青春期多囊卵巢综合征患者临床表现及内分泌代谢特征

Clinical Features,Reproductive Endocrine and Metabolic Abnormalities of Adolescent Girls with Polycystic Ovary Syndrome

目的探讨青春期多囊卵巢综合征(polycystic ovary syndrome,PCOS)患者的临床表现及内分泌代谢特征。方法选择2010-01/2012-10月间就诊于南京医科大学附属南京医院妇产科门诊的青春期PCOS患者50例,记录其身高、体质量、月经情况,完善盆腔超声检查,检测性激素水平、空腹血糖、胰岛素、血脂水平并行葡萄糖耐量试验(oral glucose tolerance test,OGTT)。根据是否合并肥胖、胰岛素抵抗、睾酮升高进行分组,比较各组之间激素及代谢水平的差异。结果 1青春期PCOS患者中月经稀发或闭经的发生率达90%;至少一侧卵巢多囊样改变者占90%;肥胖、胰岛素抵抗、高睾酮的发生率分别为36%,30%,20%;糖耐量减低患者7例(14%),血脂代谢异常患者2例(4%)。2肥胖组较非肥胖组空腹胰岛素(fasting insulin,FINS)、胰岛素抵抗指数(insulin resistance index,IR)、甘油三酯(triglyceride,TG)、低密度脂蛋白(low density lipoprotein,LDL)、OGTT2h血糖均显著升高,而黄体生成素(luteinizing hormone,LH)、黄体生成素/卵泡刺激素(the ratio of luteinizing hormone and follicle stimulating hormone,LH/FSH)、高密度脂蛋白(high density lipoprotein,HDL)则显著降低;胰岛素抵抗组较非胰岛素抵抗组体质量指数(body mass index,BMI)、FINS、TG、LDL、OGTT2h血糖均显著升高,而HDL则显著降低;高睾酮组较非高睾酮组IR、OGTT2h血糖均显著升高。结论月经失调是青春期PCOS患者最常见的临床表现;糖脂代谢障碍,肥胖、高睾酮是加重胰岛素抵抗及糖代谢的高危因素,肥胖、胰岛素抵抗是影响脂代谢的高危因素。

Objective To investigate the clinical features,reproductive endocrine and metabolic abnormalities in adolescent girls with polycystic ovary syndrome （PCOS） .Methods A total of 50 adolescent patients with PCOS were selected in The Affiliated Hospital of Nanjing Medical University from Jannary 2010 to October 2012. The general information were recorded, serum levels of fasting plasma glucose, lipids, sexy hormones were detected. Body mass index （BMI） was measured and oral glucose tolerance test （OGTT） was performed. The patients were divided according to obesity, insulin resistance, elevated testosterone and the differences in the levels of hormones and metabolism were compared between different groups.Results 100% adolescent PCOS patients suffered from abnormal menstruation, and 90% of them had polycystic ovaries （PCO） . The incidence of obesity, insulin resistance, high testosterone, impaired glucose tolerance and lipid abnormalities were respectively 36%, 30%, 20%,14% and 4%. The level of fasting insulin （FINS） , insulin resistance index （IR） , triglycerides （TG） , low density lipoprotein （LDL） , OGTT2h glucose in obese group were significantly elevated than that in non-obese group, and the level of luteinizing hormone （LH） , high-density lipoprotein （HDL） and LH/FSH ratios were significantly reduced. BMI and the level of FINS, TG, LDL, OGTT2h glucose in insulin resistance group than that in non-insulin resistance group, whereas HDLwas significantly reduced. The IR and the level of OGTT 2h glucose in high testosterone group were significantly elevated than that in non-high testosterone group.Conclusion Menstrual disorders are the commonest clinical features of PCOS patients. Glucose metabolism and lipid metabolism disorders, obesity and high testosterone are the risk factors of aggravating insulin resistance and glucose metabolism. Oobesity and insulin resistance are the high risk factors affecting lipid metabolism.