肥胖对多囊卵巢综合征患者非酒精性脂肪性肝病的影响

Effect of obesity on nonalcoholic fatty liver disease in Chinese women with polycystic ovary syndrome

目的 研究肥胖对多囊卵巢综合征（PCOS）患者中非酒精性脂肪性肝病（NAFLD）发病的影响.方法 对306例PCOS患者及286例对照者进行基础内分泌、口服糖耐量试验及胰岛素释放试验、肝功、血脂等检查,B超诊断脂肪肝.结果 306例PCOS患者中诊断NAFLD 94例,占30.7%,明显高于对照组发病率17.5%（P＜0.05）;PCOS患者中NAFLD轻度56例（59.6%）,中度34例（36.2%）,重度4例（4.2%）.PCOS患者中NAFLD发病率随着体重指数（BMI）、腰臀比（WHR）、甘油三酯（TG）、HOMA-IR的增加而升高,脂肪肝程度随着BMI的增加而加重.腹型肥胖的PCOS患者NAFLD发病率为43.4%,明显高于腰围正常的PCOS患者NAFLD发生率为2.2%（P＜0.05）.且随着BMI的增加,PCOS患者胰岛素抵抗、代谢综合征的发生率亦随之升高.结论 PCOS患者NAFLD发病率较高,腹型肥胖和Ⅱ肥胖的PCOS患者更易发生NAFLD,其发病率和脂肪肝的程度与BMI呈正相关.PCOS患者NAFLD的发生与胰岛素抵抗、肥胖、代谢异常密切相关.肥胖的PCOS患者应加强NAFLD的诊断并及时指导其改善生活方式.

Objective To investigate the effect of obesity on nonalcoholic fatty liver disease （NAFLD） in women with polycystic ovary syndrome （PCOS）. Methods The patient data were acquired from 306 women with PCOS by Rotterdam consensus criteria and 286 women selected as controls. Basal endocrine, oral glucose tolerance test （OGTT）, insulin release test, lipid profile, blood pressure and body mass index （BMI） were tested. The essays of liver chemistries, B-hepatitis and c-hepatitis were performed and alcoholic liver diseases excluded. Fatty liver was diagnosed by ultrasound. Results Patients with PCOS showed a higher prevalence of NAFLD than control group （30. 7% vs 17. 5% ）, including 56 mild cases （59.6%）, 34 moderate cases （36. 2% ） and 4 severe cases （4. 2% ）. The prevalence of NAFLD in PCOS increased with BMI, waist hip ratio, triglyceride and HOMA-IR. The prevalence of NAFLD in abdominal obese PCOS patients was significantly higher than those with normal waist. In addition to the prevalence of insulin resistance, metabolic syndrome in PCOS women significantly increased with BMI. Conclusion These findings indicate that Chinese women with PCOS have a high prevalence of NAFLD, especially in abdominal and Ⅱ obese PCOS patients. The prevalence and severity of NAFLD are positively correlated with BMI. It seems that insulin resistance and metabolic abnormalities are closely associated with NAFLD in PCOS. It is essential to give a high priority to the screening and treatment of NAFLD in obese PCOS patients.