不同表型多囊卵巢综合征患者代谢指标及肥胖相关指标对多囊卵巢综合征合并代谢综合征人群的诊断效能分析  

Analysis of metabolic indexes among patients with different polycystic ovary syndrome(PCOS)phenotypes and diagnostic efficacy of obesity-related indexes in PCOS patients complicated with metabolic syndrome

作　　者：何玉花 钟欢妹 王文惠 沈永棋 刘映云 顾国威 陈丹娜 He Yuhua;Zhong Huanmei;Wang Wenhui;Shen Yongqi;Liu Yingyun;Gu Guowei;Chen Danna(Department of Clinical Laboratory,the Fourth Affiliated Hospital of Guangzhou Medical University,Guangzhou Guangdong 511300,China)

机构地区：[1]广州医科大学附属第四医院检验科,广东广州511300

出　　处：《中华临床实验室管理电子杂志》2024年第4期212-220,共9页Chinese Journal of Clinical Laboratory Management(Electronic Edition)

基　　金：广州医科大学科研能力提升项目(2024KYQB01PT)。

摘　　要：目的比较不同表型多囊卵巢综合征(PCOS)患者的代谢指标,建立并使用新的人体测量指标及血液实验室检测指标评估PCOS患者的代谢紊乱性。方法根据2003年鹿特丹标准,共纳入270名PCOS患者,基于稀发排卵(OA)、雄激素过多(HA)和多囊卵巢形态(PCOM)3项基本特征的存在,可出现4种PCOS表型,将PCOS患者分为4组:表型A(经典型):OA+HA+PCOM为64名;表型B(高雄激素型):OA+HA为64名;表型C(排卵型):HA+PCOM为78名;表型D(非高雄激素型):OA+PCOM为64名。测量并计算体质量指数(BMI)、腰臀比、腰高比、内脏脂肪指数(VAI)、脂质堆积指数(LAP),在经期的第3~5天,空腹抽取静脉血,测量血液性激素、血脂水平,经口服葡萄糖耐量试验测量血糖、胰岛素(INS),计算三酰甘油-葡萄糖(TyG)指数、TyG-腰高比、游离雄激素指数(FAI)、稳态INS评估模型INS抵抗(HOMA-IR)指数,比较4组PCOS表型患者的人体测量指标及血液实验室检测指标,以及PCOS患者代谢综合征(MetS)中不同指标之间的差异性,使用受试者工作特征曲线比较新的人体测量指标及血液实验室检测指标诊断PCOS患者MetS的效能。结果BMI、臀围、卵泡刺激素(FSH)、性激素结合球蛋白(SHBG)、FAI、抗苗勒管激素(AMH)、总胆固醇(TC)、总三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、TyG、TyG-腰高比、INS、HOMA-IR、LAP在4组PCOS表型患者中的差异有统计学意义(均P<0.05)。在MetS与非MetS的患者中,人体测量指标(体质量、BMI、血压、腰围、臀围、腰臀比、腰高比)、生殖激素(LH、LH/FSH、SHBG、FAI、AMH)、血糖及INS(VAI、LAP、TyG-腰高比)、血脂(TG、HDL-C、LDL-C及TyG)间的差异均具有统计学意义(均P<0.05)。VAI诊断PCOS合并MetS患者时曲线下面积为0.976(95%CI=0.960~0.992),敏感度和特异度分别为100.000%和89.669%。结论广州增城地区不同表型的PCOS患者间的生殖激素、血脂、血糖及INS、人体测量指标存在差异性,且VAIObjective To compare the metabolic markers of polycystic ovary syndrome(PCOS)patients with different phenotypes,and establish and use new anthropometric and blood markers to evaluate the metabolic deregulations of PCOS patients.Methods 270 PCOS patients were enrolled according to the 2003 Rotterdam criteria.4 phenotypes of PCOS can occur based on the presence of 3 basic characteristics:oligovulation(OA),hyperandrogenism(HA),and polycystic ovarian morphology(PCOM).PCOS patients were divided into 4 groups:phenotype A(classic type):OA+HA+PCOM,with 64 patients in it;phenotype B(hyperandrogen type):OA+HA,with 64 patients in it;phenotype C(ovulatory type):HA+PCOM,with 78 patients in it;phenotype D(non-hyperandrogenic type):OA+PCOM,including 64 patients in it.Body mass index(BMI),waist-to-hip ratio,waist-to-height ratio,visceral adiposity index(VAI),and lipid accumulation product(LAP)were measured and calculated.Venous blood was drawn on the fasting stomach on the 3~5th day of menstrual period to measure blood sex hormones and blood lipids.Blood glucose and insulin(INS)were measured by oral glucose tolerance test,triglyceride glucose(TyG)index,TyG waist-to-height ratio,free androgen index(FAI)and homeostasis model assessment of insulin resistance(HOMA-IR)index were calculated,and anthropometric indexes and blood markers of PCOS phenotype patients in the 4 groups were compared.The effectiveness of new anthropometric indicators and blood markers in the diagnosis of metabolic syndrome(MetS)in PCOS patients was compared using receiver operating characteristic curve.Results BMI,hip circumference,follicle-stimulating hormone(FSH),sex hormone-binding globulin(SHBG),FAI,anti-Müllerian hormone(AMH),total cholesterol(TC),total triglycerides(TG),low density lipoprotein cholesterol(LDL-C),TyG,TyG-waist height ratio,INS,HOMA-IR and LAP were differences among the 4 groups of PCOS phenotypes(P<0.05).In the patients with MetS and non-MetS,there were significant differences in anthropometric indicators such as body mass,BMI,blood press

关 键 词：多囊卵巢综合征 代谢综合征 内脏脂肪指数 三酰甘油葡萄糖指数 稳态胰岛素评估模型胰岛素抵抗指数 

分 类 号：R71[医药卫生—妇产科学]