多囊卵巢综合征患者血浆致动脉硬化指数与其性激素的相关性

Relationship between atherogenic index of plasma and sex hormones in patients with polycystic ovary syndrome

目的探讨多囊卵巢综合征(PCOS)患者血浆致动脉粥样硬化指数(AIP)水平变化及其与性激素的相关性,旨在为临床改善PCOS生殖代谢及降低远期心血管疾病风险提供新思路。方法选择2016年5月至2018年12月在南京鼓楼医院就诊的335例PCOS患者为研究对象。同时纳入151例年龄、BMI等相匹配的正常女性体检者作为对照组。收集一般资料,测定糖脂代谢、性激素指标,计算并比较两组AIP、稳态模型评估的胰岛素抵抗指数(HOMA-IR)、稳态模型评估的胰岛β细胞分泌指数(HOMA-β)、游离雄激素指数(FAI)等。依据AIP由低到高的三分位数水平将PCOS患者分成AIP低水平亚组(111例)、中水平亚组(112例)、高水平亚组(112例),比较各亚组的性激素水平。Spearman相关分析探讨AIP与性激素的相关性。结果与对照组相比,PCOS组患者的空腹胰岛素(FINS)、餐后2 h胰岛素(2 hINS)、HOMA-IR、HOMA-β、黄体生成素(LH)、雌二醇(E2)、总睾酮(T)、FAI水平均显著增高(P<0.05,P<0.01),而性激素结合球蛋白(SHBG)水平显著下降(P=0.042)。与对照组的AIP[0.13(-0.06,0.31)]相比,PCOS组的AIP[0.19(0.04,0.37)]显著增高(P=0.007)。不同AIP水平亚组间比较发现,AIP高水平亚组FSH、SHBG水平显著低于低水平亚组,FAI高于低水平亚组(P均<0.05)。Spearman相关分析显示,AIP与FSH、SHBG呈负相关,与FAI呈正相关(P均<0.01);校正年龄、BMI、血压等,AIP仍与FSH呈负相关(P均<0.01)。结论 PCOS患者较同年龄、同体重的正常女性存在明显的糖代谢及性激素紊乱,且更易发生动脉硬化,性激素水平与PCOS患者的AIP存在相关性,监测及改善患者性激素水平不容忽视。

Objective To investigate the change of atherosgenic index of plasma(AIP) and its correlation with sex hormones in patients with polycystic ovary syndrome(PCOS) to provide new ideas for improving reproductive metabolism and reducing long-term cardiovascular disease risk.Methods A total of 335 PCOS patients admitted to Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School from May 2016 to December 2018 were selected as research group.At the same time, 151 women with normal physical examination matched with age and body mass index(BMI) were served as control group.General data, glucose and lipid metabolism indexes and sex hormone levels were collected.AIP,homeostasis model assessment of insulin resistance index(HOMA-IR),homeostasis model assessment beta cell function(HOMA-β) and free androgen index(FAI) were detected and compared between two groups.According to AIP level from low to high tertile, PCOS patients were divided into AIP low-level subgroup(n=111),middle-level subgroup(n=112) and high-level sub group(n=112),and the sex hormone levels of different subgroups were compared.Spearman correlation analysis was used to explore the relationship between AIP and sex hormones.Results Compared with control group, the levels of fasting insulin(FINS),2 h postprandial serum insulin(2 hINS),HOMA-IR,HOMA-β,luteinizing hormone(LH),estradiol(E2),total testosterone(T) and FAI in PCOS group increased significantly(P<0.05,P<0.01),and sex hormone binding globulin(SHBG) decreased significantly(P=0.042).Compared with control group, AIP significantly increased in PCOS group [0.19(0.04,0.37) vs 0.13(-0.06,0.31),P=0.007].The levels of FSH and SHBG in AIP high-level subgroup were significantly lower than those in AIP low-level subgroup, and FAI level was higher than that in AIP low-level subgroup(all P<0.05).Spearman correlation analysis showed that AIP was negatively correlated with FSH and SHBG and was positively correlated with FAI(all P<0.01).After adjusting for age, BMI and blood pressure, AIP was still negatively correlated with FSH(P<0.01).Conclusions Compared with normal women of the same age and weight, the patients with PCOS have obvious disorder of glucose metabolism and sex hormone, and are more prone to develop atherosclerosis.There is a certain correlation between AIP and sex hormone in PCOS patients.Monitoring and improving the levels of related hormones in the patients should not be ignored.