不同体质量指数多囊卵巢综合征患者内分泌代谢特征的临床研究

doi:10.16138/j.1673-6087.2021.06.003

摘要/Abstract

摘要：

目的：探讨不同体质量指数（body mass index,BMI）多囊卵巢综合征（polycystic ovarian syndrome,PCOS）患者的内分泌激素及代谢指标的临床特征。方法：收集PCOS患者共76例,记录患者的年龄、身高、体重,计算BMI,检测患者性激素水平、甲状腺功能、空腹血糖(fasting plasma glucose,FPG)、空腹胰岛素（fasting serum insulin,FINS）、总胆固醇（total cholesterol,TC）、三酰甘油（triacylglycerol,TG）、高密度脂蛋白胆固醇（high density lipoprotein cholesterol,HDL-C）及低密度脂蛋白胆固醇（low density lipoprotein cholesterol,LDL-C）,并计算稳态模型胰岛素抵抗指数（homeostasis model assessment of insulin resistance,HOMA-IR）及游离雄激素指数（free androgen index,FAI）。按BMI不同将患者分为肥胖组、超重组及正常组,比较组间内分泌代谢指标的差异;按HOMA-IR≥2.69作为胰岛素抵抗的诊断切点,分别计算各组伴有胰岛素抵抗的患者比例;按FAI≥6.1作为高雄激素血症的诊断切点,分别计算各组伴有高雄激素血症的患者比例,通过χ²检验分析各组PCOS患者胰岛素抵抗或高雄激素血症发生比例的差异。结果：肥胖组、超重组及正常组PCOS患者中性激素结合球蛋白（sex hormone binding globulin,SHBG）水平逐渐升高,FINS、HOMA-IR水平逐渐下降,在3组间差异均有统计学意义（均P<0.05）;黄体生成素（luteinizing hormone,LH）、LH/卵泡刺激素（follicle-stimulating hormone,FSH）仅在肥胖组显著低于超重组及正常组（P<0.05）,同时促甲状腺素（thyroid stimulating hormone,TSH）显著高于超重组及正常组（P<0.05）;FAI、TC、TG、LDL-C在肥胖组和超重组显著高于正常组（P<0.05）;游离甲状腺素（free thyroxine,FT₄）、抗缪勒管激素（anti-Müllerian hormone,AMH）、HDL-C仅在肥胖组显著低于正常组（P<0.05）。Spearman相关分析显示,BMI与FAI、TSH、FPG、FINS、HOMA-IR、TG、LDL-C均呈正相关（r=0.401、0.315、0.362、0.644、0.656、0.582、0.315,均P<0.05）,而与LH、LH/FSH、SHBG、FT₄、AMH、HDL-C呈负相关（r=-0.364、 -0.236、-0.624、-0.304、-0.369、-0.542,均P<0.05）。χ²检验分析结果提示胰岛素抵抗及高雄激素血症的发生率在正常组、超重组及肥胖组PCOS患者中均逐步增加,且胰岛素抵抗在肥胖组及超重组明显高于正常组（P<0.05）,但肥胖组与超重组之间差异无统计学意义;高雄激素血症发生率在3组之间差异均有统计学意义（P<0.05）。结论：肥胖及超重组PCOS患者具有更明显的胰岛素抵抗、高雄激素血症及血脂代谢异常,而正常体重PCOS患者垂体促性腺激素水平升高更明显。

关键词: 多囊卵巢综合征, 体质量指数, 高雄激素血症, 胰岛素抵抗, 促甲状腺激素

Abstract:

Objective To investigate clinical characteristics of endocrine hormones and metabolic indicators in the patients of polycystic ovarian syndrome (PCOS) with different body mass index (BMI). Methods A total of 76 patients with PCOS were enrolled. Their age, height, and weight were recorded, and their BMI were calculated. The sex hormone levels, thyroid function, fasting plasma glucose (FPG), fasting serum insulin (FINS), total cholesterol (TC), triacylglycerol (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were measured, and the homeostasis model assessment of insulin resistance (HOMA-IR) and free androgen index (FAI) were calculated. According to different BMI, the patients were divided into obese, overweight, and normal weight groups, and the differences of endocrine and metabolism indexes among three groups were compared. As HOMA-IR≥2.69 was diagnostic cut-off point of insulin resistance, the proportion of patients with insulin resistance in different BMI groups was calculated respectively. As FAI≥6.1 was the diagnostic cut-off point of hyperandrogenism, the proportion of patients with hyperandrogenism in different BMI groups were also calculated. The chi-square test was used to analyze the difference of the incidence of insulin resistance or hyperandrogenemia in PCOS patients among three groups. Results The levels of sex hormone binding globulin (SHBG) all increased gradually while the levels of FINS and HOMA-IR decreased gradually in the PCOS patients in the obesity, overweight and normal weight groups. The differences had statistical significance among the three groups (P<0.05). Luteinizing hormone (LH), LH/follicle-stimulating hormone (FSH) were significantly lower while thyroid stimulating hormone (TSH) was significantly higher in the obese group than those in both overweight and normal weight groups (P<0.05). FAI, TC, TG, LDL-C in both obese and overweight groups were significantly higher than those in normal weight group (P<0.05). Free thyroxine (FT₄), anti-Müllerian hormone (AMH) and HDL-C in obesity group were significantly lower than those in normal weight group(P<0.05). Spearman correlation analysis showed that BMI was positively correlated with FAI, thyroid-stimulating hormone (TSH), FPG, INS, HOMA-IR, TG, LDL-C (r=0.401, 0.315, 0.362, 0.644, 0.656, 0.582, 0.315 respectively, P<0.05), and negatively correlated with LH, LH/FSH, SHBG, FT₄, AMH, HDL-C (r=-0.364, -0.236, -0.624, -0.304, -0.369, -0.542, P<0.05). The results of the chi-square test indicated that the incidence of insulin resistance and hyperandrogenemia increased gradually in the patients in normal, overweight, and obese groups, and the insulin resistance in the obese and overweight groups was significantly higher than normal weight group (P<0.05), while there was no significant difference between the overweight group and the obese group. In addition, there were statistical difference in hyperandrogenism among three groups (P<0.05). Conclusions The PCOS patients with obesity or overweight have more significant insulin resistance, hyperandrogenemia and abnormal blood lipid metabolism, while the level of pituitary gonadotropin increased more in the PCOS patients with normal weight.

