不同证型多囊卵巢综合征伴低水平性激素结合球蛋白患者的临床特征研究

Study on the clinical characteristics of patients with different TCM syndrome of polycystic ovary syndrome with low levels of sex hormone binding globulin

目的探讨痰湿型及非痰湿型多囊卵巢综合征(PCOS)伴低性激素结合球蛋白(SHBG)患者的临床特征。方法收集2017年1月—2019年8月黑龙江中医药大学附属第一医院临床科研信息一体化系统中PCOS患者349例,将患者分为痰湿证低SHBG组66例,痰湿证正常SHBG组100例,非痰湿证低SHBG组52例,非痰湿证正常SHBG组131例,比较各组一般临床特征、性激素指标、糖脂代谢指标,分析SHBG与PCOS患者各项指标的相关性。结果痰湿证低SHBG组、痰湿证正常SHBG组、非痰湿证低SHBG组体质量、体质量指数(BMI)、腰臀比(WHR)及超重或肥胖发生率、黑棘皮发生率均显著高于非痰湿证正常SHBG组(P均<0.05),痰湿证低SHBG组体质量及BMI显著高于痰湿证正常SHBG组(P均<0.05),痰湿证低SHBG组、痰湿证正常SHBG组中心型肥胖发生率和非痰湿证低SHBG组溢脂发生率均显著高于非痰湿证正常SHBG组(P均<0.05)。痰湿证低SHBG组、非痰湿证低SHBG组的硫酸脱氢表雄酮(DHEAS)、雄烯二酮(AND)水平显著高于痰湿证正常SHBG组(P均<0.05),空腹血糖(FPG)、载脂蛋白B(ApoB)水平显著高于非痰湿证正常SHBG组(P均<0.05),空腹胰岛素(FINS)水平、胰岛素抵抗指数(HOMA-IR)、胰岛素抵抗发生率显著高于痰湿证正常SHBG组和非痰湿证正常SHBG组(P均<0.05),痰湿证低SHBG组的三酰甘油(TG)水平显著高于痰湿证正常SHBG组和非痰湿证正常SHBG组(P均<0.05),非痰湿证低SHBG组的TG、低密度脂蛋白(LDL)水平显著高于非痰湿证正常SHBG组(P均<0.05),痰湿证低SHBG组、非痰湿证低SHBG组的高密度脂蛋白(HDL)水平显著低于非痰湿证正常SHBG组(P均<0.05),非痰湿证低SHBG组的载脂蛋白A(ApoA)水平显著低于痰湿证正常SHBG组和非痰湿证正常SHBG组(P均<0.05)。相关性分析显示SHBG与HDL、ApoA呈正相关(P均<0.05),与收缩压、舒张压、体质量、BMI、腰围、臀围、WHR、睾酮(T)、DHEAS、AND、HOMA-IR、FINS、TG、LDL、ApoB呈负相关(P均<0.05)。结论痰湿型及非痰湿型PCOS伴低SHBG患者临床体征较严重,DHEAS、AND水平较高,糖脂代谢紊乱较重。

Objective It is to investigate the clinical characteristics of patients with phlegm-dampness syndrome or non-phlegm-dampness syndrome of polycystic ovary syndrome(PCOS)with low sex hormone binding globulin(SHBG).Methods 349 patients with PCOS were enrolled in the clinical research information integration system of the First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine from January 2017 and August 2019.They were divided into phlegm-dampness syndrome with low SHBG group(group A,66 cases),phlegm-dampness syndrome with normal SHBG group(group B,100 cases),non-phlegm-dampness syndrome with low SHBG group(group C,52 cases),and non-phlegm dampness syndrome with normal SHBG group(group D,131 cases).The general clinical characteristics,sex hormone indexes,glucose and lipid metabolism indexes of each group were compared,and the correlation between SHBG and various indexes of PCOS patients was analyzed.Results The weight,Body mass index(BMI),waist to hip ratio(WHR),the incidence of overweight or obesity and black echinoderma of group A,group B and group C were significantly higher than those of group D(P<0.05),the weight and BMI of group A were significantly higher than that of group B(P<0.05);the incidence of central obesity in group A and group B and the incidence of lipid leakage in group C was significantly higher than that in group D(P<0.05).The levels of dehydroepiandrosterone sulfate(DHEAS)and androstenedione(AND)in group A and group C were significantly higher than those in group B(P<0.05),while the levels of fasting plasma glucose(FPG),apolipoprotein B(ApoB)were significantly higher than those in group D(P<0.05),the level of fasting insulin(FINS),insulin resistance index(HOMA-IR)and IR incidence rate were significantly higher than those in group B and group D(P<0.05);the level of triacylglycerol(TG)in group A was significantly higher than that of group B and group D(P<0.05),the levels of TG and low-density lipoprotein(LDL)in group C were significantly higher than that of group D(P<0.05);the level of high Density Lipoprotein(HDL)in group A and group C was significantly lower than that in group D(P<0.05);the level of ApoA in group C was significantly lower than that in group B and group D(P<0.05).Correlation analysis showed that SHBG was positively correlated with HDL and ApoA,and negatively correlated with systolic blood pressure,diastolic blood pressure,body weight,BMI,waist circumference,hip circumference,WHR,testosterone(T),DHEAS,AND,IR,FINS,TG,LDL and ApoB(P<0.05).Conclusion The clinical signs of patients with phlegm-dampness syndrome and non-phlegm-dampness syndrome of PCOS with low SHBG are more serious,DHEAS,AND level are higher,and glucose and lipid metabolism disorders are more serious.