中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2013年
6期
2411-2416
,共6页
多囊卵巢综合征%促肾上腺皮质激素%氢化可的松%高雄激素血症
多囊卵巢綜閤徵%促腎上腺皮質激素%氫化可的鬆%高雄激素血癥
다낭란소종합정%촉신상선피질격소%경화가적송%고웅격소혈증
Polycystic ovary syndrome%Adrenocorticotropic hormone%Hydrocortisone%Hyperandro-genemia
目的比较多囊卵巢综合征（ PCOS ）伴或不伴高雄激素血症患者血浆促肾上腺皮质激素（ ACTH）、皮质醇水平有无差异。方法选择PCOS患者109例和年龄匹配的健康对照36例。测量身高、体重、腰围、臀围，计算腰臀比、体质指数，进行多毛、痤疮评分；测定黄体生成素（ LH）、卵泡刺激素（ FSH）、总睾酮、雌二醇、泌乳素、性激素结合球蛋白（SHBG）、脱氢表雄酮硫酸酯（DHEAS）、8am及4pm血浆ACTH和皮质醇水平；计算LH/FSH比值、游离雄激素指数（ FAI）、4pm/8am ACTH比值、4pm/8am皮质醇比值、ACTH昼夜节律消失率、皮质醇昼夜节律消失率。测定空腹血糖和胰岛素，采用稳态模型法评估胰岛素抵抗指数（ HOMA-IR）和胰岛分泌功能（ HOMA-β）；并行卵巢超声检查。比较PCOS患者和对照组临床生化特征和ACTH、皮质醇水平的差异；将所有的PCOS患者分为高雄组（ FAI≥4.5）和非高雄组（ FAI＜4.5），比较两组的临床生化特征和ACTH、皮质醇水平。为排除肥胖因素对ACTH、皮质醇结果的影响，又选取了体质指数正常（BMI在18.5～23.9 kg/m2）的PCOS患者与健康对照进行对比。结果（1）PCOS组较对照组LH、LH/FSH、总睾酮、DHEAS、FAI水平显著升高（P＜0.01），ACTH-8am、ACTH昼夜节律消失率显著升高（P＜0.05），SH-BG显著降低（P＜0.01），余指标差异无统计学意义（P＞0.05）。（2）高雄组较非高雄组总睾酮、FAI水平显著升高（P＜0.01），ACTH-8am、ACTH-4pm和ACTH昼夜节律消失率显著升高（P＜0.05），余指标差异无统计学意义（P＞0.05）。（3）体质指数正常的PCOS患者ACTH-8am水平、ACTH昼夜节律消失率显著高于对照组，体质指数正常的高雄组PCOS患者较非高雄组PCOS患者ACTH-8am水平仍显著升高（P＜0.05），余指标差异无统计学意义（ P＞0.05）。结论 PCOS患者存在血浆ACTH水平异常，伴高雄激素血症患者异常更加显著。
目的比較多囊卵巢綜閤徵（ PCOS ）伴或不伴高雄激素血癥患者血漿促腎上腺皮質激素（ ACTH）、皮質醇水平有無差異。方法選擇PCOS患者109例和年齡匹配的健康對照36例。測量身高、體重、腰圍、臀圍，計算腰臀比、體質指數，進行多毛、痤瘡評分；測定黃體生成素（ LH）、卵泡刺激素（ FSH）、總睪酮、雌二醇、泌乳素、性激素結閤毬蛋白（SHBG）、脫氫錶雄酮硫痠酯（DHEAS）、8am及4pm血漿ACTH和皮質醇水平；計算LH/FSH比值、遊離雄激素指數（ FAI）、4pm/8am ACTH比值、4pm/8am皮質醇比值、ACTH晝夜節律消失率、皮質醇晝夜節律消失率。測定空腹血糖和胰島素，採用穩態模型法評估胰島素牴抗指數（ HOMA-IR）和胰島分泌功能（ HOMA-β）；併行卵巢超聲檢查。比較PCOS患者和對照組臨床生化特徵和ACTH、皮質醇水平的差異；將所有的PCOS患者分為高雄組（ FAI≥4.5）和非高雄組（ FAI＜4.5），比較兩組的臨床生化特徵和ACTH、皮質醇水平。為排除肥胖因素對ACTH、皮質醇結果的影響，又選取瞭體質指數正常（BMI在18.5～23.9 kg/m2）的PCOS患者與健康對照進行對比。結果（1）PCOS組較對照組LH、LH/FSH、總睪酮、DHEAS、FAI水平顯著升高（P＜0.01），ACTH-8am、ACTH晝夜節律消失率顯著升高（P＜0.05），SH-BG顯著降低（P＜0.01），餘指標差異無統計學意義（P＞0.05）。（2）高雄組較非高雄組總睪酮、FAI水平顯著升高（P＜0.01），ACTH-8am、ACTH-4pm和ACTH晝夜節律消失率顯著升高（P＜0.05），餘指標差異無統計學意義（P＞0.05）。（3）體質指數正常的PCOS患者ACTH-8am水平、ACTH晝夜節律消失率顯著高于對照組，體質指數正常的高雄組PCOS患者較非高雄組PCOS患者ACTH-8am水平仍顯著升高（P＜0.05），餘指標差異無統計學意義（ P＞0.05）。結論 PCOS患者存在血漿ACTH水平異常，伴高雄激素血癥患者異常更加顯著。
목적비교다낭란소종합정（ PCOS ）반혹불반고웅격소혈증환자혈장촉신상선피질격소（ ACTH）、피질순수평유무차이。방법선택PCOS환자109례화년령필배적건강대조36례。측량신고、체중、요위、둔위，계산요둔비、체질지수，진행다모、좌창평분；측정황체생성소（ LH）、란포자격소（ FSH）、총고동、자이순、비유소、성격소결합구단백（SHBG）、탈경표웅동류산지（DHEAS）、8am급4pm혈장ACTH화피질순수평；계산LH/FSH비치、유리웅격소지수（ FAI）、4pm/8am ACTH비치、4pm/8am피질순비치、ACTH주야절률소실솔、피질순주야절률소실솔。측정공복혈당화이도소，채용은태모형법평고이도소저항지수（ HOMA-IR）화이도분비공능（ HOMA-β）；병행란소초성검사。비교PCOS환자화대조조림상생화특정화ACTH、피질순수평적차이；장소유적PCOS환자분위고웅조（ FAI≥4.5）화비고웅조（ FAI＜4.5），비교량조적림상생화특정화ACTH、피질순수평。위배제비반인소대ACTH、피질순결과적영향，우선취료체질지수정상（BMI재18.5～23.9 kg/m2）적PCOS환자여건강대조진행대비。결과（1）PCOS조교대조조LH、LH/FSH、총고동、DHEAS、FAI수평현저승고（P＜0.01），ACTH-8am、ACTH주야절률소실솔현저승고（P＜0.05），SH-BG현저강저（P＜0.01），여지표차이무통계학의의（P＞0.05）。（2）고웅조교비고웅조총고동、FAI수평현저승고（P＜0.01），ACTH-8am、ACTH-4pm화ACTH주야절률소실솔현저승고（P＜0.05），여지표차이무통계학의의（P＞0.05）。（3）체질지수정상적PCOS환자ACTH-8am수평、ACTH주야절률소실솔현저고우대조조，체질지수정상적고웅조PCOS환자교비고웅조PCOS환자ACTH-8am수평잉현저승고（P＜0.05），여지표차이무통계학의의（ P＞0.05）。결론 PCOS환자존재혈장ACTH수평이상，반고웅격소혈증환자이상경가현저。
