肥胖指标与多囊卵巢综合征患者糖脂代谢异常的关系

Relationship between obesity indexes and abnormal glycolipid metabolism in patients with polycystic ovary syndrome

目的探讨肥胖指标与多囊卵巢综合征(PCOS)患者糖脂代谢异常的关系。方法收集321例PCOS患者BMI、腰围、腰臀比(WHR)、腰高比(WHtR)等肥胖指标资料,同时检测TG、TC、HDL-C、LDL-C、载脂蛋白A1(ApoA1)、ApoB、空腹血糖(FPG)、空腹胰岛素(FINS)等糖脂代谢指标,计算稳态模型胰岛素抵抗指数(HOMA-IR)。分析肥胖指标与糖脂代谢指标的相关性,评估各肥胖指标对PCOS患者糖脂代谢异常的预测价值。结果4项肥胖指标分别与TG、TC、ApoB、ApoB/ApoA1、FPG、FINS、HOMA-IR呈正相关(均P<0.05),与HDL-C、ApoA1呈负相关(均P<0.05);仅WHR与LDL-C呈正相关(P<0.05)。腰围对TG异常的预测价值最高,其AUC、Cut-off值、灵敏度、特异度分别为0.606、85.5cm、0.677、0.484。4项肥胖指标中仅WHR对TC异常有预测价值,其AUC、Cut-off值、灵敏度、特异度分别为0.606、0.87、0.675、0.463。BMI、腰围、WHtR对HDL-C异常均有预测价值,其中BMI的预测价值最高,其AUC、Cut-off值、灵敏度、特异度分别为0.707、26.65kg/m^2、0.339、0.706。4项肥胖指标对LDL-C异常的预测价值从高到低依次为腰围、WHtR、WHR、BMI,其中腰围的AUC、Cut-off值、灵敏度、特异度分别为0.580、79.5cm、0.790、0.625。BMI对ApoB、ApoB/ApoA1、FPG、FINS、HOMA-IR异常的预测价值均最高,其AUC分别为0.667、0.660、0.741、0.812、0.863。结论肥胖指标对PCOS患者糖脂代谢异常具有一定的预测价值,其中BMI、腰围的预测价值较高。

Objective To investigate the relationship between obesity indexes and abnormal glycolipid metabolism in patients with polycystic ovary syndrome(PCOS).Methods Three hundred and twenty one patients with PCOS were enrolled in the study.The obesity indexes,including body mass index(BMI),waist circumference(WC),waist-hip ratio(WHR)and waist-height ratio(WHtR)were measured.The blood triglyceride(TG),total cholesterol(TC),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),apolipoprotein A1(ApoA1),apolipoprotein B(ApoB),fasting plasma glucose(FPG),fasting insulin(FINS)and other glycolipid metabolic indexes were detected,and the homeostasis model assessment of insulin resistance(HOMA-IR)was calculated.The correlation between obesity indexes and the level of glucose and lipid metabolism was analyzed;and the predictive value of obesity indexes for abnormal glycolipid metabolism in patients with PCOS was evaluated.Results The above obesity indexes were all positively correlated with TG,TC,ApoB,ApoB/ApoA1,FPG,FINS and HOMA-IR(all P<0.05),while negatively correlated with HDL-C and ApoA1(all P<0.05).Moreover,WHR was positively correlated with LDL-C(P<0.05).Waist circumference had the highest predictive value for TG abnormalities,and its area under curve(AUC),cut-off value,sensitivity and specificity are 0.606,85.5 cm,0.677 and 0.484,respectively.WHR had predictive value for TC,with AUC,cut-off value,sensitivity and specificity of 0.606,0.87,0.675 and 0.463,respectively.BMI,WC and WHtR had predictive value for HDL-C,among those indexes BMI had the highest predictive value,with AUC,cut-off value,sensitivity and specificity of 0.707,26.65 kg/m^2,0.339 and 0.706,respectively.The predictive values of four obesity indexes for LDL-C from high to low in order were WC,WHtR,WHR and BMI.The AUC,cut-off value,sensitivity and specificity of WC were 0.580,79.5 cm,0.790 and 0.625,respectively.BMI had the highest predictive value for ApoB,ApoB/ApoA1,FPG,FINS and HOMA-IR,with AUC of 0.667,0.660,0.741,0.812 and 0.863,respectively.Conclusion Obesity indexes have certain predictive value for abnormal glycolipid metabolism in patients of PCOS,and BMI and waist circumference have higher predictive value.