多囊卵巢综合征病人生殖内分泌与血脂谱相关性研究

A CORRELATION STUDY OF REPRODUCTIVE ENDOCRINOLOGY AND LIPID PROFILE IN PATIENTS WITH POLYCYSTICOVARIAN SYNDROME

目的分析多囊卵巢综合征(PCOS)病人的内分泌及代谢特征,探讨高雄激素血症、腹型肥胖、胰岛素抵抗与血脂谱的关系。方法选择42例PCOS病人作为研究组,按体质量指数(BMI)、Homa-胰岛素抵抗(Ho-ma-IR)指数(Homa-IRI)分别再分为肥胖型PCOS组和非肥胖型PCOS组、胰岛素抵抗型PCOS组和非胰岛素抵抗型PCOS组;另外选择20例正常生育期女性作为对照组。分别测定腹围、臀围、身高、体质量、生殖激素及血脂谱。结果与对照组相比,研究组BMI、腹围、腰臀比(WHR)、促黄体生成素(LH)、睾酮(T)、硫酸脱氢表雄酮(DHE-AS)、空腹胰岛素(FINS)、Homa-IRI、载脂蛋白B(apoB)、低密度脂蛋白(LDL)、胆固醇(TC)、三酰甘油(TG)显著升高;载脂蛋白A1(apoA1)显著降低(t=2.02～9.96,P<0.05)。与非肥胖型PCOS组相比,肥胖型PCOS组apoB、TC、TG水平显著升高(t=2.18～4.12,P<0.05)。与非胰岛素抵抗型PCOS组相比,胰岛素抵抗型PCOS组TG水平显著升高(t=3.63,P<0.01)。研究组脂蛋白(a)[LP(a)]与T呈正相关(r=0.44,P<0.01),与WHR、腹围呈负相关(r=-0.46、-0.39,P<0.01);apoB与T、BMI、腹围呈正相关(r=0.31～0.35,P<0.05);TC与腹围呈正相关(r=0.33,P<0.05);高密度指蛋白(HDL)与DHEAS呈负相关(r=-0.33,P<0.05);TG与BMI、腹围、WHR、Homa-IRI呈正相关(r=0.32～0.60,P<0.05);BMI与腹围、WHR、Homa-IRI呈正相关(r=0.70～0.94,P<0.01);腹围与WHR、Homa-IRI均呈正相关(r=0.68、0.81,P<0.01);WHR与Homa-IRI、DHEAS均呈正相关(r=0.42、0.59,P<0.01);Homa-IRI与T呈正相关(r=0.48,P<0.01);T与DHEAS呈正相关(r=0.32,P<0.05)。肥胖型PCOS病人T与BMI、腹围呈正相关(r=0.47、0.49,P<0.05)。结论 PCOS病人存在血脂谱异常,以肥胖型PCOS病人和胰岛素抵抗型PCOS病人更为明显。高雄激素血症、腹型肥胖、胰岛素抵抗可能是引起P-COS病人血脂谱异常的原因。

Objective To analyze the characteristics of endocrinology and metabolism in patients with polycystic ovarian syndrome（PCOS）,and investigate the relationship among hyperandrogenism,abdominal obesity,insulin resistance and lipid spectrum.Methods Forty-two patients with PCOS were enrolled and divided into obese PCOS and Non-obese PCOS,insulin-resistant PCOS and non-insulin-resistant PCOS according to body mass index（BMI） and Homa-IR index（Homa-IRI）.Twenty normal child-bearing period women were enrolled as controls.Abdomen circumference（AC）,hip circumference（HC）,body height,body weight,reproductive hormones and lipid spectrum were determined.Results Compared with the control group,BMI,AC,waist/ hip ratio（WHR）,luteinizing hormone（LH）,testosterone（T）,dehydroepiandrosterone sulfate（DHEAS）,fasting insulin（FINS）,Homa-IRI,apolipoprotein B（apoB）,low-density lipoprotein（LDL）,total cholesterol（TC）and triglyceride（TG） in study groups were higher,and the level of apolipoprotein A1（apoA1） was lower（t=2.02-9.96,P〈0.05）;compared with non-obese group,the levels of apoB,TC,TG in obese PCOS group were higher（t=2.18-4.12,P〈0.05）.Compared with noninsulin-resistant group,the TG level in insulin-resistant was higher（t=3.63,P〈0.01）.In study groups,lipoprotein（a） was positively correlated with T（r=0.44,P〈0.01）,and negatively correlated with WHR and AC（r=-0.46,-0.39;P〈0.01）;apoB was positively correlated with T,BMI and AC（r=0.31-0.35,P〈0.05）;TC was positively correlated with AC（r=0.33,P〈0.05）;HDL was negatively correlated with DHEAS（r=-0.33,P〈0.05）;TG was positively correlated with BMI,AC,WHR and Homa-IRI（r=0.32-0.60,P〈0.05）;BMI was positively correlated with AC,WHR and Homa-IRI（r=0.70-0.94,P〈0.01）;AC was positively correlated with WHR and Homa-IRI（r=0.68,0.81;P〈0.01）;WHR was positively related with Homa-IRI and DHEAS（r=0.42,0.59;P〈0.01）;Homa-IRI was positively correlated with T（r=0.48,P〈0.01）;T was positively correlated with DHEAS（r=0.32,P〈0.05）.In the obese PCOS patients,T was positively correlated with BMI and AC（r=0.47,0.49;P〈0.05）.Conclusion There is an abnormal lipid spectrum in patients with PCOS,which is more obvious in obese and insulin-resistant patients.Hyperandrogenism,abdominal obesity and insulin resistance are likely to be causes leading to dyslipidemia of the disease.