Objective To compare plasma level of adrenocorticotropic hormone ( ACTH ) and cortisol between polycystic ovary syndrome ( PCOS ) patients with and without hyperandrogenemia .Methods 109 PCOS patients and 36 healthy controls were enrolled in this study .Height,weight,waist circumference,hip circumference were measured and body mass index ,waist/hip ratio were calculated .Hirsutism and acne scoring were graded .Fasting blood samples were collected at 8am for measurement of luteinizing hormone (LH),follicular stimulating hormone (FSH),total testosterone,prolactin,estrogen,sex hormone binding globulin(SHBG),dehydroepiandrosterone sulfate (DHEAS),adrenocorticotropic hormone (ACTH) and cortisol.Blood sample was also collected at 4pm on the same day to measure plasma ACTH and cortisol level .LH/FSH ratio,free androgen index(FAI),4pm/8am ratio of ACTH, 4pm/8am ratio of cortisol,ACTH and cortisol circadian rhythm disappear rate were calculated .In order to evaluate homeostasis model of insulin resistance ( HOMA-IR) and pancreatic βcell function ( HOMA-β) ,fasting blood glucose and serum insulin were measured .All subjects were examined by ultrasound .All the PCOS patients were divided into two groups,hyperandrogenemia group (FAI≥4.5) and non-hyperandrogenemia group (FAI <4.5).The clinical features,biochemical parameters , plasma levels of ACTH & cortisol and their circadian rhythm were compared between PCOS patients and healthy controls , as well as PCOS patients with and without hyperandrogenemia .To exclude the influence of obesity on ACTH ,cortisol results ,PCOS patients and healthy controls with normal BMI were further compared.Results (1)Compared with healthy controls,the PCOS patients had significantly higher LH,LH/FSH ratio, total testosterone, DHEAS, FAI, ACTH-8am, ACTH circadian rhythm disappear rate ( P <0.05 ) and significantly lower SHBG(P<0.05).The statistical differences of other indexes were not seen between two groups (P>0.05).(2) Total testosterone,FAI,ACTH-8am,ACTH-4pm and ACTH circadian rhythm disappear rate in hyperandrogenemia PCOS group were significantly higher than those without ( P <0.05 ) .( 3 ) PCOS patients with normal BMI had much significantly higher ACTH-8am level,ACTH circadian rhythm disappear rate than healthy controls.ACTH-8am level,in hyperandrogenemia PCOS group with normal BMI was also significantly higher than that without.Conclusions PCOS patients have the level anomalies of plasma ACTH , and it is more significant in hyperandrogenemia PCOS patients .
