多囊卵巢综合征患者亚临床甲状腺功能减退与其内分泌代谢特征的关系

Subclinical hypothyroidism and endocrine metabolic characteristics in women with polycystic ovary syndrome

目的:研究多囊卵巢综合征(polycystic ovary syndrome,PCOS)患者中亚临床甲状腺功能减退(subclinical hypothyroidism,SCH)与其内分泌代谢特征之间的关系。方法:采用2003年鹿特丹PCOS诊断标准,共收集321例新诊断PCOS患者的临床资料。甲状腺功能以化学发光法测定。分别以促甲状腺激素(thyroid stimulating hormone,TSH)值4.2 m U/L和2.5 m U/L为SCH诊断截点,将PCOS患者分为SCH组和甲状腺功能正常组,比较两组间内分泌代谢特征的差异。结果:1)以TSH值4.2 m U/L为SCH诊断截点,SCH组泌乳素及黄体生成素与卵泡刺激素的比值显著升高,空腹血糖显著降低,内脏脂肪指数显著升高(均P<0.05),血三酰甘油有升高趋势(P=0.085),高密度脂蛋白胆固醇有下降趋势(P=0.060);2)以TSH值2.5 m U/L为SCH诊断截点,SCH组雌二醇、泌乳素显著升高,血三酰甘油显著升高,高密度脂蛋白胆固醇显著下降,内脏脂肪指数显著升高(均P<0.05)。结论:PCOS合并SCH组其内分泌激素紊乱、血脂异常及内脏脂肪增多较甲状腺功能正常组更严重;以TSH值2.5 m U/L为PCOS患者SCH诊断截点,其SCH组较甲状腺功能正常组内分泌代谢特征差异更为显著,提示临床可以TSH值2.5 m U/L为SCH截点对PCOS患者进行分组评估、优化诊治。

Objective： To explore associations of subclinical hypothyroidism（SCH） with endocrine metabolic characteristics in women with polycystic ovary syndrome（PCOS）. Methods： A total of 321 women who were newly diagnosed as PCOS were recruited from two endocrine outpatient clinics. The diagnosis of PCOS was established according to the 2003 Rotterdam consensus criteria. Thyroid function was examined by chemiluminescent immunoassay. Patients who had normal free thyroxine（FT4） were divided into different SCH subgroups according to two thyroid stimulating hormone（TSH） cutoff points（4.2 and 2.5 m U/L）. Endocrine metabolic characteristics in different subgroups were compared and analyzed. Results： In PCOS women with normal FT4, the patients with TSH≥4.2 m U/L had higher prolactin（PRL）, luteinizing hormone-to-follicle stimulating hormone ratio, and visceral adipose index（all P0.05）. There were trends toward an increase in triglyceride（P=0.085） and a decrease in high-density lipoprotein cholesterol（HDL-C）（P=0.060） in the patients with TSH≥4.2 m U/L compared with that in the patients with TSH4.2 m U/L. Also in PCOS women with normal FT4, the patients with TSH≥2.5 m U/L had higher body mass index, PRL, triglyceride, visceral adipose index and lower HDL-C in comparison of that in the patients with TSH2.5 m U/L（all P0.05）. Conclusion： SCH is associated with more severe endocrine abnormality, dyslipidemia, and visceral obesity in PCOS women. PCOS women with normal FT4 and endocrine metabolic characteristics are more prone to be different between the SCH group and the euthyroid group when setting 2.5 m U/L as a TSH cutoff for SCH, indicating that 2.5 m U/L is a good TSH cutoff for SCH in PCOS women.