多囊卵巢综合征患者临床特征分析
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摘要
目的分析多囊卵巢综合征(PCOS)患者的临床特征。方法回顾性分析2017年1月至2018年6月武汉市武昌医院收治的83例PCOS患者(研究组)和同期体检的39例健康女性(对照组)的临床资料。结果研究组患者体重指数、月经异常发生率、多毛评分、黄体生成素(LH)、LH/卵泡刺激素(FSH)、空腹血糖、糖化血红蛋白、空腹胰岛素、稳态模型胰岛素抵抗指数、血脂水平均明显高于对照组,差异均有统计学意义(P<0.05),而2组FSH、睾酮水平比较,差异均无统计学意义(P>0.05)。结论 PCOS有较明显的代谢和内分泌异常,但临床表现多样,诊断PCOS应综合多因素判断。
Objective To analyze the clinical characteristics of PCOS.Methods Clinical data of 83 PCOS patients(study group)admitted to the Wuchang Hospital from January 2017 to June 2018 and 39 healthy women(control group)who underwent physical examination during the same period were retrospectively analyzed.Results The BMI,incidence of abnormal menstruation,hairy score,LH,LH/FSH,fasting glucose,glycosylated hemoglobin,fasting insulin,steady state model,dyslipidemia,insulin resistance index in the study group were significantly higher than those in the control group,the differences were statistical significance(P<0.05),and FSH,testosterone levels in the 2 groups were compared,there were no statistically significant difference(P>0.05).Conclusion PCOS has obvious metabolic and endocrine abnormalities,but its clinical manifestations are diverse.
Objective To analyze the clinical characteristics of PCOS.Methods Clinical data of 83 PCOS patients(study group)admitted to the Wuchang Hospital from January 2017 to June 2018 and 39 healthy women(control group)who underwent physical examination during the same period were retrospectively analyzed.Results The BMI,incidence of abnormal menstruation,hairy score,LH,LH/FSH,fasting glucose,glycosylated hemoglobin,fasting insulin,steady state model,dyslipidemia,insulin resistance index in the study group were significantly higher than those in the control group,the differences were statistical significance(P<0.05),and FSH,testosterone levels in the 2 groups were compared,there were no statistically significant difference(P>0.05).Conclusion PCOS has obvious metabolic and endocrine abnormalities,but its clinical manifestations are diverse.
引文
[1] LI R,ZHANG Q,YANG D,et al.Prevalence of polycystic ovary syndrome in women in China:a large community-based study[J].Hum Reprod,2013,28(9):2562-2569.
[2] BOZDAG G,MUMUSOGLU S,ZENGIN D,et al.The prevalence and phenotypic features of polycystic ovary syndrome:a systematic review and meta-analysis[J].Hum Reprod,2016,31(12):2841-2855.
[3] Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshopgroup.Revised 2003consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome(PCOS)[J].Hum Reprod,2004,19(1):41-47.
[4] LI R,QIAO J,YANG D,et al.Epidemiology of hirsutism among women of reproductive age in the community:a simplified scoring system[J].Eur J Obstet Gynecol Reprod Biol,2012,163(2):165-169.
[5] MATTHEWS DR,HOSKER JP,RUDENSKI AS,et al.Homeostasis model assessment:insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man[J].Diabetologia,1985,28(7):412-419.
[6] DIAMANTI-KANDARAKIS E,KANDARAKIS H,LEGRO RS.The role of genes and environment in the etiology of PCOS[J].Endocrine,2006,30(1):19-26.
[7] MOORE AM,CAMPBELL RE.Polycystic ovary syndrome:Understanding the role of the brain[J].Front Neuroendocrinol,2017,46:1-14.
[8] DUMESIC DA,OBERFIELD SE,STENER-VICTORIN E,et al.Scientific statement on the diagnostic criteria,epidemiology,pathophysiology,and molecular genetics of polycystic ovary syndrome[J].Endocr Rev,2015,36(5):487-525.
[9] AZZIZ R,CARMINA E,DEWAILLY D,et al.The androgen excess and PCOS society criteria for the polycystic ovary syndrome:the complete task force report[J].Fertil Steril,2009,91(2):456-488.
[10]WICKENHEISSER JK,NELSON-DEGRAVE VL,MCALLISTER JM.Human ovarian theca cells in culture[J].Trends Endocrionol Metab,2006,17(2):65-71.
[11]DE LEO V,LA MARCA A,PETRAGLIA F.Insulin-lowering agents in the management of polycystic ovary syndrome[J].Endocr Rev,2003,24(5):633-667.
[12]CORBOULD A.Effects of androgens on insulin action in women:is androgen excess a component of female metabolic syndrome?[J].Diabetes Metab Res Rev,2008,24(7):520-532.
[13]韩杨,赵晓苗,杨冬梓.女性雄激素检测指标,方法与现状[J].中外医学研究,2014,12(13):157-158.
