瘦素和多囊卵巢综合征(PCOS)伴非酒精性脂肪肝(NAFLD)相关性的临床观察

Clinical observation on correlation between serum leptin and the non-alcoholic fatty liver disease(NAFLD) in women with polycystic ovary syndrome(PCOS)

目的通过对多囊卵巢综合征(polycystic ovary syndrome,PCOS)人群中伴非酒精性脂肪肝(non-acoholic fatty liver disease,NAFLD)的分析,探讨瘦素与PCOS伴NAFLD之间的关系。方法收集35例PCOS伴有NAFLD的患者为脂肪肝组,同期选择35例PCOS不伴NAFLD的患者为非脂肪肝组,健康女性志愿者20例为对照组。所有受试者进行相关问卷调查建立个人病例档案,测量身高(height,H)、体重(weight,W)、体重指数(body mass index,BMI)、腰围(waist circumference,WC)、臀围(hip circumference,HC)及腰臀比(wasit hip ratio,WHR);检测血清睾酮(testosterone,T)、泌乳素(prolactin,PRL)、卵泡刺激素(folliclestimulating hormone,FSH)、黄体生成素(luteinizing hormone,LH)、雌二醇(estradiol,E2)、瘦素、空腹血糖(fasting blood sugar,FBG)、空腹胰岛素(fasting insulin,FINS)、餐后2h血糖(2hpostprandial blood glucose,2hPBG)、稳态模型胰岛素抵抗指数(homeostatic model assessment for insulin resistance,HOMA-IR)、总胆固醇(total cholesterol,TC)、三酰甘油(triglyceride,TG)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)及丙氨酸转氨酶(alaninetransaminase,ALT)等指标。结果两组PCOS的瘦素、W、BMI、WHR、T、LH、LH/FSH、FINS、PBG、HOMA-IR、LDL-C各项指标均高于对照组(P<0.05),FSH显著低于对照组(P<0.05);而PCOS伴NAFLD的瘦素、W、BMI、WC、HC、WHR、FINS、PBG、HOMA-IR、TG、LDL-C、ALT较不伴NAFLD显著升高(P<0.05),HDL-C显著降低(P<0.05)。脂肪肝组的瘦素水平与年龄、W、BMI、WC、HC、WHR、FINS、HOMA-IR及TG呈均显著正相关性(P<0.01),与HDL-C呈显著负相关性(P<0.01),控制与体脂有关的如W、BMI、WC、HC、WHR,脂肪肝组的瘦素水平与HOMA-IR、TG仍有显著正相关性(P<0.01)。结论瘦素水平异常与PCOS伴NAFLD的形成密切相关,及早重视瘦素干预,对于防治PCOS伴NAFLD有重要意义。

Objective To determine whether leptin is associated with the non-alcoholic fatty liver disease（NAFLD） in women with polycystic ovary syndrome（PCOS）.Methods Seventy female PCOS patients of reproductive age（20-40 years） were recruited.Among them,35 patients were complicated with NAFLD（PCOS-NAFLD group） and the other were not complicated with NAFLD（PCOS-nNAFLD group）.At the same time,20 healthy women volunteers（control group） were chosen as compared group.All subjects underwent relevant questionnaire and clinical exam.The clinical data,in terms of height（H）,weight（W）,body mass index（BMI）,waist circumference（WC）,hip circumference（HC）,wasit hip ratio（WHR）,testosterone（T）,prolactin（PRL）,follicle stimulating hormone（FSH）,luteinizing hormone（LH）,estradiol（E2）,leptin,fasting blood sugar（FBG）,fasting insulin（FINS）,2 h postprandial blood glucose（2hPBG）,homeostatic model assessment for insulin resistance（HOMA-IR）,total cholesterol（TC）,triglyceride（TG）,low-density lipoprotein cholesterol（LDL-C）,high-density lipoprotein cholesterol（HDL-C） and alanine transaminase（ALT） were collected,compared and analyzed.Results The levels of Leptin,weight,BMI,WHR,T,LH,LH/FSH,FINS,PBG,HOMA-IR,LDL-C in PCOS with or without NAFLD patients were significantly higer than those in control group（P0.05）.The level of FSH in PCOS with or without NAFLD patients was lower than that in control group（P0.05）.Furthermore,the levels of cholesterol and triglyceride were significantly higher in PCOS with NAFLD than in control group（P0.05）.HDL-C was significantly lower in PCOS with NAFLD than in control group（P0.05）.Compared with PCOS without NAFLD,the levels of leptin,FINS,PBG,HOMA-IR,TG,LDL-C,ALT were significantly higher in PCOS with NAFLD（P0.05）.In addition,the level of HDL were significantly lower（P0.05）.The occurrence of leptin was highly positively correlated with levels of age,weight,BMI,WC,HC,WHR,FINS,HOMA-IR,TG and highly negatively correlated with level of HDL-C（P0.01） in PCOS with NAFLD.After adjusting the factors of body fat such as W,BMI,WC,HC and WHR,the occurrence of leptin was still highly positively correlated with levels of HOMA-IR and TG（P0.01） in PCOS with NAFLD.Conclusions It is indicated that the disorder of leptin is closely related to the formation of PCOS with NAFLD.So,early treatment on leptin is of important significance for preventing PCOS with NAFLD.