多囊卵巢综合征患者心脏变时功能的研究

Cardiac chronotropic function in patients with polycystic ovary syndrome

目的探讨多囊卵巢综合征(polycystic ovary syndrome,PCOS)患者的心脏变时功能及其可能的相关因素,为PCOS患者继发心血管疾病提供预测指标和干预方向。方法选取2015年1月至2018年12月在南京医科大学第一附属医院康复医学中心门诊就诊的306例患者,其中PCOS患者145例,健康对照161例,所有受试者均行人体形态学[体质量指数(body mass index,BMI)、腰臀比(waist-to-hip ratio,WHR)]、血清学[睾酮(testosterone,T)、空腹血糖、空腹胰岛素(fasting insulin,FINS)]及平板运动试验评估,分析PCOS患者的心脏变时功能及其相关因素。结果PCOS组患者BMI、腰臀比分别为(28.70±3.68)kg/m^(2)、0.90±0.04,对照组为(21.32±1.64)kg/m^(2)、0.82±0.06,两组比较差异有统计学意义(P<0.05)。PCOS组患者FINS、胰岛素抵抗指数(homa-insulin resistance homa-index,HOMA-IR)、T分别为(18.21±8.72)mU/L、4.48±2.38、(15.09±3.14)nmol/L,对照组分别为(13.04±1.77)mU/L、2.81±0.56、(6.88±1.80)nmol/L,两组比较差异有统计学意义(P<0.05)。PCOS组患者峰值运动时的代谢当量为11.05±1.39,对照组为11.91±1.44,两组比较差异有统计学意义(P<0.05)。PCOS组患者的运动的峰值心率(maximum heart rate,MHR)/最大预测心率(predicted maximum heart rate,PMHR)<85%、心脏变时性指数(chronotropic response index,CRI)小于0.8或大于1.3、运动后1 min的心率恢复值(heart rate recovery,HRR)≤18次/min的患者比例均显著高于对照组,差异有统计学意义(P<0.05)。CRI与HOMA-IR指数显著相关,运动后1 min的HRR和腰臀比显著相关(P<0.05)。结论PCOS患者表现出明显的心脏变时功能受损,且心脏变时性指标与腰臀比和HOMA-IR显著相关。

Objectives To explore the cardiac chronotropic function and its possible related factors in patients with polycystic ovary syndrome(PCOS),and to provide predictive indicators and intervention directions for secondary cardiovascular disease in patients with PCOS.Methods A total of 306 outpatients were enrolled in the rehabilitation medical center of The First Affiliated Hospital of Nanjing Medical University from January 2015 to December 2018,including 145 patients with PCOS and 161 healthy controls.All the subjects underwent human morphology examination[body mass index(BMI),waist-to-hip ratio(WHR)],serology test[testosterone(T),fasting blood glucose,fasting insulin(FINS)]and treadmill exercise test.We analyzed the cardiac chronotropic function and its related factors in patients with PCOS.Results The BMI and WHR of PCOS group were(28.70±3.68)kg/m^(2),0.90±0.04,and those of control group were(21.32±1.64)kg/m^(2),0.82±0.06.There were significant differences of BMI and WHR between the two groups(P<0.05).FINS,homa-insulin resistance homa-index(HOMA-IR)and T in PCOS group were(18.21±8.72)mU/L,4.48±2.38,(15.09±3.14)nmol/L,respectively,in control group were(13.04±1.77)mU/L,2.81±0.56,(6.88±1.80)nmol/L.There were statistical differences of FINS,homa-insulin resistance homa-index(HOMA-IR)and T between the two groups(P<0.05).The metabolic equivalent of peak exercise in PCOS group was 11.05±1.39,and that in control group was 11.91±1.44.There was a statistical difference of metabolic equivalent of peak exercise between the two groups(P<0.05).The proportion of patients of PCOS group with maximum heart rate(MHR)/predicted maximum heart rate(PMHR)<85%,chronotropic response index(CRI)less than 0.8 or greater than 1.3,and heart rate recovery(HRR)≤18 bit/min at 1 minute after exercise were significantly higher than those of control group and the differences were statis⁃tically significant(P<0.05).CRI was significantly associated with HOMA-IR(P<0.05).One min HRR after exercise was significantly correlated with WHR(P<0.05).Conclusions Patients with PCOS show significant impairment of cardiac chronotropic dysfunction and their cardiac chronotropic indexes are related to WHR and HOMA-IR.