摘要
目的探讨多囊卵巢综合征(PCOS)患者Ⅰ级亲属异常家族史与 PCOS 患者临床表型的相关性。方法选择2004年8月至2006年4月在北京大学第三医院生殖医学中心诊断为 PCOS的不孕症患者139例,计算体重指数(BMI)、腰围臀围比值(WHR)并进行多毛评分,测定卵泡刺激素(FSH)、黄体生成素(LH)、泌乳素、睾酮、雄烯二酮(A)、雌二醇水平,进行口服糖耐量试验(OGTT)及胰岛素释放试验等。收集 PCOS 患者Ⅰ级亲属的异常家族史,并分析其与 PCOS 患者临床表型的相关性。结果 (1)有糖尿病家族史 PCOS 患者与无糖尿病家族史者相比,WHR(分别为0.99±0.10、0.79±0.08)、多毛评分[分别为(1.9±1.2)、(1.8±1.2)分]、月经稀发周期[分别为(108±10)、(92±19)d]均明显增加,稳态模型胰岛素抵抗指数(HOMA-IR,分别为3.5±2.0、2.7±1.6)、葡萄糖曲线下面积[GLU AUC,分别为(836±245)、(748±139)nmol·L^(-1)·min^(-1)]、胰岛素曲线下面积[INSAUC,分别为(9670±4582)、(7330+4311)mIU·L^(-1)·min^(-1)]、空腹血糖(FG)水平[分别为(5.0±1.1)、(4.8±0.5)mmol/L]、空腹胰岛素(FINS)水平[分别为(15±8)、(11±8)mIU/L]和 A 水平[分别为(11±6)、(8±5)nmol/L]均明显升高,胰岛初期分泌功能指数(Δ160/ΔG60,分别为32±22、52±30)、胰岛素敏感指数(ISI,分别为0.019±0.011、0.033±0.014)和葡萄糖处置指数(DI,分别为18±10、30±22)明显降低,以上各指标两者间比较,差异均有统计学意义(P<0.05)。(2)有月经紊乱家族史 PCOS 患者与无月经紊乱家族史者相比,WHR(分别为0.99±0.09、0.80±0.10)明显增加,多毛评分[分别为(1.9±1.0)、(1.6±1.1)分]也明显增加,月经稀发周期[分别为(105±28)、(84±31)d]明显延长,HOMA-IR 和 FINS 水平[分别为(3.6±2.4)、(2.5±1.7)和(15±14)、(12±11)mIU/L]明显升高,而胰岛β细胞功能指数(HOMA-β)、ISI 和 DI(分别为178±134和207±175,0.017±0.019和0.034±0.012,23±18和28±19)明显降低,以上各指标两者间比较,差异均有统计学意义(P<0.05)。(3)有早秃家族史 PCOS 患者与无早秃家族史者相比,BMI[分别为(26±4)、(23±5)kg/m^2]和多毛评分[分别为(2.1±1.1)、(1.7±1.3)分]也明显增加,DI(分别为20±11、30±23)明显降低,差异均有统计学意义(P<0.05)。(4)有高血压家族史 PCOS 患者与无高血压家族史者相比,Δ160/ΔG60(分别为34±27、50±30)明显降低,FINS 水平[分别为(13±10)、(10±9)mIU/L]明显升高,上述指标两者间比较,差异均有统计学意义(P<0.05)。(5)冠心病家族史则对上述各指标无明显影响(P>0.05)。结论糖尿病家族史对 PCOS 患者临床表型影响最大,其次为月经紊乱家族史、早秃家族史、高血压家族史等,冠心病家族史则对 PCOS 患者临床表型无明显影响。
Objective To study the relationship of abnormal family history in the first degree relatives and the clinical phenotype of patients with polycystic ovary syndrome (PCOS). Methods Clinical data of first degree relatives of 139 women with PCOS were collected by questionnaires, including body mass index (BMI), waist hip ratio (WHR), and hursutism score. Follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), testosterone (T), androstenedione (A), oral glucose tolerance test (OGTT) and insulin releasing test were measured. Results ( 1 ) Compared with patients with a negative family history of diabetes mellitus, for women with a positive family history, WHR (0. 99 ± 0. 10 vs 0. 79 ± 0. 08 ) and score of hirsutism ( 1.9 ± 1.2 vs 1.8 ± 1.2 ) were increased, the duration of menstruation was longer [ ( 108 ± 10) vs (92 ± 19) days ] ; A [ ( 11 ± 6) vs ( 8 ± 5 ) nmol/L ], homeostasis model assessment of insulin resistance ( HOMA-IR, 3.5 ± 2. 0 vs 2. 7 ± 1.6), area under curve ( AUC ) glucose[ (836 ±245)vs(748 ± 139)nmol · L^-1 · min^-1 ], AUC insulin [ (9670 ±4582)vs(7330 ±4311 ) mIU · L^-1 · min^-1 ], fasting glucose [ ( 5.0 ± 1.1 ) vs (4. 8 ± 0. 5 ) mmol/L ] and fasting insulin [ ( 15 ± 8) vs (11 ±8)mIU/L] were increased, while early insulin secretion function index (△I60/△G60, 32 ± 22 vs 52 ± 30), insulin sensitive index (ISI, 0. 019 ± 0. 011 vs 0. 033 ± 0. 014)and disposition index (DI, 18 ± 10 vs 30 ± 22 ; P 〈 0.05 ) were decreased. (2) For women with a positive family history of menstrual disorder, WHR and score of hirsutism (0.99 ± 0. 09 vs 0. 80 ± 0. 10 and 1.9 ± 1.0 vs 1.6 ± 1.1 ) were increased respectively, the duration of menstruation [ ( 105 ±28)vs(84 ±31 )days] was longer, HOMA-IR (3.6 ± 2.4 vs 2. 5 ± 1.7)and fasting insulin level [ ( 15 ± 14) vs ( 12 ± 11 ) mIU/L ] were increased, while HOMA-β( 178 ± 134 vs 207 ± 175 ), ISI (0. 017 ± 0. 009 vs 0. 033 ± 0. 012) and DI (23 ± 18 vs 28 ± 19, P 〈 0. 05 ) were decreased. (3) For women with a positive family history of premature balding, BMI and the score of hirsutism [ (26 ± 4) vs (23 ± 5 ) kg/m^2 and 2. 1 ± 1.1 vs 1.7 ± 1.3 ] were increased respectively, while DI(20 ± 11 vs 30±23, P〈0.05)was decreased. (4) △I60/△G60(34±27 vs 50±30)was decreased and fasting insulin [ FINS, ( 13± 10) vs ( 10 ± 9) mIU/L] was increased in PCOS women with a family history of hypertension ( P 〈 0.05 ). (5) For women with or without a family history of coronary heart disease, they did not have any difference in every parameter mentioned before. Conclusions The family history of diabetes mellitus has the most effect on the clinical phenotype in women with PCOS. The family history of other diseases such as menstrual disorder, premature balding and hypertension play less significant roles. A family history of positive coronary heart disease does not affect the clinical phenotype of such patients.
出处
《中华妇产科杂志》
CAS
CSCD
北大核心
2007年第11期756-760,共5页
Chinese Journal of Obstetrics and Gynecology
关键词
多囊卵巢综合征
表型
胰岛素抗药性
突变
Polycystic ovary syndrome
Phenotype
Insulin resistance
Mutation