Key words: Polycystic ovary syndrome, Body mass index, Hyperandrogenemia, Insulin resistance, Thyroid stimulating hormone

中图分类号:

R711.75

曹维, 陈柔柔, 谢媛, 邹婧, 赫荣波, 钱莉, 刘煜. 不同体质量指数多囊卵巢综合征患者内分泌代谢特征的临床研究[J]. 内科理论与实践, 2021, 16(06): 381-386.

CAO Wei, CHEN Rourou, XIE Yuan, ZOU Jing, HE Rongbo, QIAN Li, LIU Yu. Clinical study on characteristics of endocrine metabolism in the patients of polycystic ovary syndrome with different body mass index[J]. Journal of Internal Medicine Concepts & Practice, 2021, 16(06): 381-386.

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参考文献 13

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项目	正常组（n=30）	超重组（n=21）	肥胖组（n=25）	F/Z	P
LH（U/L）	15.4±9.6	12.2±5.3	8.7±5.6^1）2）	5.531	0.006
FSH（U/L）	5.3±1.7	5.1±1.5	4.9±2.0	0.363	0.697
LH/FSH	2.6（1.7,3.2）	2.5（1.7,3.4）	1.8（1.1,2.6）^1）2）	6.790	0.034
TT（nmol/L）	1.6±1.2	1.5±0.6	1.5±0.9	0.294	0.746
FAI	3.9（2.4,5.6）	5.1（3.3,9.1）^1）	7.3（4.0,10.3）^2）	10.248	0.006
E₂（pmol/L）	147.3（95.7,189.8）	132.3（118.3,197.9）	159.8（120.0,232.1）	1.684	0.431
SHBG（nmol/L）	37.5（28.5,57.6）	23.7（16.7,35.5）	18.3（14.8,22.5）^1）2）	29.855	0.000
PRL（ng/mL）	22.7±14.2	20.6±10.1	18.5±7.0	0.981	0.380
FT₃（pmol/L）	4.9±0.7	4.8±0.8	4.9±0.6	0.303	0.697
FT₄（pmol/L）	17.0±2.1	16.4±2.0	15.8±1.8^1）	2.216	0.117
TSH（mU/L）	2.5±1.6	2.7±1.8	4.3±1.8^1）2）	7.491	0.001
AMH（mg/L）	8.6±3.7	7.2±4.9	5.5±2.9^1）	2.938	0.062

项目	正常组（n=30）	超重组（n=21）	肥胖组（n=25）	F/Z	P
年龄（岁）	25.7±4.0	26.7±5.7	26.7±5.7	0.373	0.690
身高（m）	162（159,166）	161（158,165）	162（159,165）	0.135	0.935
体重（kg）	56.3±5.9	68.5±5.6^1）	87.1±11.2^1）2）	101.263	0.000
BMI（kg/m²）	21.2±1.6	25.7±1.0^1）	33.0±3.7^1）2）	168.654	0.000

项目	正常组（n=30）	超重组（n=21）	肥胖组（n=25）	F/Z	P
FPG（mmol/L）	4.8±0.5	4.8±0.5	5.6±1.2^1）2）	7.927	0.001
FINS（pmol/L）	58.2（45.1,90.1）	96.6（56,142.8）^1）	183.6（98.0,253.4）^1）2）	28.391	0.000
HOMA-IR	1.8（1.4,2.6）	2.9（1.7,4.6）^1）	6.3（3.0,10.8）^1）2）	29.696	0.000
TC（mmol/L）	4.1±0.7	4.7±0.9^1）	4.6±0.8^1）	3.427	0.040
TG（mmol/L）	0.8±0.4	1.2±0.6^1）	1.6±0.6^1）	12.909	0.000
HDL-C（mmol/L）	1.4±0.3	1.3±0.4	1.1±0.2^1）	6.655	0.003
LDL-C（mmol/L）	2.6±0.6	3.1±0.7^1）	3.2±0.8^1）	4.380	0.017

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