三种医学营养减重法对超重或肥胖多囊卵巢综合征患者代谢参数和雄激素水平的影响

Effects of three medical nutrition therapies for weight loss on metabolic parameters and androgen level in overweight/obese patients with polycystic ovary syndrome

目的探讨3种医学营养减重法对超重或肥胖多囊卵巢综合征(PCOS)患者代谢参数和雄激素水平的影响。方法本研究为随机对照试验,选取2018年10月至2020年2月于北京大学第一医院就诊的90例PCOS合并超重或肥胖患者进行8周的营养减重,采用随机数字表法分为限能量膳食(CRD)组、高蛋白饮食(HPD)组、高蛋白高膳食纤维饮食(HPD+HDF)组,每组30例;所有患者的年龄为22~44(31±5)岁,体质指数(BMI)为(28.07±3.59)kg/m^(2)。检测减重前后体成分、胰岛素抵抗和雄激素指标,分别比较3组患者减重前后上述指标差异,以评价3种减重方法的疗效。结果CRD组有8例患者因不能严格完成随访而退出,故在减重结束时,CRD组、HPD组、HPD+HDF组分别有22、30、30例患者纳入最终分析,3组患者基线年龄分别为(31±2)、(32±5)、(31±5)岁(P=0.952)。3组患者减重后,HPD组和HPD+HDF组相关指标下降较CRD组多,其中体重在CRD组、HPD组、HPD+HDF组分别下降4.20(11.92,1.80)、5.00(5.10,3.32)、6.10(8.10,3.07)kg(P=0.038),BMI分别下降0.80(1.70,0.40)、0.90(1.23,0.50)、2.20(3.30,1.12)kg/m^(2)(P=0.002),稳态模型胰岛素抵抗(HOMA-IR)指数分别下降0.48(1.93,0.05)、1.21(2.91,0.18)、1.22(1.75,0.89)(P=0.196),游离雄激素指数(FAI)分别下降0.23(0.67,-0.04)、0.41(0.64,0.30)、0.44(0.63,0.24)(P=0.357)。结论3种方法均可有效降低超重或肥胖PCOS患者的体重,改善胰岛素抵抗和高雄激素血症,与CRD法相比,HPD法和HPD+HDF法可更好地减轻脂肪,并且可以同时保留肌肉和基础代谢率。

Objective To investigate the effects of calorie-restricted diet(CRD),high protein diet(HPD),high protein,and high dietary fiber diet(HPD+HDF)on metabolic parameters and androgen level in overweight/obese patients with polycystic ovary syndrome(PCOS).Methods Ninety overweight/obese patients with PCOS from Peking University First Hospital from October 2018 to February 2020 were given medical nutrition weight loss therapy for 8 weeks and were randomly divided into CRD group,HPD group,and HPD+HDF group,with 30 patients in each group.Body composition,insulin resistance,and androgen level were detected before and after weight loss,and the efficacy of three weight loss therapies was compared through variance analysis and Kruskal-Wallis H test.Results Eight patients in CRD group quit because they could not strictly complete the follow-up,therefore at the end of weight loss,22,30,and 30 patients in CRD group,HPD group and HPD+HDF group,respectively,were included in the final analysis.The baseline ages of the three groups were(31±2)years,(32±5)years and(31±5)years,respectively(P=0.952).After weight loss,the relevant indicators in HPD group and HPD+HDF group decreased more than those in CRD group.The body weight of CRD group,HPD group and HPD+HDF group decreased by 4.20(11.92,1.80),5.00(5.10,3.32)and 6.10(8.10,3.07)kg,respectively(P=0.038);BMI of the three groups decreased by 0.80(1.70,0.40),0.90(1.23,0.50)and 2.20(3.30,1.12)kg/m^(2),respectively(P=0.002);homeostatic model assessment-insulin resistance(HOMA-IR)index decreased by 0.48(1.93,0.05),1.21(2.91,0.18)and 1.22(1.75,0.89),respectively(P=0.196);and free androgen index(FAI)decreased by 0.23(0.67,-0.04),0.41(0.64,0.30)and 0.44(0.63,0.24),respectively(P=0.357).Conclusions The three medical nutrition therapies can effectively reduce the weight of overweight/obese patients with PCOS,and improve insulin resistance and hyperandrogenism.Compared with CRD group,HPD group,and HPD+HDF group have better fat-reducing effect,and can better preserve muscle and basal metabolic rate while losing weight.