新疆部分地区维吾尔族、汉族多囊卵巢综合征的临床研究
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摘要
研究背景：多囊卵巢综合征(polyeystic ovary syndrome, PCOS)是青春期及育龄期妇女最常见的内分泌及代谢性疾病,在育龄期妇女中的群体发病率为5%～10%,该病由于不同个体的临床表现不同,实验室检查和辅助检查差异很大,临床上表现为高度的异质性,虽然多囊卵巢综合征的自然特征有高度的异质性,但是长期无排卵和高雄激素血症为其基本特征。近年来的研究发现该疾病的功能紊乱远超出生殖轴反馈机制的异常,多囊卵巢综合征已成为代谢综合征(metabolic syndrome,MD)的前期病变即存在着发生2型糖尿病、脂代谢异常、高血压和心血管疾病的风险。此外,由于患者长期不排卵,极易发生子宫内膜增生性病变,甚至子宫内膜癌。
临床上胰岛素抵抗虽然不是诊断多囊卵巢综合征的指标,但是,由于它引起的远期并发症对PCOS患者的危害严重影响患者的生活质量,因此,对于PCOS患者,要重视寻找胰岛素抵抗的征象如：黑棘皮征、腹型肥胖、高血压等,注意PCOS患者家族中2型糖尿病和高血压病等代谢性疾病史。
目前对PCOS的治疗没有统一的方案。强调根据不同的年龄阶段治疗目标的不同的个性化治疗；治疗的重点不仅要改善患者高雄激素血症所致的多毛、痤疮和不孕,还要重视由于胰岛素抵抗所致的远期并发症的防治。根据患者不同阶段的治疗目的制定不同的治疗方案。把针对减轻体重和保持足够的运动等改变生活方式的治疗作为长期治疗的基础。治疗策略分为四个部分,其中的三部分是针对调整并规律月经、治疗多毛、痤疮和不孕症等的近期治疗或称为“急性治疗”,这一部分的治疗可以随着不同年龄时期患者的需求不同进行改变；非常重要的远期治疗即“长期治疗”是指对胰岛素抵抗引起的远期并发症的治疗。
PCOS发病机制仍不明确,很多研究认为PCOS可能是一种多基因遗传病,其发生可能是遗传因素和环境因素交互作用的结果。新疆地区是一个多民族聚集的地区,目前缺乏相关疾病的研究,由于维吾尔族和汉族在生活习惯、饮食习惯、生活地域等方面存在差异。因此,我们希望通过调查和分析PCOS在维吾尔族、汉族不同种族中的临床表型的差异,为进一步研究该病的发病机制的提供线索；通过采用干预措施观察维吾尔族、汉族PCOS患者的临床表现及血清激素水平、生化指标的变化在不同种族间的差别,为疾病的治疗提供理论依据。
目的：1)通过问卷调查获取新疆部分地区维吾尔族、汉族多囊卵巢综合征患者的发病分布情况,高发人群年龄段,为进一步研究不同民族PCOS病人发病情况差异的奠定基础。2)根据鹿特丹专家会议诊断标准,分析维吾尔族、汉族PCOS组患者之间临床、内分泌及代谢特征的差别；同时评估随年龄变化各项特征变化的趋势。3)调查环境因素及遗传因素对PCOS发病的可能作用。4)比较维吾尔族、汉族肥胖PCOS患者的糖、脂代谢差异,为进一步探讨维吾尔族、汉族PCOS患者的发病机制奠定基础。5)分析PCOS患者内分泌、代谢特征与胰岛素抵抗的相关关系；6)分析维吾尔族、汉族肥胖青春期多囊卵巢综合征的临床特点及用复方醋酸环丙孕酮及二甲双胍治疗的疗效和安全性。
方法：本研究第一部分：1)按照2003年鹿特丹专家会议进行PCOS的诊断,抽取新疆部分地区的3010名育龄期妇女为调查对象,检查出PCOS患者,与同期进行调查的正常妇女按照1：1配对,选出对照组。获取PCOS发生的分布情况；2)比较所检出的维吾尔族、汉族PCOS患者临床表现的不同；3)按照年龄分组,分析维吾尔族、汉族PCOS患者月经周期,与临床高雄激素有关指标的差别并评估随年龄变化临床特征的变化趋势；4)比较维吾尔族、汉族肥胖和非肥胖PCOS患者的胰岛素抵抗(IR)、糖、脂代谢在不同民族之间的差异及特征；5)调查PCOS患者家族中糖尿病(DM)及女性月经失调、家族中男性秃顶(NA)的患病情况、PCOS患者出生体重(BW)、饮食习惯、运动习惯等与PCOS发病的关系；6)本研究第二部分对2008年4月至2009年9月在新疆医科大学妇科门诊就诊的166例PCOS患者,年龄为18～45岁,平均(24.44±6.89)岁,测定血清性激素水平、性激素结合球蛋白(SHBG)、口服糖耐量试验(OGTT)、血清胰岛素释放试验(IRT)、血脂检查、测量其身高、体重,计算体重指数(BMI),测量臀围、腰围,计算臀围比(WHR)、计算游离睾酮指数(FAI)；测定空腹胰岛素(FNS)、空腹血糖(FBG),计算胰岛素抵抗指数(HOMA-IR);胰岛素敏感指数(ISI)；根据这些指标不同的组合分析各指标与PCOS患者胰岛素抵发生的相关性；7)本研究的第三部分对105例肥胖青春期多囊卵巢综合征患者,其中维吾尔族45例,汉族60例,分析维吾尔族、汉族青春期肥胖PCOS患者临床特征及用复方醋酸环丙孕酮、二甲双胍治疗6个周期前、后,临床特征、血清性激素水平、卵巢超声检查的变化情况以及用药的安全性,同时观察停药后的相应临床症状及体征的变化。
