多囊卵巢综合征患者促甲状腺激素水平与糖脂代谢紊乱关系

Correlation between the thyroid stimulating hormone level of women with polycystic ovary syndrome and their gluco lipid metabolism disorder

目的:分析多囊卵巢综合征(PCOS)患者血清促甲状腺激素(TSH)水平与糖脂代谢指标的相关性.方法:选择2018年3月—2020年8月本院妇产科诊治的PCOS患者224例,均行甲状腺功能及糖脂代谢指标检测.按照TSH水平的三分位数分为TSH低水平组、中水平组、高水平组,分析TSH水平与糖脂代谢指标的相关性.结果:低水平组、中水平组、高水平组代谢综合征(MS)发生率逐渐升高,FPG、FINS、HOMA-IR逐渐升高(P<0.05),高水平组体质指数(BMI)、腰臀比(WHR)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL)高于低水平组及中水平组,高密度脂蛋白(HDL)低于低水平组及中水平组(P<0.05),TSH低水平组与TSH中水平组BMI、WHR、TC、TG、HDL、LDL无差异(P>0.05).单纯PCOS患者,血清TSH水平与BMI、WHR、TC、TG、HDL、LDL、空腹血糖(FPG)、空腹胰岛素(FINS),计算胰岛素抵抗指数(HOMA-IR)均无相关性(P>0.05);PCOS合并亚临床甲减患者,TSH水平与TC、TG、FPG、FINS、HOMA-IR呈正相关(P<0.05);PCOS合并临床甲减患者,血清TSH水平与BMI、WHR、TC、TG、LDL、FPG、FINS、HOMA-IR呈正相关,与HDL呈负相关(均P<0.05).TSH对PCOS合并MS具有预测价值(P<0.001),曲线下面积为0.719,截断值4.32mIU/L,灵敏度69.7%,特异性76.2%.结论:PCOS患者血清TSH水平越高,MS发生风险越高,但仅在PCOS合并亚临床或临床甲减的患者中血清TSH水平与糖脂代谢指标存在相关性.

Objective: To analyze the correlation between the serum level of thyroid stimulating hormone(TSH)of women with polycystic ovary syndrome(PCOS)and their indexes of glucolipid metabolism. Methods: 224 women with PCOS were selected as the study subjects from March 2018 to August 2020. All of these women were given the detections of thyroid function and glucolipid metabolism indicators. According to the tertiles of TSH level, these women were divided into group A(women with low-level TSH),group B(women with middle-level TSH) and group C(women with high-level TSH). The correlation between the TSH level of the women and their glucolipid metabolism indexes was analyzed. Results: The incidence of metabolic syndrome(MS) of the women in group A, group B, and group C had increased gradually, the levels of FPG and FINS and the value of homeostasis model assessment of insulin resistance(HOMA-IR) of the women in group A, group B, and group C had also increased gradually(P<0.05). The values of body mass index(BMI) and waist to hip ratio(WHR), and the levels of total cholesterol(TC), triglyceride(TG), and low density lipoprotein(LDL) of the women in group C were significantly higher than those of the women in group A and in group B, and the High density lipoprotein(HDL) level of the women in group C was significantly lower(P<0.05). There were no significant differences in the values of BMI and WHR, and the levels of TC, TG, HDL, and LDL of the women between group A and group B(P>0.05). There was no correlation between the serum TSH level of the women with PCOS only and their BMI,WHR,and HOMA-IR values,and their levels of TC,TG,HDL,LDL,fasting blood glucose(FPG),and fasting insulin(FINS)(P>0.05).The TSH level of the women with subclinical hypothyroidism was positively correlated with their TC,TG,FPG,and FINS levels,and their HOMA-IR value(P<0.05).The TSH level of the women with PCOS and subclinical hypothyroidism was positively correlated with their BMI,WHR,and HOMA-IR values,and their levels of TC,TG,LDL,FPG,and FINS,but which was negatively correlated with their HDL level(all P<0.05).The TSH level of the women has predictive value for PCOS complicated with MS(P<0.001),and the area under the curve(AUC),the cut-off value,the sensitivity,and the specificity of which were 0.719,4.32mIU/L,69.7%,and 76.2%,respectively.Conclusion:The higher TSH level of the women with PCOS,the higher risk of their MS occurrence.However,the TSH level only in the women with PCOS complicated with subclinical or clinical hypothyroidism is correlated with their glucolipid metabolism indexes.