中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2010年
25期
1729-1734
,共6页
赵赟%徐晶晶%朱铭伟%林金芳
趙赟%徐晶晶%硃銘偉%林金芳
조빈%서정정%주명위%림금방
青春期%多囊卵巢综合征%雄激素过多症%高胰岛素血症%肥胖
青春期%多囊卵巢綜閤徵%雄激素過多癥%高胰島素血癥%肥胖
청춘기%다낭란소종합정%웅격소과다증%고이도소혈증%비반
Polycystic ovary syndrome%Adolescence%Hyperandrogenism%Insulin resistance%Obesity
目的 了解青春期多囊卵巢综合征患者的临床、内分泌代谢紊乱特征.方法 167例青春期PCOS患者为研究对象,其中肥胖型(OB-PCOS组)90例、非肥胖型(NOB-PCOS组)77例.325例月经正常的15～18岁女中学生为对照组,其中肥胖(OB-CON组)18例,非肥胖(NOB-CON组)307例.问卷调查月经史,并对进行临床体征评分及内分泌、代谢指标测定.结果 (1)正常青春期女性近95%在初潮2年内建立规律月经.对照组激素指标的第95百分位数为生理高限值:总睾酮2.77nmol/L,游离雄激素指数(FAI)4.64,黄体生成素(LH)16.1 IU/L,LH/卵泡刺激素(FSH)1.54,硫酸脱氢表雄酮(DHEA-S)11.02μmol/L;空腹胰岛素(FINS)和HOMA-IR的75%位点值为生理高限值分别是13.13和2.69 mIU/L;青春期PCOS患者月经初潮年龄(12.7岁)较对照组(13.1岁)提前,84.85%的患者未能在初潮后2年内建市规律月经.(2)青春期PCOS患者肥胖的发生率显著高于对照人群,P<0.01.(3)青春期PCOS患者的总睾酮、FAI、DHEA-S均显著高于对照人群,P<0.01;而OB-PCOS组的FAI显著高于NOB-PCOS组;78.44%患者雄激素水平超过正常值高限.(4)青春期PCOS患者FINS、HOMA-IR值均显著高于对照人群,P<0.01;OB-PCOS组空腹胰岛素、HOMA-IR及甘油三酯水平均显著高于NOB-PCOS组;患者中有53.19%FINS、47.52%HOMA-IR水平超过正常值高限.(5)PCOS组LH水平、LH/FSH比值均显著高于对照组:NOB-PCOS组的LH、LH/FSH比值显著高于OB-PCOS组.(6)95.21%的青春期PCOS患者卵巢超声影像多囊性改变符合鹿特丹共识的诊断标准.结论 青春期PCOS的基本特征为月经初潮提前并存在持续性的月经失调;循环中雄激素及空腹胰岛素水平高于正常青春期水平;普遍存在病理性胰岛素抵抗和卵巢多囊性增大;肥胖发生率增高且肥胖型PCOS病情较重;NOB-PCOS组中LH、LH/FSH升高更为明显.
目的 瞭解青春期多囊卵巢綜閤徵患者的臨床、內分泌代謝紊亂特徵.方法 167例青春期PCOS患者為研究對象,其中肥胖型(OB-PCOS組)90例、非肥胖型(NOB-PCOS組)77例.325例月經正常的15～18歲女中學生為對照組,其中肥胖(OB-CON組)18例,非肥胖(NOB-CON組)307例.問捲調查月經史,併對進行臨床體徵評分及內分泌、代謝指標測定.結果 (1)正常青春期女性近95%在初潮2年內建立規律月經.對照組激素指標的第95百分位數為生理高限值:總睪酮2.77nmol/L,遊離雄激素指數(FAI)4.64,黃體生成素(LH)16.1 IU/L,LH/卵泡刺激素(FSH)1.54,硫痠脫氫錶雄酮(DHEA-S)11.02μmol/L;空腹胰島素(FINS)和HOMA-IR的75%位點值為生理高限值分彆是13.13和2.69 mIU/L;青春期PCOS患者月經初潮年齡(12.7歲)較對照組(13.1歲)提前,84.85%的患者未能在初潮後2年內建市規律月經.(2)青春期PCOS患者肥胖的髮生率顯著高于對照人群,P<0.01.(3)青春期PCOS患者的總睪酮、FAI、DHEA-S均顯著高于對照人群,P<0.01;而OB-PCOS組的FAI顯著高于NOB-PCOS組;78.44%患者雄激素水平超過正常值高限.(4)青春期PCOS患者FINS、HOMA-IR值均顯著高于對照人群,P<0.01;OB-PCOS組空腹胰島素、HOMA-IR及甘油三酯水平均顯著高于NOB-PCOS組;患者中有53.19%FINS、47.52%HOMA-IR水平超過正常值高限.(5)PCOS組LH水平、LH/FSH比值均顯著高于對照組:NOB-PCOS組的LH、LH/FSH比值顯著高于OB-PCOS組.(6)95.21%的青春期PCOS患者卵巢超聲影像多囊性改變符閤鹿特丹共識的診斷標準.結論 青春期PCOS的基本特徵為月經初潮提前併存在持續性的月經失調;循環中雄激素及空腹胰島素水平高于正常青春期水平;普遍存在病理性胰島素牴抗和卵巢多囊性增大;肥胖髮生率增高且肥胖型PCOS病情較重;NOB-PCOS組中LH、LH/FSH升高更為明顯.
