不同亚型的多囊卵巢综合征患者临床及实验室指标特征的研究

Clinical and endocrine characteristics among phenotypic expressions of polycystic ovary syndrome according to the 2003 Rotterdam consensus criteria

目的基于鹿特丹标准,依据美国国立卫生院(National Institutes of Health,NIH)最新指南推荐,探讨不同亚型多囊卵巢综合征(polycystic ovary syndrome,PCOS)患者临床、内分泌代谢等相关指标特征,以指导临床治疗。方法募集2014年12月至2015年5月在首都医科大学附属北京妇产医院内分泌科就诊的PCOS患者647例,测定人体学指标、性激素及血脂、血糖、胰岛素及阴道B超等,依据NIH指南推荐将其四型分为4组:A组409例〔O+HA+P:无排卵或稀发排卵(oligo-ovulation,O),雄激素水平升高的临床和(或)生化表现(hyperandrogeoism,HA),卵巢多囊样改变(polycystic ovary,P)〕;B组58例(O+HA);C组101例(HA+P);D组79例(O+P),另选同期就诊的基础体温双相的输卵管因素不孕症患者60例为对照组,分别评估临床及激素代谢指标。结果 647例患者,4个亚型的患病率分别为:A组63.2%,B组9%,C组15.6%,D组12.9%,647例患者中有高雄表现或血雄激素浓度高的发生率为87.8%。A组与B组:高雄血症、腰围、胰岛素抵抗及三酰甘油均明显增高,但A组最重,B组次之。C组与A、B两组相比,临床和内分泌代谢特征温和,但与对照组相比,黄体生成素(luteinizing hormone,LH)、黄体生成素/卵泡刺激素(LH/follicle stimulating hormone,FSH)均明显增高(P<0.05)。D组与对照组间体质量指数(body mass index,BMI)、腰围、臀围、Ferryman-Gallwey评分结果相似。部分特殊化指标质量浓度各组间差异均无统计学意义(P>0.05)。结论 1)基于鹿特丹诊断标准的PCOS分型方法可反映疾病的基本特征。2)高雄激素血症和/或多毛评分是区分PCOS不同亚型最主要的依据,可能是代谢障碍严重程度不同的结果。与标准组(Ⅰ型和Ⅱ型相比),正常排卵组和非高雄组可代表PCOS相对温和的表型。而非高雄组PCOS可能有不同的致病途径。因此对于不同分型PCOS患者的治疗也应该个体化。

Objective To analyze the relative prevalence and the clinical and endocrine characteristics of each phenotype expressions of polycystic ovary syndrome（PCOS） according to the National Institutes of Health（NIH） and RotterdaM Consensus criteria definitions for PCOS. Methods Clinical, endocrine and metabolic data from 647 women with PCOS diagnosed according to Rotterdam criteria and NIH recommendations between Dec. 2014 and May 2015 were collected and divided into four different phenotypes. Results The severe PCOS phenotype defined as having oligo-ovulation（ OO）, hyperandrogenism（ HA）, and polycystic ovary（ PCO）, i.e. , Group A, was the most common phenotype seen in 63.2% of the patients. Group B, defined as having OO and HA, was seen in 9% of the phenotype. Group C, defined as having HA and PCO, was seen in 15.6% and Group D, defined as having OO and PCO, was seen in 12.9%. The rate of clinical high androgen manifestation and hyperandrogenism was 87.8% , but hyperandrogenism, insulin resistance （IR） and triglyceride （TG） were significantly higher in Group A, followed by group B. Group C presented relatively milder clinical and endocrine alterations than group A and B, but had a higher luteinizing hormone/follicle-stimulating hormone （LH/FSH） than controls （P〈0.05）. Compared with controls, group D had similar body mass index （BMI）, waist and hip circumferences, and Ferryman-Gallwey scores. Several biochemical indicator were similar across all PCOS phenotypes （ P〉0.05 ）. Conclusion 1 ） The classification according to the revised 2003 consensus on diagnosis reflects the basic characteristics of PCOS. 2 ） Androgen levels are the major distinguishing endocrine feature differentiating phenotypic expressions of PCOS. Ovulatory PCOS and normoandrogenic phenotype represent the mild forms of classic PCOS, but the latter may have a different pathogenic pathway. So the choice of treatment should be individualized.