不同表型PCOS患者血清皮质醇水平及其影响因素的研究
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摘要
目的探讨不同表型多囊卵巢综合征(PCOS)患者血清皮质醇(COR)水平与糖脂代谢及性激素指标的相关性。方法纳入就诊于遵义医学院附属医院内分泌科及妇科PCOS患者150例,其中稀发排卵或无排卵(OA)+高雄激素血症(HA)临床表现和(或)HA+卵巢多囊样改变(PCO)患者66例(OHP组)、OA+HA患者42例(OH组)、OA+PCO患者40例(OP组)、HA+PCO患者2例(数量偏少未纳入研究);另选44例健康体检者作为对照组。检测各组对象空腹血糖(FPG,)、血脂谱、空腹胰岛素(FINS)、性激素、COR,并计算体质量指数(BMI)、腰臀比(WHR)、胰岛素抵抗指数(HOMA-IR)及黄体生成素/促卵泡素(LH/FSH)比值。结果各组间年龄、血糖比较差异无统计学意义(P>0.05)。3组PCOS患者腰围、三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、FINS、HOMA-IR均明显高于对照组(P<0.05),雌二醇(E2)低于对照组(P=0.036)。OHP组患者COR、血清总睾酮(TEST)、脱氢表雄酮(DHEA-S)、LH、LH/FSH比值均明显高于对照组(P<0.05),OHP组患者COR、TEST、DHEA-S均明显高于OP组(P<0.01);OH组患者BMI、TEST、DHEA-S均明显高于对照组(P<0.01),且OH组患者TEST、DHEA-S明显高于OP组(P<0.01);OP组BMI明显高于对照组(P=0.001)。相关性分析显示,PCOS患者血清基础COR与BMI呈负相关(r=-0.288,P<0.05),与LH、TEST、DHEA-S均呈正相关(r=0.257、0.231、0.323,P<0.05);多元线性回归显示,BMI、LH、DHEA-S是PCOS患者血清基础COR升高的独立危险因素。结论 PCOS患者OHP亚型血清基础COR水平明显高于其他亚组,而BMI、LH、DHEA-S可能是COR增高的独立影响因素。
Objective To investigate the cowelation between serum cortisol(COR)levels and glycolipid metabolism and sex hormonesmetabolic indexes in different phenotypes of polycystic ovary syndrome(PCOS)women.Methods A total of 150 PCOS patients were divided into three groups including group OHP [oligoanovulation(OA)+hyperandrogenism(HA)+ polycystic ovary morphology(PCO)]with 66 patients,group OH(OA+HA)with 42 patients and group OP(OA+PCO)with 40 patients.44 healthy subjects served as the control group.The levels of fasting plasma glucose(FPG),blood lipid profile,fasting insulin(FINS),sex hormones and COR were detected.Body mass index(BMI),waist-hip ratio(WHR),homeostasis model assessment for insulin resistance index(HOMA-IR)and ratio of luteinizing hormone/follicle-stimulating hormone(LH/FSH)were calculated.Results There was no statistically significant difference in age and blood glucose between the groups(P>0.05).The waist circumference,triglyeride(TG),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),FINS and HOMA-IR of PCOS patients in three groups were significantly higher than those in control group(P<0.05),estradiol(E2)was lower than that in control group(P=0.036).COR,total testosterone(TEST),dehydroepiandrosterone sulfate(DHEA-S),LH,LH/FSH ratios in group OHP were significantly higher than those in the contrl group(P<0.05),COR,TEST,DHEA-S in group OHP were significantly higher than those in group OP(P<0.01);BMI,TEST and DHEA-S in OH group were significantly higher than those in the group contrl(P<0.05),and serum TEST and DHEA-S in OH group were significantly higher than those in group OP(P<0.01);BMI in group OP was significantly higher than that in the group contrl(P=0.001).The correlation analysis showed that the COR levels has a negative correlation with the body mass index(r=-0.288,P<0.05)and has a positive correlation with LH,TEST and DHEA-S(r=0.257,0.231,0.323,P<0.05).In the multiple stepwise regression analysis,BMI,LH and DHEA-S were the independent risk factors of the COR levels increasing in PCOS patients.Conclusion The levels of OHP subtypes basal serum COR were higher than other groups.And BMI,LH,DHEA-S may be the dependent influence factors of COR levels in PCOS patients.
