慢性低度炎症反应在多囊卵巢综合征的纵向研究:炎症及相关内分泌风险指标的初步编制及分析

Longitudinal study of chronic low-grade inflammation in patients with polycystic ovary syndrome:preliminary compilation and analysis with inflammatory and related endocrine risk indicators

目的探讨炎症及相关内分泌指标与多囊卵巢综合征(PCOS)疾病发展的相关性。方法随机选取PCOS患者59例,及同期就诊的高雄激素血症(HA)患者13例,卵巢多囊样改变(PCOM)患者22例,健康对照60例,研究对象均为女性。记录并比较所有研究对象的年龄、白细胞计数(WBC)、中性粒细胞计数(Gran)、中性粒细胞百分比(Gran%)、红细胞沉降率(ESR)、丙氨酸转氨酶(ALT)、谷草转氨酶(AST)、血清肌酐(Cr)、血尿素氮(BUN)、空腹胰岛素(FINS)、促甲状腺素(TSH),计算体重指数(BMI)、代谢相关脂肪性肝病(MAFLD)病情评分及肝脏纤维化评分(HIS、BARD),利用Pearson分析法探索指标相关性,ROC曲线分析法评估指标针对PCOS疾病的诊断价值。结果 PCOS组BMI值明显高于对照组、HA组(H分别=-18.32、38.11,P均<0.05),PCOM组的BMI值也较HA组明显上调(H=38.17,P<0.05);PCOS组、PCOM组、HA组AST分别较对照组增高(H分别=-18.36、-28.13、-25.53,P均<0.05);PCOS组与PCOM组WBC均较对照组有明显增高(H分别=-20.87、-27.10,P均<0.05);PCOS组FINS较对照组、PCOM组显著增高(H分别=-31.29、28.61,P均<0.05)。超重体重组人群在WBC、ESR、ALT、FINS、MAFLD、HIS、BARD值上较低体重组、正常体重组人群增高(H分别=-27.50、-43.12、-42.19、-19.50、-50.69、-62.31、-99.63;-18.14、-24.01、-24.40、-14.61、-30.38、-33.21、-49.54,P均<0.05),在AST/ALT上较低体重组、正常体重组人群降低(H分别=42.34、27.06,P均<0.05)。正常体重组较低体重组在ESR、MAFLD、HIS、BARD值上增高(H分别=-19.11、-20.31、-29.10、-50.09,P均<0.05),在CA125值上降低(H=20.92,P<0.05)。WBC与BMI、AST、MAFLD评分、BARD评分呈正相关(r分别=0.31、0.18、0.19、0.20,P均<0.05);Gran与BMI、MAFLD评分、BARD评分呈正相关(r分别=0.27、0.18、0.19,P均<0.05);ESR与BMI、FINS、AST、MAFLD评分、HIS评分、BARD评分呈正相关(r分别=0.54、0.24、0.31、0.32、0.36、0.52,P均<0.05)。非侵袭性炎症指标(WBC、Gran、ESR)与相关非侵袭性内分泌指标(FINS、ALT、AST)、内分泌评估性指标(BMI、MAFLD、BARD)对PCOS疾病活动具有评估价值。结论 PCOS的内分泌特征不同于PCOM组,也不同于HA组,WBC、Gran、ESR、BMI、FINS、ALT、AST、MAFLD、BARD可作为评估PCOS疾病活动的有效炎症相关标记物。

Objective To explore the association between the inflammatory/endocrine indicators and polycystic ovary syndrome(PCOS)development.Methods Totally 59 females with PCOS,13 females with simple hyperandrogenism(HA),22 females with simple polycystic ovarian morphology(PCOM),and 60 healthy females were recruited.Age,white blood cell count(WBC),granulocyte(Gran),percent of granulocyte(Gran%),erythrocyte sedimentation rate(ESR),alanine aminotransferase(ALT),aspartate transaminase(AST),creatinine(Cr),blood urea nitrogen(BUN),fasting insulin(FINS),thyroid-stimulating hormone(TSH)were measured.The body mass index(BMI),MAFLD/HIS/BARD score were recorded.The differences among PCOS group,PCOM group,HA group,and control group were analyzed,and the values of these parameters for diagnosing PCOS were estimated by ROC curve.Results In PCOS group,BMI and FINS were higher than those in control group and HA group(H=-18.32,38.11,P<0.05),and the BMI of PCOM group was also higher than HA group(H=38.17,P<0.05).Compared with control group,AST was increased in PCOS group,PCOM group,and HA group(H=-18.36,-28.13,-25.53,P<0.05).WBC was higher in PCOS group and PCOM group than that in the control group(H=-20.87,-27.10,P<0.05).The FINS in PCOS group was higher than that in control group and PCOM group(H=-31.29,28.61,P<0.05).Furthermore,the WBC,ESR,ALT,FINS,MAFLD,HIS,BARD scores in obese group were higher than those in lean group,as well as with standard-weighted group(H=-27.50,-43.12,-42.19,-19.50,-50.69,-62.31,-99.63,-18.14,-24.01,-24.40,-14.61,-30.38,-33.21,-49.54,P<0.05),while the AST/ALT was lower than that in lean group and standard-weighted group(H=42.34,27.06,P<0.05).In standard-weighted group,the ESR,MAFLD,HIS,BARD were higher than those in lean group(H=-19.11,-20.31,-29.10,-50.09,P<0.05),while CA125 showed a reduction(H=20.92,P<0.05).The WBC was positively correlated with BMI,AST,MAFLD and BARD scores(r=0.31,0.18,0.19,0.20,P<0.05),the Gran was positively correlated with BMI,MAFLD and BARD scores(r=0.27,0.18,0.19,P<0.05),the ESR was positively correlated with BMI,FINS,AST,MAFLD,HIS and BARD scores(r=0.54,0.24,0.31,0.32,0.36,0.52,P<0.05).Non-invasive inflammatory indicators(WBC,Gran,ESR),related endocrine indicators(FINS,ALT,AST)and endocrine assessment index(BMI,MAFLD,BARD)had evaluating value for PCOS disease.Conclusion The endocrine characteristics of PCOS patients differ from PCOM patients and HA patients.Furthermore,WBC,Gran,ESR,BMI,FINS,ALT,AST,MAFLD,BARD can be served as the effective inflammatory markers for assessing PCOS disease activity.