多囊卵巢综合征患者泌乳素水平与性激素和糖脂代谢的相关性  

Correlation between prolactin levels and sex hormones and glucose/lipid metabolism in patients with polycystic ovary syndrome

作　　者：张晓颖 匡洪影[2] 侯丽辉[2] 徐芳[2] 曲玉芳 孙淼[2] ZHANG Xiaoying;KUANG Hongying;HOU Lihui;XU Fang;QU Yufang;SUN Miao(Graduate School of Heilongjiang University of Chinese Medicine,Harbin Heilongjiang 150040;The Second Department of Gynecology,First Affiliated Hospital,Heilongjiang University of Chinese Medicine,Harbin Heilongjiang 150040;Department of Gynecology,South Area of Qiqihar Traditional Chinese Medicine Hospital,Qiqihar Heilongjiang 161000,China)

机构地区：[1]黑龙江中医药大学研究生院,黑龙江哈尔滨150040 [2]黑龙江中医药大学附属第一医院妇科二科,黑龙江哈尔滨150040 [3]齐齐哈尔市中医医院南区妇科,黑龙江齐齐哈尔161000

出　　处：《江苏大学学报（医学版）》2023年第3期185-190,197,共7页Journal of Jiangsu University：Medicine Edition

基　　金：国家自然科学基金资助项目(81804138,82174195);黑龙江省中医药科研项目(ZHY2020-101)。

摘　　要：目的:探讨多囊卵巢综合征(polycystic ovarian syndrome,PCOS)患者血清泌乳素水平与性激素和糖脂代谢的相关性。方法:选择2015年1月至2018年11月于黑龙江中医药大学附属第一医院妇科门诊确诊为PCOS的女性657例(PCOS组),另随机选取同期在本院体检的60例非PCOS健康女性作为对照。测定PCOS患者人体量学指标、性激素指标、糖代谢指标以及脂代谢指标;根据泌乳素水平由低到高,将其分为4个亚组,Q1~Q4,通过非参数检验对4组上述指标进行分析比较。PCOS组和对照组行口服糖耐量试验(OGTT)和胰岛素释放试验(IRT),分析PCOS组与对照组以及不同泌乳素水平PCOS患者的糖代谢水平;运用多元线性回归模型分析患者PCOS病情与泌乳素水平的相关性。结果:4个亚组间年龄、腰臀比、雌二醇、睾酮、性激素结合球蛋白(SHBG)、三酰甘油水平及HOMA-β差异有统计学意义(P<0.05),其中Q4组年龄、腰臀比、雌二醇水平、HOMA-β显著低于Q1组(P<0.05),三酰甘油水平显著低于Q1及Q2组(P<0.05),睾酮显著低于其他三组(P<0.05),SHBG水平显著高于Q3组(P<0.05)。OGTT与IRT结果显示,PCOS组血糖水平整体较对照组高,其中60 min、180 min血糖显著高于对照组(P<0.05),口服葡萄糖30 min后两组血糖水平达到峰值,IRT结果无统计学意义。Q4组120 min血糖明显低于Q1、Q2组(P<0.05),其他时间未见明显差异。IRT结果显示,在60 min后4个亚组胰岛素分泌随着时间推移呈下降趋势,Q4组胰岛素水平长时间低于Q1、Q2组,在60、120 min表现明显(P<0.05或P<0.01)。180 min时,Q1~Q4组胰岛素值均未回到基线水平。校正年龄和BMI后,多元线性回归分析显示血清泌乳素水平与LH/FSH比值、睾酮、HOMA-β、三酰甘油水平呈负相关,但与SHBG水平呈正相关(P<0.05)。结论:泌乳素水平较低的PCOS患者表现为明显的雄激素异常增高、糖脂代谢水平降低,且泌乳素水平与HOMA-β呈负相关。Objective:To investigate the correlation between serum prolactin levels and sex hormones and glucose/lipid metabolism in patients with polycystic ovary syndrome(PCOS).Methods:A total of 657 women diagnosed with PCOS from Gynecology Outpatient Clinic of the First Affiliated Hospital of Heilongjiang University of Chinese Medicine from January 2015 to November 2018,and 60 healthy women without PCOS who were randomly selected to undergo physical examination during the same period were enrolled in the study.The anthropometric indicators,sex hormone indicators,glucose metabolism indicators and lipid metabolism indicators of PCOS patients were measured.According to the level of prolactin from low to high,PCOS patients were divided into 4 subgroups,Q1~Q4,the above indicators of the four groups were analysed and compared by non-parametric tests;the oral glucose tolerance test(OGTT)and insulin release test(IRT)were performed on the PCOS and control groups,and the glucose metabolism levels of PCOS patients in the PCOS and control groups and at different prolactin levels were analysed.Results:There were statistically significant differences in age,waist-to-hip ratio,estradiol,testosterone,sex hormone binding globulin(SHBG),triglyceride(TG)levels and homeostasis model assessment ofβ-cell(HOMA-β)among the four subgroups(P<0.05),among which age,waist-to-hip ratio,estradiol level and HOMA-βin Q4 group were significantly lower than those in Q1 group(P<0.05),and TG level was significantly lower than those in Q1 and Q2 group(P<0.05),testosterone was greatly lower than that of the other three groups(P<0.05),and SHBG level was markedly higher than that of Q3 group(P<0.05),the OGTT and IRT results showed that the blood glucose level in the PCOS group was higher than that in the control group on the whole,with the blood glucose levels at 60 min and 180 min significantly higher than those in the control group(P<0.05);the blood glucose level of the two groups reached the peak 30 min after oral glucose administration,and the IRT result

关 键 词：多囊卵巢综合征 泌乳素 胰岛素抵抗 口服糖耐量试验(OGTT) 胰岛素释放试验(IRT) 

分 类 号：R711.75[医药卫生—妇产科学]