多囊卵巢综合征患者非酒精性脂肪性肝病的发病情况及特点分析

Prevalence and characteristics of nonalcoholic fatty liver disease in patients with polycystic ovary syndrome

目的探讨多囊卵巢综合征(PCOS)患者非酒精性脂肪性肝病(NAFLD)的发生情况和临床特点。方法对306例PCOS患者行基础内分泌、口服糖耐量试验及胰岛素释放试验、肝功、血脂、肝脏超声等检查。分析NAFLD的发病情况及特点。结果 NAFLD发生率为30.7%(94/306);NAFLD发病率随体质量指数(BMI)和年龄的增加而升高。PCOS合并NAFLD者空腹血糖、空腹胰岛素、口服葡萄糖2h后血糖及胰岛素水平、稳态模型评估(HOMA-IR)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、TC、TG、LDL-C、BMI、腰围、腰臀比,均显著高于不合并NAFLD者(P均<0.05);而量化胰岛素敏感指数(QUICK)、HDL-C则显著低于不合并NAFLD者(P均<0.05)。PCOS合并NAFLD者胰岛素抵抗、腹型肥胖、糖耐量异常、糖尿病、肝功异常、血脂异常、高血压病及代谢综合征的患病率显著高于不合并NAFLD者(P<0.05)。结论 PCOS伴NAFLD发病率较高;其发病率与BMI和年龄呈正相关;PCOS伴NAFLD多存在胰岛素抵抗、代谢异常;超重及腹型肥胖是PCOS患者NAFLD的主要危险因素。

Objective To investigate the prevalence of nonalcoholic fatty liver disease （ NAFLD） and its clinical characteristics in patients with polycystic ovary syndrome （ PCOS） . Methods Three hundred and six patients with PCOS were enrolled in,the basal endocrine,oral glucose tolerance test（ OGTT） ,insulin release test,lipid profile,blood pressure and body mass index （ BMI） of which were examined. Liver chemistries,B-hepatitis and c-hepatitis were performed. The prevalence and clinical characteristics of NAFLD were analyzed. Results The incidence of NAFLD in PCOS was 30. 7% , which increased with BMI and aging. Serum fasting insulin,120min insulin,fasting glucose,120 min glucose,HOMA-IR, ALT,AST,LDL-C,triglycerides,total cholesterol,BMI,WHR and waist were significantly higher （ P 0. 05） in patients with NAFLD compared to patients without NAFLD. However,QUICK and HDL-C were significantly lower （ P 0. 05） in patients with NAFLD compared to patients without NAFLD. The presence of insulin resistance,abdominal obesity,diabetes mellitus,dyslipidemia,abnormal aminotransferase activity,hypertension and metabolic syndrome （ MS） in patients with NAFLD were significantly higher than those in patients without NAFLD. Conclusions Ptaients with PCOS have a high prevalence of NAFLD; the prevalence of NAFLD is positively correlated with BMI and aging. Insulin resistance and metabolic abnormalities are important associated factors with NAFLD in PCOS; overweight and abdominal obese are the main risk factors of NAFLD in PCOS patients.