Characteristics of metabolic disorders in different phenotype subgroups of patients with polycystic ovary syndrome

目的：分析多囊卵巢综合征（PCOS）患者不同表型间代谢异常的特点。方法选取因不孕症在我院门诊就诊并拟诊为PCOS的患者251例，行OGTT、血脂谱、卵泡期的性腺轴激素水平测定等，并行经阴道卵巢和子宫超声波检查。选取34名月经规律的正常育龄期女性作为健康对照组（NC ）。结果（1）根据鹿特丹诊断标准，234例确诊为PCOS，其中，同时符合全部3条诊断标准的患者129例（55．1％），为符合3条标准组；符合2条诊断标准者105例（44．9％），为符合2条标准组；单纯的卵巢多囊化（PCO）患者17例，为单纯PCO组。与NC组比较，PCOS患者雄激素水平、IR和代谢异常比例升高（P＜0．05）；与单纯PCO组比较，符合2条标准组的血清雄激素、TC水平及肥胖比例升高（P＜0．05）；符合3条标准组的BMI、肥胖比例、TC、LDL-C、雄激素水平、LH／FSH比值升高，且HOMA-IR升高，而Mat-suda指数降低（P＜0．05）。与符合2条标准组比较，符合3条标准组的BMI、肥胖比例、TC、LDL-C、雄激素水平、LH／FSH比值升高，且FPG和HOMA-IR升高，而Matsuda指数则降低（P＜0．05）。（2）在234例PCOS患者中，有高雄激素血症（HA）者占69．2％。与非HA组比较，HA组的FPG、FIns及胰岛素抵抗指数（HOMA-IR）升高，而Matsuda指数降低（P＜0．05）。（3）在234例PCOS患者中，超重或肥胖者占53．8％。与体重正常组比较，超重或肥胖组的雄激素水平、糖代谢异常和血脂异常的比例升高（P＜0．05）。结论在PCOS患者中，同时符合3条诊断标准的患者有更严重的IR和代谢异常；HA可能加重PCOS患者的IR；超重或肥胖可加重PCOS女性生殖内分泌和代谢异常。Objective To investigate the characteristics of metabolic disorders among different phenotypes of women with polycystic ovary syndrome (PCOS). Methods A total of 251 consecutive untreated subfertile women with pre-diagnosed PCOS in outpatient clinics were enrolled. Laboratory examinations including OGTT,serum lipid profile and transvaginal sonography of ovary and uterus were carried out in all participants. Gonadal axis hormones were evaluated at early follicular phase. 34 eumenorrhea female were defined as healthy control (NC). Results (1 )Of these women,234 were diagnosed as PCOS according to the 2003 Rotterdam criteria. Among all the PCOS individuals,129 (55. 1%)cases met all 3 points of the Rotterdam criteria and were defined as fit 3 points group,while 105 (44. 9%)met 2 points and were defined as fit 2 points group. The simple polycystic ovary (PCO)group included 17 patients. Compared with NC group,PCOS women presented with insulin resistance,higher androgen level and more prevalence of metabolic disorders. Compared with the simple PCO group,the fit 2 points group had a significantly higher androgen,TC and rate of obesity (P<0. 05);the fit 3 points group showed a higher BMI,TC,LDL-C,androgen,LH/FSH radio and rate of obesity,and also had a significantly higher HOMA-IR and a lower Matsuda index (P<0. 05 ). Compared with the fit 2 points group,the fit 3 points group displayed a significantly higher BMI,rate of obesity,TC,LDL-C,androgen and LH/FSH radio,and also had a significantly higher FPG and HOMA-IR and a lower Matsuda index (P<0. 05). (2)Hyperandrogenism (HA)were found in 162 (69. 2%)of the 234 PCOS women. Compared with the non-HA group,the HA group had a significantly higher FPG,FIns and HOMA-IR and a lower Matsuda index (P<0. 05). (3)Of all the 234 women with PCOS,53. 8%were overweight or obese. The proportion of patients with elevated androgen levels,abnormal glucose metabolism and dyslipidemia increased in overweight/obese group than that in normal weight group (P<0. 05 ). Conclusion In women with PCOS,insulin resistance and metabolic abnormality are more prevalent in the subgroup met all 3 points of the diagnostic criteria than that in the other phenotype subgroups. Insulin resistance is deteriorated in PCOS women with HA,and reproductive endocrine and metabolic abnormalities are worsen in PCOS women with overweight or obesity.国家973计划资助项目(2012CB517502)；国家自然科学基金资助项目中国科学引文数据库(CSCD)114-182