青春期多囊卵巢综合征的临床特点分析

Clinical characteristics of polycystic ovary syndrome in adolescent girlsClinical girls

目的探讨青春期多囊卵巢综合征(PCOS)的临床特征。方法选择在我院妇科就诊的PCOS患者80例,其中青春期组34例,育龄期组46例。对比分析两组间的临床差别、性激素和血脂水平及胰岛素释放试验结果。结果 (1)青春期组的发病年龄、病程和体重指数(BMI)均明显少于育龄期,P<0.05;但超重/肥胖的构成比、腰围和血压与育龄期组无统计学差异,P>0.05。(2)两组间的月经失调均主要表现为月经稀发,其次为闭经,均无统计学差别;青春期组的多毛和痤疮的评分及构成比均显著高于育龄期组,P<0.05。(3)青春期组血清睾酮(T),硫酸脱氢表雄酮(DHEAs)均显著高于育龄期组,P<0.01或P<0.05;性激素其余项无统计学差别P>0.05。(4)两组间空腹血糖、胰岛素和HOMA-IR均无统计学差别,P>0.05。但青春期组有胰岛素抵抗构成比和75g葡萄糖试验后,1h、2h和3h血糖和胰岛素显著低于育龄期组,P<0.05。青春期组血脂中仅LDL显著低于育龄期组,P<0.05,余项无统计学差别,P>0.05。结论与育龄期PCOS患者相比,青春期PCOS患者有更明显的高雄激素血症,较轻的肥胖、胰岛素抵抗和血脂异常。

Objective To explore the clinical features of polycystic ovary syndrome （PCOS） in adolescent girls. Methods Eighty patients with PCOS were selected and divided into adolescent （n=34） and adult （n=46） groups. Comparative analysis was made in the clinical differences, sex hormone and blood fat levels, and insulin releasing test results between the two groups. Results （1） The age of onset, course of disease, and body mass index （BMI） in the adolescent group were all lower than those in the adult group （P〈0.05）. But there was no significant difference of the ratio of overweight to obesity, waist circumference, and blood pressure between the two groups （P〉0.05）. （2） The main manifestations of menstrual disorder in both groups were oligomenorrhea and amenorrhoea, but the differences between the two groups were not significant. The scores and constituent ratio of hypertrichosis and acne in the adolescent group were all higher than those in the adult group （P〈0.05）. （3） The levels of serum testosterone and dehydroepiandrosterone sulfate in the adolescent group were significantly higher than those in the adult group （P〈0.01 or 0.05）. There was no significant difference of the other indexes of sex hormone between both groups（P〉0.05）. （4） There was no significant difference of the blood fasting sugar, insulin and HOMA-IR between the two groups （P〉0.05）. But in the adolescent group, the constituent ratio of insulin resistance and the levels of blood glucose and insulin 1, 2, and 3 h after 75 g glucose tolerance test were significantly lower than those in the adult group （P〈0.05）. Only the level of low density lipoprotein in the adolescent group was significantly lower than that in the adult group （P〈0.05）, and there was no signifi-cant difference of other blood fat indexes between the two groups （P〉0.05）. Conclusion Compared with the adult patients with PCOS, the adolescent patients with PCOS have more obvious hyperandrogenism and less obesity, insulin resistance, and dyslipidemia.