结果：第一部分：1)本调查共发出问卷3010份调查问卷,收回有效问卷2867份,反馈率为95.25%。共诊断PCOS患者217例(汉族126例,维吾尔族91例),PCOS发生构成比在总体为7.57%,汉族为6.93%,维吾尔族为8.68%;平均年龄(25.44±5.35)岁；所有患者按年龄分为6个年龄组,年龄≤35岁者占94.01%(204/217),汉族患者117例,占92.86%(117/126)；维吾尔族患者87例占95.60%(87/91)；2)调查的PCOS患者临床症状维吾尔族、汉族的差异为：维吾尔族患者以月经稀发、高雄激素血症、多毛、肥胖为主要表现；汉族以黄体生成素/促卵泡素(LH/FSH)>2、痤疮为主要表现。且不同种族的多毛特征有所不同：维吾尔族PCOS患者多毛以腹正中线,性毛(阴毛和腋毛)浓密、增粗为主,尤其是阴毛分布呈男性型,甚至下延及肛周,上及腹股沟或腹中线,而汉族PCOS患者的多毛分布于面部口周、乳周、下颌、腹正中线处的少量(通常为3-10根不等)长、粗毛为主。具体指标为：月经稀发占79.72%(173/217),其中汉族占76.98%(97/126),维吾尔族占83.52%(76/91)(P<0.05)；超声检查卵巢内卵泡呈多囊表现维吾尔族、汉族无差异;高雄激素表现占58.99%(128/217),其中汉族占45.24%(57/126)维吾尔族占78.02%(71/91)(P<0.05)；本调查PCOS组F-G评分大于6分者57例占26.27%(57/217),46例为维吾尔族占50.55%(46/91),11例为汉族占8.73%(11/126)(P<0.05)；F-G评分大于2分者占71例占32.72%(71/217),其中汉族为22例占17.46%(22/126),维吾尔族为49例占53.85%(49/91)(P<0.05)。PCOS患者的临床高雄激素征象中,有痤疮的PCOS患者67例,占30.88%(67/217),其中汉族占36.51%(46/126),维吾尔族占23.08%(21/91)(P<0.05)。本组患者自青春期即出现痤疮至进行本调查时痤疮持续出现的患者67例,痤疮持续出现率为30.88%(67/217)；曾出现痤疮经过治疗的患者52例,至进行本调查时痤疮已消失的患者15例。此外,调查发现PCOS组平均BMI (23.12±3.26) (kg/m2),肥胖[BMI≥25(kg/m2)]占33.18%(72/217),其中汉族占24.60%(31/126),维吾尔族占45.05%(41/91) (P<0.05); LH/FSH>2者占(108/217)49.77%,其中汉族占53.97%(68/126),维吾尔族占43.95%(40/91)(P<0.05)。3)不同年龄段汉族、维吾尔族妇女月经周期、雄激素相关指标比较：汉族、维吾尔族对照组及PCOS组患者以21-25岁年龄段月经周期较其他各年龄长(P<0.05),随着年龄的增长,月经周期有缩短的趋势。对照组维吾尔族、汉族26～30岁年龄段较其他年龄段睾酮(T)高、性激素结合球蛋白(SHBG)低、游离雄激素指数(FAI)高(P<0.05)：维吾尔族组F-G评分较汉族组高(P<0.05)。维吾尔族、汉族PCOS组患者18～25岁年龄段与其他年龄段相比T、FAI高(P<0.05)；维吾尔族PCOS组患者F-G评分、T、FAI较汉族高(P<0.05)；而SHGB在维吾尔族、汉族在对照组间和病例组间无差异(P>0.05),PCOS病例组不论维吾尔族还是汉族组SHGB均低于对照组(P<0.05)。不同年龄段维吾尔族、汉族PCOS患者F-G分数随年龄增加而降低,但维吾尔族患者评分仍高于汉族(P<0.05)。维吾尔族对照组T较汉族高、SHGB低(P<0.05)；维吾尔族PCOS组比较雌二醇(E2)、LH、T、FAI较汉族PCOS组高(P<0.05),LH/FSH维吾尔族较汉族低(P<0.05); PCOS组和对照组比较维吾尔族、汉族E2、LH、LH/FSH、T、FAI PCOS组均较对照组高(P<0.05), SHBG较对照组低(P<0.05)。4)肥胖及非肥胖PCOS患者的性激素水平及代谢指标的比较：维吾尔族、汉族肥胖PCOS患者与非肥胖患者比较糖、脂代谢各项指标差异均有统计学意义(P<0.05)；汉族肥胖PCOS患者与对照组肥胖组比较,WHR、HOMA-IR较高,胰岛素敏感指数(ISI)较低(P<0.05)；不同的是维吾尔族肥胖PCOS患者与对照组肥胖组比较除了具有汉族患者的特征外其甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白(LDL)也较对照组高(P<0.05)；维吾尔族、汉族PCOS非肥胖组与对照组非肥胖组比较,WHR、HOMA-IR较高,ISI较低(P<0.05)。维吾尔族组PCOS患者BMI、WHR、HOMA-IR、TG、TC较汉族PCOS肥胖组高、ISI低(P<0.05)；汉族、维吾尔族PCOS患者卵巢体积均较对照组大、卵巢内平均小卵泡数均较对照组多(P<0.05)。5)PCOS患病的相关因素：出身体重(BW)、饮食习惯、BMI、家族中糖尿病(DM)及月经紊乱家族史等因素与PCOS患病相关(P<0.05),运动习惯及家族男性秃顶患病率与PCOS患病不相关(P>0.05)。BMI与BW成负相关(r=-1.371,P<0.05)
本研究第二部分结果表明：胰岛素抵抗组BMI、WHR、TG高于非胰岛素抵抗组(P<0.05)；LH水平低于非胰岛素抵抗组(P<0.05)；胰岛素抵抗组与非胰岛素抵抗组比较,各个时点血糖及胰岛素水平均有显著性差异(P<0.05)。肥胖组与非肥胖组比较,肥胖组年龄、HOMA-IR、TG高于非肥胖组(P<0.05)；LH水平低于于非肥胖组(P<0.05)；肥胖组OGTT各时点血糖水平及胰岛素水平高于非肥胖组(P<0.05)。高雄激素血症组WHR、LH、TC及LDL水平高于非高雄激素血症组(P<0.05)；高雄激素血症组与非高雄激素血症组比较,各时点血糖及胰岛素水平均无差异(P>0.05)。PCOS病人HOMA-IR与BMI呈显著正相关；HOMA-IR与腰围呈显著正相关；与TG水平存在正相关关系；与LH水平存在负相关关系,在去除了BMI的影响后,LH水平与HOMA-IR没有相关关系；与血TC、T水平没有相关关系；LH水平与BMI呈现负相关。