Objective To investigate the cowelation between serum cortisol(COR)levels and glycolipid metabolism and sex hormonesmetabolic indexes in different phenotypes of polycystic ovary syndrome(PCOS)women.Methods A total of 150 PCOS patients were divided into three groups including group OHP [oligoanovulation(OA)+hyperandrogenism(HA)+ polycystic ovary morphology(PCO)]with 66 patients,group OH(OA+HA)with 42 patients and group OP(OA+PCO)with 40 patients.44 healthy subjects served as the control group.The levels of fasting plasma glucose(FPG),blood lipid profile,fasting insulin(FINS),sex hormones and COR were detected.Body mass index(BMI),waist-hip ratio(WHR),homeostasis model assessment for insulin resistance index(HOMA-IR)and ratio of luteinizing hormone/follicle-stimulating hormone(LH/FSH)were calculated.Results There was no statistically significant difference in age and blood glucose between the groups(P>0.05).The waist circumference,triglyeride(TG),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),FINS and HOMA-IR of PCOS patients in three groups were significantly higher than those in control group(P<0.05),estradiol(E2)was lower than that in control group(P=0.036).COR,total testosterone(TEST),dehydroepiandrosterone sulfate(DHEA-S),LH,LH/FSH ratios in group OHP were significantly higher than those in the contrl group(P<0.05),COR,TEST,DHEA-S in group OHP were significantly higher than those in group OP(P<0.01);BMI,TEST and DHEA-S in OH group were significantly higher than those in the group contrl(P<0.05),and serum TEST and DHEA-S in OH group were significantly higher than those in group OP(P<0.01);BMI in group OP was significantly higher than that in the group contrl(P=0.001).The correlation analysis showed that the COR levels has a negative correlation with the body mass index(r=-0.288,P<0.05)and has a positive correlation with LH,TEST and DHEA-S(r=0.257,0.231,0.323,P<0.05).In the multiple stepwise regression analysis,BMI,LH and DHEA-S were the independent risk factors of the COR levels increasing in PCOS patients.Conclusion The levels of OHP subtypes basal serum COR were higher than other groups.And BMI,LH,DHEA-S may be the dependent influence factors of COR levels in PCOS patients.
引文
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[7]ZHU Q,ZUO R,HE Y,et al.Local regeneration of cortisol by 11beta-HSD1contributes to insulin resistance of the granulosa cells in PCOS[J].J Clin Endocrinol Metab,2016,101(5):2168-2177.
[8]KALE-GURBUZ T,AKHAN SE,BASTU E,et al.Adiponectin,leptin and ghrelin levels in obese adolescent girls with polycystic ovary syndrome[J].J Pediatr Adolesc Gynecol,2013,26(1):27-30.
[9]SHABIR I,GANIE M A,PRAVEEN EP,et al.Morning plasma cortisol is low among obese women with polycystic ovary syndrome[J].Gynecol Endocrinol,2013,29(12):1045-1047.
[10]MROZINSKA S,MILEWICZ T,KIALKA M,et al.There is no difference in the plasma cortisol level between women with body mass index(BMI)greater than or equal 25kg/m(2)and polycystic ovary syndrome and the control group without polycystic ovary syndrome and BMI 25kg/m(2)[J].Przegl Lek,2016,73(4):207-209.
[11]KIALKA M,OCIEPKA A,MILEWICZ T,et al.Evening not morning plasma cortisol level is higher in women with polycystic ovary syndrome[J].Przegl Lek,2015,72(5):240-242.
[12]CINAR N,HARMANCI A,AKSOY D Y,et al.Adrenocortical steroid response to ACTH in different phenotypes of non-obese polycystic ovary syndrome[J].J Ovarian Res,2012,5(1):103-111.
