不同亚型多囊卵巢综合征患者的临床及生化特征比较

Compared the clinical and biochemical features of different phenotypic subtype of polycystic ovary syndrome

目的比较不同亚型多囊卵巢综合征患者的临床及生化特征,分析中国(2011年)多囊卵巢综合征(PCOS)诊断标准与2003年鹿特丹诊断标准在临床应用中的差异。方法回顾性分析2008年1月到2012年12月就诊于本院生殖医学研究所门诊的1,248例PCOS患者,根据2011年中国的PCOS诊断标准和2003年鹿特丹PCOS诊断标准,将患者分为四个亚型:Ⅰ型PCO+高雄激素临床或生化特征+月经异常;Ⅱ型PCO+月经异常;Ⅲ型高雄激素临床或生化特征+月经异常;Ⅳ型PCO+高雄激素临床或生化特征,对四组PCOS患者的临床生化特征进行分析。结果 (1)收集的1,248例PCOS患者中多囊卵巢、月经异常、高雄激素的临床表现或高雄激素血症、肥胖、胰岛素抵抗、黄体生成素/卵泡刺激素(LH/FSH)>1、LH/FSH≥2的发生率分别为:99.5%、89.6%、33.1%、29.5%、46.1%、67.0%、26.7%。(2)Ⅰ型的基础黄体生成素(bLH)及LH/FSH比值最高,且与Ⅲ型、Ⅳ型的差异有统计学意义(P<0.05);Ⅱ型的雄激素水平(T)最低,与其他三组比较差异有统计学意义(P<0.05);Ⅲ型的卵巢体积最小,与其他三组比较差异有统计学意义(P<0.05);四组之间的年龄、体重指数(BMI)、基础卵细胞刺激素(bFSH)、空腹血糖、空腹胰岛素等的差异均无统计学意义(P>0.05)。结论 (1)收集的PCOS患者的主要特征为PCO、月经异常、LH/FSH>1及高雄激素临床或生化特征。(2)除了分型因素导致的差异,不同亚型PCOS的其他临床生化特征无明显差异。(3)本次调查结果提示,相对于2011年中国PCOS的诊断标准,2003年鹿特丹诊断标准更全面、客观。

Objective： To compare the clinical and biochemical features of different phenotypic subtypes of polycystic ovary syndrome（PCOS）and analyze the difference between the PCOS diagnostic criteria of China （2011）and the PCOS criteria of Rotterdam（2003）. Methods： A total of 1,248 patients with PCOS were collected from January 2008 to December 2012 in the Reproductive Center of Henan PrOvincial People s Hospital retrospectively. According to the PCOS diagnostic criteria of China（2011）and the PCOS cri.teria＇of Rotterdam（2003）, the patients with PCOS were divided.to 4 Subtypes ： Subtype I PCO＋ biochemical ＇or clinical of hyperandrogenism＋ irregular menstrual cycle;Subtype PCO-irregular mefistrual cycle; Subtype III biochemical or clinical of hyperandrogenism ＋irregular menstrual cycle. Subtype IV PCO＋ bi0ch＇emical or clinical of hyperandrogenism. The clinical and biochemical features Of the four subtypes patients were compared. Results： （1）Among PCOS patients,the occurrence rates of PCO, irregular menstrual cycles bi0chemical and clinical of hyperandrogenism, obesity, insulin resist, LH/FSH 1, LH/FSH 2 were99.5%,89.6%,33.1%,29.5%,46.1%,67.0%,26.7% respectively. （2）The basal LH levels and LH/ FSH of subtype I was significantly higher than subtype and subtype IV （P〉0.05）. The testosterone （T）levels of subtype is significantly lower than the another three groups（P〈0, 05）. The ovari＇an volume in subtype III was the smallest compared with the other groups （P〈 0. 05）. There waS no ＇significant difference among the four subtypes in age, BMI, basic FSH, fasting blood glucose and fasting ＇insulin （P〈0. O5）. Conclusions： （1）The main feature of PCOS patients is PCO, irregular menstrual cycles, LH/FSH 1 and biochemical or clinical of hyperandr0genism. （2）There are no significant differences in biochemical and clinical features among the different subtypes PCOS except the typing factors. （3）,The study results show that the PCOS criteria of Rotterdam （2003）are more comprehensive and objective than PCOS diagnostic criteria of China（2011）.