本研究第三部分结果表明：维吾尔族、汉族肥胖青春期PCOS患者的初潮年龄与正常女性相同。主要临床症状为闭经、月经稀发及月经不规律等月经异常。其中维吾尔族青春期肥胖患者出现闭经者较汉族多见(P<0.05)；体检发现多毛,维吾尔族患者多毛较汉族多见(P<0.05),多毛特征同第一部分所述。肥胖青春期维吾尔族PCOS以LH/FSH>2多见；痤疮则表现为汉族多于维吾尔族(P<0.05)。月经周期维吾尔族组较汉族组长(P<0.05)。治疗后,72例PCOS患者恢复月经。多毛和痤疮评分明显下降(P<0.05)。血清各性激素水平均有明显下降,E2、LH、FSH、LH/FSH、T、FAI下降(P<0.05), SHBG增加(P<0.05)。双侧卵巢体积及双侧卵泡数目减少(P<0.05)。副反应轻微。
结论：1)本调查得出结果35岁以下的育龄妇女是PCOS患者的主要人群,PCOS发生构成比分别为整体、维吾尔族、汉族分别为7.57%、6.93%、8.68%；2)检出的PCOS患者的临床表现维吾尔族患者以月经稀发、高雄激素血症、多毛、肥胖为主要表现；汉族以LH/FSH>2.痤疮为主要表现。且不同种族的多毛特征有所不同。3)按照年龄将所检出的PCOS患者分组PCOS患者21-25岁年龄段者以的稀发排卵为主要表现,而随年龄增长有缩短趋势；18～25岁年龄段者岁以高雄激素血症及临床高雄激素体征为主要表现,而性激素结合球蛋白(SHBG)降低；不同年龄段维吾尔族、汉族PCOS患者F-G分数随年龄增加而降低,但维吾尔族患者评分仍高于同年龄组汉族组(P<0.05),提示维吾尔族患者的多毛表现可能与种族差异有关。4)PCOS肥胖患者存在糖代谢和脂肪代谢方面的改变,汉族患者以腹型肥胖和胰岛素抵抗为特征,而维吾尔族肥胖PCOS患者除了具有汉族的特征外还伴有血脂增高的表现。5)PCOS患者的出生体重(BW)、体重指数(BMI)、糖尿病家族史、月经紊乱家族史与PCOS的发病有关。6)肥胖尤其是腹型肥胖、脂代谢异常与PCOS患者的胰岛素抵抗有关。高雄激素血症及高LH血症与PCOS患者的胰岛素抵抗没有相关性。7)青春期肥胖PCOS患者在维吾尔族、汉族不同族别间临床表现有一定差异。复方醋酸环丙孕酮及二甲双胍可很好改善青春期多囊卵巢综合征患者的高雄激素症状及内分泌状况,对恢复排卵有一定疗效。副反应轻微。
Background:Polycystic ovarian syndrome (PCOS) is an extremely common disorder affecting 5%～10% of women of reproductive age. Despite being heterogeneous in nature, the hallmarks of the disease are hyperandrogenism and chronic anovulation. Nowdays much studies has been learned about the pathophysiology of PCOS from its neuroendocrine underpinnings to an evergrowing understanding of the link between obesity, insulin resistance (IR) and PCOS. Women affected by PCOS also show a higher risk of type 2 diabetes, dyslipidaemia, hypertension and cardiovascular diseases. Besides, Because of chronic anovulation there also show a higher risk of endometrial cancer.
When clinically evaluating a patient for the possibility of PCOS, it is also important to search for signs of IR. Upper-body obesity is a key component of the IR syndrome. Acanthosis nigricans on physical examination is a sign of IR. A personal or family history of type 2 diabetes mellitus or gestational diabetes mellitus, or the presence of hyertension should also be sought in the evaluation. Overall, the criteria for diagnosis of the IR syndrome in women should be evaluated in all patients.
