汉族多囊卵巢综合征患者各雄激素指标的临床意义分析

Clinical Significance of the Androgenic Parameters in Polycystic Ovary Syndrome Patients of Han Chinese

目的:探讨多囊卵巢综合征(PCOS)患者的雄激素表现及其与内分泌和代谢改变之间的关系。方法:分析100例PCOS患者及100例对照女性的临床和生化雄激素(A)指标及其与内分泌和代谢参数间的关系。结果:PCOS患者多毛评分高于对照组,但症状程度较轻(中位数=2)。生化雄激素指标中,硫酸脱氢表雄酮(DHEAS)和双氢睾酮(DHT)在组间无统计学差异(P>0.05),而PCOS组患者睾酮(T,1.46 nmol/L vs 0.90 nmol/L)、雄烯二酮(A4,8.24 nmol/L vs 4.96 nmol/L)和游离雄激素指数(FAI,3.70 vs 1.54)显著高于对照组(P<0.05),性激素结合球蛋白(SHBG,35.84 nmol/L vs56.08 nmol/L)则明显低于对照组(P<0.05)。相关分析表明,与对照组相比PCOS组各雄激素指标间相关性明显减低。雄激素指标与内分泌和代谢参数的相关性在组间也存在统计学差异(P<0.05)。对照组中FAI、A4、T、DHEAS与FSH呈负相关,而在PCOS组中FSH相关性消失,而是与LH呈正相关;对照组雄激素指标与糖脂代谢参数的相关性不明显,但在PCOS组中FAI、A4、T均与代谢指标明显呈正相关。结论:对于中国PCOS患者来说,生化雄激素指标较临床指标更为显著;FAI和A4在评价生化高雄激素时更有意义。PCOS中特异存在的雄激素代谢和作用过程改变可能是疾病病因机制的关键。

Objective： To explore the androgenic characteristics in polycystic ovary syndrome（PCOS）and its relation with endocrine and metabolic changes. Methods： Retrospective study was performed in 100 PCOS and 100 control women. Clinical and biochemical androgenic index parameters were detected and their relationship with endocrine and metabolic index variables were analyzed. Results： Compared with control women, Chinese PCOS patients had slightly higher modified Ferriman and Gallwey（m-FG） score（meidan=2）, and significantly increased testosterone（T, 1.46 nmol/L vs 0.90 nmol/L, P〈0.01）, androstenedione（A4, 8.24 nmol/L vs4.96 nmol/L, P〈0.01）, and free androgen index（FAI, 3.70 vs 1.54, P〈0.01）. No difference was found in dehydroepiandrosterone（DHEAS） and dihydrotestosterone（DHT） between the two groups. sex hormone binding globulin（SHBG） in PCOS group was lower than that in the control（35.84 nmol/L vs 56.08 nmol/L, P〈0.01）. The correlation between different androgenic parameters was reduced in PCOS group than the control. Significant difference was also found in the association between androgen and endocrine as well as metabolic characteristics.In control group, FSH was positively correlated with FAI, A4, T, DHEAS, whereas in PCOS women,luteinizing hormone（LH） was the correlated one instead. Besides, different from controls, there was a significant correlation between FAI, A4, T and metabolic characteristics in PCOS women. Conclusion： Biological androgen has more important pathologic significance in patients with PCOS than clinical manifestation. FAI and A4 are more meaningful in evaluating the biological androgenic status. The PCOS specific change of metabolic process of androgen might be the key in the mechanism of the syndrome.