伴有高雄激素血症的多囊卵巢综合征患者患有Ⅱ型糖尿病和肥胖的风险升高

Hyperandrogenic women with polycystic ovary syndrome have higher risks for type 2 diabetes and obesity

目的评估鹿特丹标准的多囊卵巢综合征(PCOS)患者中,高雄激素血症对代谢紊乱的影响。方法收集符合2003年鹿特丹诊断标准的883名PCOS患者的临床资料,按照不同的PCOS诊断标准和是否合并高雄激素血症,分组比较患有肥胖和糖代谢异常的发生率,并用717名正常育龄女性作为对照。结果共有719例(81.4%)PCOS患者伴有高雄激素血症。鹿特丹PCOS、美国国立卫生研究院(NIH)-PCOS和雄激素过多协会(AES)-PCOS(又称伴高雄激素血症的PCOS)患者肥胖的发生率分别为42.0%、45.3%和44.8%,Ⅱ型糖尿病的发生率分别依次为4.2%、4.9%和4.9%;而雄激素水平正常的PCOS的肥胖发生率为29.9%,Ⅱ型糖尿病的发生率为0.7%,对照组Ⅱ型糖尿病的发生率为1.0%。与正常雄激素患者相比,伴高雄激素血症的PCOS患者中,肥胖、Ⅱ型糖尿病、黑棘皮症和糖尿病家族遗传史的发生率均明显升高。生化高雄激素血症是Ⅱ型糖尿病(OR=5.7,P=0.028)及肥胖(OR=1.7,P=0.005)的独立危险因素。结论 PCOS患者中高雄激素血症与Ⅱ型糖尿病及肥胖的发生风险相关,在PCOS的高雄激素血症和不孕的一线治疗中应该作为考虑因素。

Objective To evaluate the effect of hyperandrogenism（HA） on obesity and the disturbance of carbohydrate metabolism among patients with polycystic ovary syndrome（PCOS） diagnosed by the Rotterdam criteria. Methods The incidences of obesity and abnormal glucose disorders were compared among a cohort of 883 women with PCOS diagnosed by the Rotterdam criteria, according to different diagnostic criteria including Rotterdam（Rott）, National Institutes of Health（NIH） and Androgen Excess Society（AES） criteria, and whether accompany with HA, with 717 premenopausal normal controls identified from the general population as the control. Results A total of 719（81.4%） patients were classified with PCOS and HA, which is also as AES criteria. The incidence of obesity of the Rott-PCOS, NIH-PCOS and AES-PCOS was 42.0%, 45.3% and 44.8%, respectively. And the incidence of type-2 diabetes mellitus（2-DM） was 4.2%, 4.9% and 4.9%, respectively. Nevertheless, the incidence of obesity in PCOS group with normal androgens was 29.9%, and that of 2-DM was 0.7%. The incidence of 2-DM in control group was 1.0%. Women with HA exhibited higher incidences of obesity, 2-DM, acanthosis nigricans and genetic history of diabetes, compared with those with normal androgen levels. HA was independently associated with the risk for 2-DM（OR=5.7, P=0.028） and obesity（OR=1.7, P=0.005）. Conclusion HA is associated with increased risks for 2-DM and obesity among women with PCOS and should be considered at first-line management of HA and infertility due to PCOS.