多囊卵巢综合征患者促甲状腺激素对血糖、血脂的影响

Impact of thyroid-stimulating hormone on blood glucose and serum lipids in patients with polycystic ovary syndrome

目的分析多囊卵巢综合征(PCOS)患者的促甲状腺激素(TSH)对血糖、血脂的影响。方法选择无甲状腺疾病治疗史的PCOS患者1 034例,测量其身高、体质量、腰围、臀围、血压等,实验室检测包括TSH、性激素、血糖、胰岛素、血脂总胆固醇(TC)、三酰甘油TG)、低密度脂蛋白胆固醇(LDL-C)等指标,计算体质量指数(BMI)、腰臀比,稳态模型评估胰岛素抵抗指数(HOMA-IR)。并根据TSH界值将PCOS患者分为TSH正常组(0.27μIU/m L≤TSH≤4.2μIU/m L)和TSH升高组(TSH>4.2μIU/m L),比较两组间各项生化指标的差异。结果 1 034例PCOS患者中有163例(15.76%)TSH升高。TSH升高组和TSH正常组的患者比较体质量(P=0.015)、BM I(P=0.021)、臀围(P=0.023)、收缩压(P=0.006)、舒张压(P=0.001),差异有统计学意义,且TSH升高组的肥胖患者占比明显高于TSH正常组。两组间的2 h血糖、空腹胰岛素、2 h胰岛素以及HOMA-IR差异均无统计学意义(P>0.05),但PCOS伴TSH升高组相比TSH正常组有升高趋势。TSH升高组PCOS患者TC(P=0.027)、TG(P=0.022)及LDL-C(P=0.049)高于TSH正常组。相关性分析结果显示,TSH与臀围、收缩压、舒张压、空腹胰岛素、2 h胰岛素、HOMA-IR、TC、TG、LDL-C呈正相关性(P均<0.05)。结论 TSH升高的PCOS患者更容易发生肥胖,导致血脂代谢紊乱,同时糖代谢异常和胰岛素抵抗有加剧的趋势,建议PCOS患者常规检查TSH。

Objective To analyze the effect of thyroid stimulating hormone（ TSH） on blood glucose and serum lipids in patients with polycystic ovary syndrome（ PCOS）. Methods A total of 1 034 PCOS patients without thyroid disease history were collected. Their height,weight,waist circumference（ WC）,hip circumference（ HC）,blood pressure,TSH,sex hormones,blood glucose,insulin,serum lipids were measured; body mass index（ BMI）,waist hip ratio,and homeostasis model assessment of insulin resistance（ HOMA-IR） were calculated. Based on the normal TSH cut-off adopted in our hospital,the PCOS patients were divided into two groups： normal TSH group（ 0. 27 μIU / m L≤TSH≤4. 2 μIU / m L）and elevated TSH group（ TSH 〉4. 2 μIU / m L）. The biochemical indicators of the two groups were compared. ResultsOf all patients,163（ 15. 76%） had elevated TSH level. There were significant differences between the elevated and normal TSH groups in body weight（ P = 0. 015）,BMI（ P = 0. 021）,WC（ P = 0. 023）,systolic pressure（ P =0. 006）,and diastolic pressure（ P = 0. 001）. The prevalence of obesity was significantly higher in elevated TSH group than in normal TSH group. There are no significant differences between the two groups in 2 h blood glucose,FINS,2 h insulin,and HOMA-IR（ all P〈0. 05）,but there was a rising trend in the elevated TSH group. The elevated TSH group had higher TC（ P = 0. 027）,TG（ P = 0. 022） and LDL-C（ P = 0. 049） than those of the normal TSH group.TSH was positively correlated to hip circumference,systolic pressure,diastolic blood pressure,FINS,2 h insulin,HOMA-IR,TC,TG and LDL-C（ all P〈0. 05）. Conclusion PCOS patients with TSH elevated are prone to obesity,dyslipidemia,glucose metabolism disorder and insulin resistance. Therefore,such patients are suggested to have TSH level screened.