목적 료해청춘기다낭란소종합정환자적림상、내분비대사문란특정.방법 167례청춘기PCOS환자위연구대상,기중비반형(OB-PCOS조)90례、비비반형(NOB-PCOS조)77례.325례월경정상적15～18세녀중학생위대조조,기중비반(OB-CON조)18례,비비반(NOB-CON조)307례.문권조사월경사,병대진행림상체정평분급내분비、대사지표측정.결과 (1)정상청춘기녀성근95%재초조2년내건립규률월경.대조조격소지표적제95백분위수위생리고한치:총고동2.77nmol/L,유리웅격소지수(FAI)4.64,황체생성소(LH)16.1 IU/L,LH/란포자격소(FSH)1.54,류산탈경표웅동(DHEA-S)11.02μmol/L;공복이도소(FINS)화HOMA-IR적75%위점치위생리고한치분별시13.13화2.69 mIU/L;청춘기PCOS환자월경초조년령(12.7세)교대조조(13.1세)제전,84.85%적환자미능재초조후2년내건시규률월경.(2)청춘기PCOS환자비반적발생솔현저고우대조인군,P<0.01.(3)청춘기PCOS환자적총고동、FAI、DHEA-S균현저고우대조인군,P<0.01;이OB-PCOS조적FAI현저고우NOB-PCOS조;78.44%환자웅격소수평초과정상치고한.(4)청춘기PCOS환자FINS、HOMA-IR치균현저고우대조인군,P<0.01;OB-PCOS조공복이도소、HOMA-IR급감유삼지수평균현저고우NOB-PCOS조;환자중유53.19%FINS、47.52%HOMA-IR수평초과정상치고한.(5)PCOS조LH수평、LH/FSH비치균현저고우대조조:NOB-PCOS조적LH、LH/FSH비치현저고우OB-PCOS조.(6)95.21%적청춘기PCOS환자란소초성영상다낭성개변부합록특단공식적진단표준.결론 청춘기PCOS적기본특정위월경초조제전병존재지속성적월경실조;순배중웅격소급공복이도소수평고우정상청춘기수평;보편존재병이성이도소저항화란소다낭성증대;비반발생솔증고차비반형PCOS병정교중;NOB-PCOS조중LH、LH/FSH승고경위명현.
Objective To investigate the clinical features,reproductive endocrine and metabolic abnormalities in adolescent girls with polycystic ovary syndrome (PCOS).Methods A total of 325 adolescent girls with normal menstruation,18 obese (OB-CON) and 307 non-abese (NOB-CON),were enrolled as controls from multiple middle schools in Shanghai,China.A total of 167 adolescent girls with PCOS,90 obese (OB-PCOS) and 77 non-obese (NOB-PCOS),were also recruited.All cases were evaluated for their clinical manifestations, reproductive endocrine and metabolic parameters.Hyperandrogenism was determined by serum testosterone (T),free androgen index (FAI) and dehydroepiandrosterone sulfate (DHEA-S).Insulin sensitivity was measured by fasting insulin (FINS) and homeostasis model assessment of insulin resistance (HOMA-IR).Results (1) Menarche Was significantly earlier in adolescent PCOS than in controls.The incidence of obesity Was significantly higher in adolescent PCOS than that in control group.(2) T,FAI and DHEA-S were significantly higher in adolescent PCOS group than those in control group.FAI Was higher in OB-PCOS group than in NOB-PCOS group.LH and LH/FSH were higher in PCOS groups than those in controls.LH and LH/FSH were also much higher in NOB-PCOS group than those in OB-PCOS group.(3) HOMA-IR and FINS were significantly higher in PCOS group than those in control group. Incidence of acanthosis nigricans,FINS,HOMA-IR and triglyceride were significantly higher in OB-PCOS group than those in NOB-PCOS group.(4) 95.21% PCOS girls presented with an ultrasonic morphological evidence of polycystic ovarian.Conclusion The essential features of adolescent PCOS are an earlier onset of menarche,a persistent menstrual disorder over 2 years after menarche,a higher incidence of obesity,marked hyperandrogenism and insulin resistance and disorderly gonadotropine secretion in comparison with control subjects.Hyperandrogenism and insulin resistance are much more severe in obese adolescent PCOS.
