CAJ | 학술논문

目的多囊卵巢综合征(PCOS)患者表型的高度异质性决定了其合并代谢异常及预后的不同,故本研究调查不同表型的PCOS患者的代谢综合征(MS)患病率,并探讨代谢紊乱发生的危险因素.方法比较305例PCOS患者及123例非PCOS女性的MS及其组分的患病率.PCOS的诊断根据2003年鹿特丹标准,将其分为高雄激素PCOS和无高雄激素PCOS两个亚组.MS诊断根据2005年国际糖尿病联盟(IDF)标准.结果 (1)无高雄激素PCOS组及高雄激素PCOS组的MS患病率分别为12.3％和22.9％,高雄激素PCOS组的MS患病率显著高于非PCOS对照组的6.5％(P＜0.05),除空腹血糖和血压外,其他的MS组分在高雄激素PCOS组和无高雄激素PCOS组均高于非PCOS对照组(P＜0.05).在血脂异常谱中,无高雄激素PCOS组高甘油三酯组分出现率显著高于高雄激素PCOS组及非PCOS对照组(均P＜O.01),而在高雄激素PCOS组低高密度脂蛋白胆固醇组分出现率最高.(2)无高雄激素PCOS组及高雄激素PCOS组的葡萄糖处置指数(DI)及全身胰岛素敏感性(Matsuda Index)均明显低于正常对照组(均P＜O.01),校正体重指数后差异仍有统计学意义.但无高雄激素PCOS组与高雄激素PCOS组的DI及全身胰岛素敏感性之间差异无统计学意义.(3)多元逐步回归分析显示全身胰岛素敏感性和体重指数是MS的独立预测因素(均P＜O.01).结论肥胖和全身胰岛素敏感性是MS的独立危险因素,高雄激素PCOS患者MS风险显著增加,而不同表型PCOS之间MS的组分有所差异.
목적 다낭란소종합정(PCOS)환자표형적고도이질성결정료기합병대사이상급예후적불동,고본연구조사불동표형적PCOS환자적대사종합정(MS)환병솔,병탐토대사문란발생적위험인소.방법 비교305례PCOS환자급123례비PCOS녀성적MS급기조분적환병솔.PCOS적진단근거2003년록특단표준,장기분위고웅격소PCOS화무고웅격소PCOS량개아조.MS진단근거2005년국제당뇨병련맹(IDF)표준.결과 (1)무고웅격소PCOS조급고웅격소PCOS조적MS환병솔분별위12.3％화22.9％,고웅격소PCOS조적MS환병솔현저고우비PCOS대조조적6.5％(P＜0.05),제공복혈당화혈압외,기타적MS조분재고웅격소PCOS조화무고웅격소PCOS조균고우비PCOS대조조(P＜0.05).재혈지이상보중,무고웅격소PCOS조고감유삼지조분출현솔현저고우고웅격소PCOS조급비PCOS대조조(균P＜O.01),이재고웅격소PCOS조저고밀도지단백담고순조분출현솔최고.(2)무고웅격소PCOS조급고웅격소PCOS조적포도당처치지수(DI)급전신이도소민감성(Matsuda Index)균명현저우정상대조조(균P＜O.01),교정체중지수후차이잉유통계학의의.단무고웅격소PCOS조여고웅격소PCOS조적DI급전신이도소민감성지간차이무통계학의의.(3)다원축보회귀분석현시전신이도소민감성화체중지수시MS적독립예측인소(균P＜O.01).결론 비반화전신이도소민감성시MS적독립위험인소,고웅격소PCOS환자MS풍험현저증가,이불동표형PCOS지간MS적조분유소차이.
Objective To test the hypothesis that different phenotypes Chinese women with polycystic ovary syndrome(PCOS) have various risk of metabolic syndrome(MS) and different metabolic phenotypes.Methods This was a prospective case-control study.A total of 305 women were diagnosed as PCOS based on the 2003 Rotterdam criteria.123 women with regular menstrual cycles and without hyperandrogenism were recruited and served as controls.PCOS patients were divided into two subgroups:according to their phenotypes with and without hyperandrogenism.The diagnosis of MS was based on 2005 modified International Diabetes Federation criteria.Results The prevalence of MS was 12.3％ in PCOS without hyperandrogenism,22.9％ in PCOS with hyperandrogenism,both significantly higher than 6.5％ in control group (P＜0.05).The rates of MS components,except for the fasting glucose level and blood pressure,all were significantly higher in both PCOS groups than those in control group(both P＜0.05).Furthermore,the triglyceride level was significantly higher in PCOS women without hyperandrogenism than that in PCOS women with hyperandrogenism as well as control women (both P＜0.05).The incidence of lowered high density lipoprotein-cholesterol (HDL-C) level was the highest in PCOS women with hyperandrogenism.The disposition index(DI) and Matsuda Index in PCOS women with and without hyperandrogenism were significantly lower compared with the control subjects after adjustment for body mass index (BMI,all P ＜O.05).However,there was no significant difference in DI and Matsuda Index between PCOS women with and without hyperandrogeuism.The results of logistic regression analysis revealed that Matsuda Index and BMI were the independent predictors of MS (both P ＜ 0.05).Conclusion Obesity and Matsuda Index are the independent predictors of MS in PCOS women.PCOS women with hyperandrogenism have high risk of MS.The rates of MS components in PCOS women with and without hyperandrogenism are different.