广东地区不同表型多囊卵巢综合征患者临床特点及代谢特征分析

Analysis of clinical characteristics and metabolic characteristics of patients with different phenotypes of PCOS in Guangdong

目的 探讨广东地区3种不同表型多囊卵巢综合征(PCOS)患者游离雄激素指数(FAI)、代谢特征及胰岛素敏感性是否具有差异及临床意义。方法 回顾性分析2021年4月至2022年3月因“月经不规则”等原因就诊于广州医科大学附属第三医院的217例PCOS患者,诊断依据采用2003年欧洲人类生殖和胚胎学学会/美国生殖医学学会(ESHRE/ASRM)共识研讨会提出的鹿特丹诊断标准,根据其不同特征的组合将患者分为经典表型、有排卵表型、正常雄激素表型,比较各表型之间FAI、代谢特征及胰岛素敏感性是否具有差异及临床意义。结果 3种不同表型PCOS患者间体重指数(BMI),FAI,口服葡萄糖耐量试验(OGTT)1h血糖(1h PG)、2h血糖(2h PG),空腹胰岛素(FINS),胰岛素释放试验1h胰岛素(Ins 1h)、2h胰岛素(Ins 2h)、3h胰岛素(Ins 3h),稳态模型胰岛素抵抗指数(HOMA-IR),高密度脂蛋白(HDL),甘油三脂(TG),尿酸(UA)的差异总体比较,均有统计学意义(P<0.05),且经典表型组患者各指标测量值与其他两组两两比较,差异均有统计学意义(P<0.05);3种不同表型PCOS患者间年龄、空腹血糖(FPG)、OGTT 3h血糖(3h PG)、低密度脂蛋白(LDL)、胆固醇(TC)的差异总的比较,均无统计学意义(P>0.05)。结论 广东地区不同表型PCOS患者FAI、代谢指标及HOMA-IR具有一定的差异性。经典表型PCOS患者常具有较高的BMI、FAI以及HOMA-IR,也更易发生代谢指标的异常。在临床工作中应该注意不同表型PCOS患者的特征,根据其不同的临床特征及代谢指标的变化提供个体化管理与治疗方案。

Objective To investigate the difference in FAI,metabolic characteristics and insulin sensitivity in different phenotypes of PCOS in Guangdong and its clinical significance.Methods Clinical,endocrine and metabolic data from217 women with PCOS diagnosed in the Third Affiliated Hospital of Guangzhou Medical University according to Rotterdam criteria between Apr. 2021 and Mar 2022 were collected and divided into classic phenotype,ovulatory phenotype and normal androgenic phenotype. To analyze the significance of FAI,metabolic characteristics and insulin sensitivity among the phenotypes.Results There were statistical differences in BMI,FAI,1h PG,2h PG,FINS,Ins 1h,Ins 2h,Ins 3h,HOMA-IR,HDL,TG and UA among the patients with 3 different phenotypes of PCOS(P<0.05).However,there were no statistical differences in age,FPG,3h PG,LDL or TC among the patients with 3 different phenotypes of PCOS(P>0.05).Conclusions PCOS patients with the classic phenotype often have higher BMI,FAI and HOMA-IR,and are more prone to abnormal metabolic indicators.it is noticeable of clinical attention.