[13]TOCK L,CARNEIRO G,PEREIRA A Z,et al.Adrenocortical production is associated with higher levels of luteinizing hormone in nonobese women with polycystic ovary syndrome[J].Int J Endocrinol,2014,2014(1):620605-620612.
[14]KERO J,POUTANEN M,ZHANG FP,et al.Elevated luteinizing hormone induces expression of its receptor and promotes steroidogenesis in the adrenal cortex[J].J Clin Invest,2000,105(5):633-641.
[15]SANER-AMIGH K.Elevated expression of luteinizing hormone receptor in aldosterone-producing adenomas[J].J Clin Endocrinol Metab,2005,91(3):1136-1142.
[2]The Rotterdam ESHRE/ASRM-sponsored PCOS consensus workshop group.Revised 2003consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome(PCOS)[J].Hum Reprod,2004,19(1):41-47.
[3]GUASTELLA E,LONGO R A,CARMINA E.Clinical and endocrine characteristics of the main polycystic ovary syndrome phenotypes[J].Fertil Steril,2010,94(6):2197-2201.
[4]PANIDIS D,TZIOMALOS K,MISICHRONIS G,et al.Insulin resistance and endocrine characteristics of the different phenotypes of polycystic ovary syndrome:aprospective study[J].Hum Reprod,2012,27(2):541-549.
[5]PIKEE S,SHIVANI S,JAYSHREE B.Endocrine and metabolic profile of different phenotypes of polycystic ovarian syndrome[J].J Obstet Gynaecol India,2016,66(Suppl 1):S560-566.
[6]CAGLAR G S,KAHYAOGLU I,PABUCCU R,et al.Anti-mullerian hormone and insulin resistance in classic phenotype lean PCOS[J].Arch Gynecol Obstet,2013,288(4):905-910.
[7]ZHU Q,ZUO R,HE Y,et al.Local regeneration of cortisol by 11beta-HSD1contributes to insulin resistance of the granulosa cells in PCOS[J].J Clin Endocrinol Metab,2016,101(5):2168-2177.
[8]KALE-GURBUZ T,AKHAN SE,BASTU E,et al.Adiponectin,leptin and ghrelin levels in obese adolescent girls with polycystic ovary syndrome[J].J Pediatr Adolesc Gynecol,2013,26(1):27-30.
[9]SHABIR I,GANIE M A,PRAVEEN EP,et al.Morning plasma cortisol is low among obese women with polycystic ovary syndrome[J].Gynecol Endocrinol,2013,29(12):1045-1047.
[10]MROZINSKA S,MILEWICZ T,KIALKA M,et al.There is no difference in the plasma cortisol level between women with body mass index(BMI)greater than or equal 25kg/m(2)and polycystic ovary syndrome and the control group without polycystic ovary syndrome and BMI 25kg/m(2)[J].Przegl Lek,2016,73(4):207-209.
[11]KIALKA M,OCIEPKA A,MILEWICZ T,et al.Evening not morning plasma cortisol level is higher in women with polycystic ovary syndrome[J].Przegl Lek,2015,72(5):240-242.
[12]CINAR N,HARMANCI A,AKSOY D Y,et al.Adrenocortical steroid response to ACTH in different phenotypes of non-obese polycystic ovary syndrome[J].J Ovarian Res,2012,5(1):103-111.
[13]TOCK L,CARNEIRO G,PEREIRA A Z,et al.Adrenocortical production is associated with higher levels of luteinizing hormone in nonobese women with polycystic ovary syndrome[J].Int J Endocrinol,2014,2014(1):620605-620612.
[14]KERO J,POUTANEN M,ZHANG FP,et al.Elevated luteinizing hormone induces expression of its receptor and promotes steroidogenesis in the adrenal cortex[J].J Clin Invest,2000,105(5):633-641.
[15]SANER-AMIGH K.Elevated expression of luteinizing hormone receptor in aldosterone-producing adenomas[J].J Clin Endocrinol Metab,2005,91(3):1136-1142.