多囊卵巢综合征表型与妊娠糖尿病、脂质代谢的关系

Relationship between different phenotypes of polycystic ovary syndrome and gestational diabetes mellitus and lipid metabolism disorder

目的探讨不同表型多囊卵巢综合征(PCOS)与妊娠糖尿病(GDM)、脂质代谢紊乱的关系研究。方法收集2014年1月至2016年12月期间就诊浙江省舟山市普陀医院132例PCOS患者的临床资料进行回顾性分析,根据2003年鹿特丹会议诊断标准分为4组不同表型(A组:高雄激素血症+多囊卵巢+无/稀发排卵;B组:高雄激素血症+多囊卵巢;C组:多囊卵巢+无/稀发排卵;D组:高雄激素血症+无/稀发排卵),同时选择100例健康怀孕期女性作为对照组,分析每种表型与妊娠糖尿病、脂质代谢紊乱的关系。结果不同表型PCOS组体重指数(BMI)、腰围(WC)、黄体生成素与卵泡刺激素比值(LH/FSH)、总睾酮(TT)水平均显著高于对照组(t=4.27~7.89,均P<0.05)。A组、B组、C组、D组的年龄、BMI、WC、LH/FSH无显著性差异(t=1.02~1.58,均P>0.05),A组TT水平明显高于B组、C组和D组(t值分别为4.67、4.78、5.33,均P<0.05),而B组、C组和D组每两组之间比较无显著差异(t值分别为1.17、1.36,均P>0.05)。不同表型PCOS组比对照组的空腹血糖(FPG)、第1h血糖、第2h血糖、第3h血糖值、GDM、妊娠期糖耐量低减(IGGT)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白-胆固醇(LDL-C)存在显著性差异(t=4.67~6.54,χ2=5.96~7.33,均P<0.05),A组、B组、C组、D组之间的FPG、第1h血糖、第2h血糖、第3h血糖值、TC、TG、LDL-C每两组之间比较均无显著性差异(t=0.93~1.58,均P>0.05),A组GDM、IGGT显著高于B组、C组、D组(χ2=5.98~6.30,均P<0.05),但B组、C组、D组之间GDM、IGGT每两组之间比较均无显著性差异(χ2=2.09~2.30,均P>0.05)。PCOS组高密度脂蛋白-胆固醇(HDL-C)含量显著低于对照组(t=5.33,P<0.05),但A组、B组、C组、D组HDL-C值每两组之间比较均无显著性差异((t=0.54~1.33,均P>0.05)。不同表型PCOS组流产、子痫早期、早产、羊水过多、羊水过少、巨大儿、新生儿黄疸、新生儿低血糖发生率均显著高于对照组(χ2=7.33~15.97,均P<0.05)。但A组、B组、C组、D组每两组之间比较以上围产结局情况之间无显著差异(χ2=1.59~2.39,均P>0.05)。结论不同表型多囊卵巢综合征患者脂质代谢紊乱差异不明显,GDM和IGGT发生率以高雄激素血症+多囊卵巢+无/稀发排卵的表型最高。

Objective To investigate the relationship between different phenotypic polycystic ovary syndrome（PCOS）and gestational diabetes mellitus（GDM）as well as lipid metabolism disorder.Methods From January 2014 to December 2016,the clinical data of132 PCOS patients treated in Putuo Hospital of Zhoushan City were retrospectively analyzed.According to diagnostic criteria of2003 Rotterdam meeting,patients were divided into four groups（group A：hyperandrogenism ＋polycystic ovary＋no/rare ovulation,group B：hyperandrogenemia ＋ polycystic ovary,group C：polycystic ovary ＋ no/rare ovulation,group D：hyperandrogenemia＋no/rare ovulation）.And 100 healthy pregnant women were selected in control group.The relationship between phenotypes and GDM as well as lipid metabolism disorder was analyzed.Results Body mass index（BMI）,waist circumference（WC）,luteinizing hormone/follicle stimulating hormone（LH/FSH）and total testosterone（TT）levels of PCOS groups with different phenotypes were significantly higher than those of the control group（t value ranged 4.27-7.89,all P〈0.05）.There was no significant difference in age,BMI,WC and LH/FSH among group A,group B,group C and group D（t value ranged 1.02-1.58,all P〉0.05）.TT level in group A was significantly higher than in group B,group C and group D（t value was4.67,4.78 and 5.33,respectively,all P〈0.05）,but there was no significant difference among group B,group C and group D（t value was 1.17 and 1.36,respectively,both P〉0.05）.There were significant differences in FPG,1 hblood glucose,2 hblood glucose,3 hblood glucose,GDM,IGGT,TC,TG and LDL-C among different PCOS groups and the control group（t value ranged4.67-6.54,χ^2 value ranged 5.96-7.33,all P〈0.05）.Group comparison of group A,group B,group C and group D showed that there were no significant differences in FPG,1 hblood glucose,2 hblood glucose,3 hblood glucose,TC,TG and LDL-C（t value ranged 0.93-1.58,P〉0.05）.GDM and IGGT in group A were significantly higher than those in group B,group C and group D（χ^2 value ranged 5.98-6.30,P〈0.05）,but group comparison of group B,group C and group D showed no significant difference（χ^2 value ranged 2.09-2.30,P〉0.05）.The content of HDL-C in PCOS groups was significantly lower than in the control group（t=5.33,P〈0.05）,but there was no significant difference in HDL-C value when group comparison was made among group A,group B,group C and group D（t value ranged 0.54-1.33,all P〉0.05）.The incidences of abortion,early eclampsia,premature delivery,excessive amniotic fluid,oligohydramnios,macrosomia,neonatal jaundice and neonatal hypoglycemia in PCOS groups were significantly higher than in the control group（χ^2 value ranged 7.33-15.97,all P 〈0.05）.However,group comparison revealed no significant difference among group A,group B,group C and group D in the above perinatal outcomes（χ^2 value ranged1.59-2.39,all P〉 0.05）.Conclusion The difference in lipid metabolism disorder is not obvious among patients with different phenotypic PCOS.The incidence of GDM and IGGT is highest in patients with hyperandrogenism＋polycystic ovary＋ no/rare ovulation.