard proportion of skeletal muscle weight(r=-0.492,P=0.001;r=-0.536,P<0.001,respectively).After 12 weeks of lifestyle intervention,the body fat rate of non-obese PCOS patients decreased significantly(P<0.01);standard proportion of skeletal muscle weight and skeletal muscle weight increased significantly(P<0.001);HOMA-IR decreased significantly(P<0.001);level of luteinizing hormone(LH)and decreased significantly(P=0.005,P=0.004);and 31(70%)patients recovered with spontaneous ovulation(P<0.001).Correlation analysis showed that:1)after treatment,standard proportion of skeletal muscle weight in non-obese PCOS patients was negatively correlated with HOMA-IR(r=-0.512,P=0.001),and insulin-under-curve-area(r=-0.421,P=0.007);2)after treatment,the body fat rate was positively correlated with LH and total testerone(r=0.455,P=0.003;r=0.377,P=0.015);after treatment,standard proportion of skelet

关 键 词：非肥胖型 多囊卵巢综合征 体成分 胰岛素抵抗 生活方式管理 

分 类 号：R711.75[医药卫生—妇产科学]