[14]狄娜,韩杨,翁雪玲,等.高效液相色谱串联质谱法与化学发光法定量测定女性血清总睾酮的比较分析[J].中山大学学报(医学版),2018,39(4):581-589.
[15]HOMBURG R.Angrogen circle of polycystic ovary syndrome[J].Hum Reprod,2009,24(7):1548-1555.
[16]李萌,张晓松.多毛症的病因和药物治疗进展[J].生殖医学杂志,2003,12(3):181-184.
[17]唐蓉辉,汤惠茹,王丽平,等.深圳市汉族育龄妇女多囊卵巢综合征患病率及临床特征分析[J].罕少疾病杂志,2010,17(1):1-5.
[18]GALLUZZO A,AMATO MC,GIORDANO C.Insulin resistance and polycystic ovary syndrome[J].Nutr Metab Cardiovasc Dis,2008,18(7):511-518.
[19]TRIKUDANATHAN S.Polycystic ovarian syndrome[J].Med Clin North Am,2015,99(1):221-235.
[20]SOKHI J,SIKKA R,RAINA P,et al.Association of genetic variants inINS(rs689),INSR(rs1799816)and PP1G.G(rs1799999)with type2diabetes(T2D):a case-control study in three ethnic groups from North-West India[J].Mol Genet Genomics,2016,291(1):205-216.
[21]PETERSEN KF,SHULMAN GI.Etiology of insulin resistance[J].Am J Med,2006,119(5Suppl 1):10-16.
[22]DING Y,ZHUO G,ZHANG C,et al.Point mutation in mitochondrialt RNA gene is associated with polycystic ovary syndrome andinsulin resistance[J].Mol Med Rep,2016,13(4):3169-3172.
[23]李婧博,刘洪彬,贾月月,等.micro RNA-183在PCOS胰岛素抵抗中的表达及其临床意义[J].山东大学学报(医学版),2017,55(1):69-74.
[24]SHI Y,ZHAO H,SHI Y,et al.Genome-wide association studyidentifies eight new risk loci for polycystic ovary syndrome[J].NatGenet,2012,44(9):1020-1025.
[25]印存思,潘维君,高超,等.胰岛素受体基因酪氨酸激酶区单核苷酸多态性与多囊卵巢综合征的相关性[J].重庆医学,2014,43(16):2002-2005.
[26]MORAN C,HUERTA R,CONWAY-MYERS BA,et al.Altered autophosphorylation of the insulin receptor in the ovary of a woman with polycystic ovary syndrome[J].Fertil Steril,2001,75(3):625-628.
[27]KIM SH,ABBASI F,REAVEN GM.Impact of degree of obesity on surrogate estimates of insulin resistance[J].Diabetes Care,2004,27(8):1998-2002.
[28]KINOSHITA T,KATO J.Impaired glucose tolerance in patients with polycystic ovary syndrome(PCOS)[J].Horm Res,1990,33Suppl 2:18-20.
[29]HOLTE J,BERGH T,BERNE C,et al.Enhanced early insulin response to glucose in relation to insulin resistance in women with polycystic ovary syndrome and normal glucose tolerance[J].J Clin Endocrinol Metab,1994,78(5):1052-1058.
[30]LIM SS,DAVIES MJ,NORMAN RJ,et al.Overweight,obesity and central obesity in women with polycystic ovary syndrome:a systematic review and meta-analysis[J].Hum Reprod Update,2012,18(6):618-637.
[31]中国超重肥胖医学营养治疗专家共识编写委员会.中国超重/肥胖医学营养治疗专家共识(2016年版)[J].中华糖尿病杂志,2016(9):525-540.
[2] BOZDAG G,MUMUSOGLU S,ZENGIN D,et al.The prevalence and phenotypic features of polycystic ovary syndrome:a systematic review and meta-analysis[J].Hum Reprod,2016,31(12):2841-2855.
[3] Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshopgroup.Revised 2003consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome(PCOS)[J].Hum Reprod,2004,19(1):41-47.
[4] LI R,QIAO J,YANG D,et al.Epidemiology of hirsutism among women of reproductive age in the community:a simplified scoring system[J].Eur J Obstet Gynecol Reprod Biol,2012,163(2):165-169.
[5] MATTHEWS DR,HOSKER JP,RUDENSKI AS,et al.Homeostasis model assessment:insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man[J].Diabetologia,1985,28(7):412-419.
[6] DIAMANTI-KANDARAKIS E,KANDARAKIS H,LEGRO RS.The role of genes and environment in the etiology of PCOS[J].Endocrine,2006,30(1):19-26.
[7] MOORE AM,CAMPBELL RE.Polycystic ovary syndrome:Understanding the role of the brain[J].Front Neuroendocrinol,2017,46:1-14.
[8] DUMESIC DA,OBERFIELD SE,STENER-VICTORIN E,et al.Scientific statement on the diagnostic criteria,epidemiology,pathophysiology,and molecular genetics of polycystic ovary syndrome[J].Endocr Rev,2015,36(5):487-525.
[9] AZZIZ R,CARMINA E,DEWAILLY D,et al.The androgen excess and PCOS society criteria for the polycystic ovary syndrome:the complete task force report[J].Fertil Steril,2009,91(2):456-488.
[10]WICKENHEISSER JK,NELSON-DEGRAVE VL,MCALLISTER JM.Human ovarian theca cells in culture[J].Trends Endocrionol Metab,2006,17(2):65-71.
[11]DE LEO V,LA MARCA A,PETRAGLIA F.Insulin-lowering agents in the management of polycystic ovary syndrome[J].Endocr Rev,2003,24(5):633-667.
[12]CORBOULD A.Effects of androgens on insulin action in women:is androgen excess a component of female metabolic syndrome?[J].Diabetes Metab Res Rev,2008,24(7):520-532.
[13]韩杨,赵晓苗,杨冬梓.女性雄激素检测指标,方法与现状[J].中外医学研究,2014,12(13):157-158.
[14]狄娜,韩杨,翁雪玲,等.高效液相色谱串联质谱法与化学发光法定量测定女性血清总睾酮的比较分析[J].中山大学学报(医学版),2018,39(4):581-589.
[15]HOMBURG R.Angrogen circle of polycystic ovary syndrome[J].Hum Reprod,2009,24(7):1548-1555.
[16]李萌,张晓松.多毛症的病因和药物治疗进展[J].生殖医学杂志,2003,12(3):181-184.
[17]唐蓉辉,汤惠茹,王丽平,等.深圳市汉族育龄妇女多囊卵巢综合征患病率及临床特征分析[J].罕少疾病杂志,2010,17(1):1-5.
[18]GALLUZZO A,AMATO MC,GIORDANO C.Insulin resistance and polycystic ovary syndrome[J].Nutr Metab Cardiovasc Dis,2008,18(7):511-518.
[19]TRIKUDANATHAN S.Polycystic ovarian syndrome[J].Med Clin North Am,2015,99(1):221-235.
[20]SOKHI J,SIKKA R,RAINA P,et al.Association of genetic variants inINS(rs689),INSR(rs1799816)and PP1G.G(rs1799999)with type2diabetes(T2D):a case-control study in three ethnic groups from North-West India[J].Mol Genet Genomics,2016,291(1):205-216.
[21]PETERSEN KF,SHULMAN GI.Etiology of insulin resistance[J].Am J Med,2006,119(5Suppl 1):10-16.
[22]DING Y,ZHUO G,ZHANG C,et al.Point mutation in mitochondrialt RNA gene is associated with polycystic ovary syndrome andinsulin resistance[J].Mol Med Rep,2016,13(4):3169-3172.
[23]李婧博,刘洪彬,贾月月,等.micro RNA-183在PCOS胰岛素抵抗中的表达及其临床意义[J].山东大学学报(医学版),2017,55(1):69-74.
[24]SHI Y,ZHAO H,SHI Y,et al.Genome-wide association studyidentifies eight new risk loci for polycystic ovary syndrome[J].NatGenet,2012,44(9):1020-1025.
[25]印存思,潘维君,高超,等.胰岛素受体基因酪氨酸激酶区单核苷酸多态性与多囊卵巢综合征的相关性[J].重庆医学,2014,43(16):2002-2005.
[26]MORAN C,HUERTA R,CONWAY-MYERS BA,et al.Altered autophosphorylation of the insulin receptor in the ovary of a woman with polycystic ovary syndrome[J].Fertil Steril,2001,75(3):625-628.
[27]KIM SH,ABBASI F,REAVEN GM.Impact of degree of obesity on surrogate estimates of insulin resistance[J].Diabetes Care,2004,27(8):1998-2002.
[28]KINOSHITA T,KATO J.Impaired glucose tolerance in patients with polycystic ovary syndrome(PCOS)[J].Horm Res,1990,33Suppl 2:18-20.
[29]HOLTE J,BERGH T,BERNE C,et al.Enhanced early insulin response to glucose in relation to insulin resistance in women with polycystic ovary syndrome and normal glucose tolerance[J].J Clin Endocrinol Metab,1994,78(5):1052-1058.
[30]LIM SS,DAVIES MJ,NORMAN RJ,et al.Overweight,obesity and central obesity in women with polycystic ovary syndrome:a systematic review and meta-analysis[J].Hum Reprod Update,2012,18(6):618-637.
[31]中国超重肥胖医学营养治疗专家共识编写委员会.中国超重/肥胖医学营养治疗专家共识(2016年版)[J].中华糖尿病杂志,2016(9):525-540.