Based on this current understanding of PCOS, it is important that the patient and medical provider approach management not only toward improving the often troublesome hirsutism and infertility but also toward the long-term risks associated with IR. Indeed, the management of the PCOS patient often will vary over time as the patient enters different stages of life with different goals. In contrast, because of the long-term health implications of IR, the importance of lifestyle modification toward weight management and maintaining adequate physical activity should be the one constant in the management of these patients. The medical management of PCOS can be broken down into four components, three of which are "acute" issues (control of irregular menses, treatment of hirsutism and management of infertility) and one that is more "chronic". This latter issue may be the most important but least remembered by patients and providers alike management of the IR syndrome. "Acute" issues that need management may changed, however, a continuous life-long management approach is important for the IR of PCOS.
The pathogenesis of PCOS is still not clear, many studies suggest that PCOS may be a polygenic disease, its occurrence may be the interaction of genetic and environmental factor. Xinjiang is a multiethnic gathering region lacking of related study on this diseases, There are a lot of difference between Uighurs and Han,such as living habits, eating habits, living area and so on. Therefore, The investigation and analysis the difference clinical phenotype of PCOS in the Uighurs and Han nationalities is very useful. It can provide some clues on further study on the pathogenesis of PCOS; Use some interventions to observe the difference in Uighur and Han on clinical performance, serum hormone levels, biochemical indicators may provide some theoretical basis on the clinical mangement of PCOS.
Objective: 1) To obtain the distribution incidence of PCOS patients and high risk age groups in child-bearing women by questionnaire between Uighur and Han in some areas of Xinjiang, for the further study on the reasons for differences between PCOS patients in different nationalities; 2) According to the diagnostic criteria of the Rotterdam meeting,To analysis the difference characteristics of clinical, endocrine and metabolic Uighur and Han nationnalities; evaluated the characteristics change with ageing; 3) To investigate the environmental factors and genetic factors on the pathogenesis of PCOS; 4) Compared the differences about glucose and lipid metabolic in Uighur, and Han obese PCOS patients, for the further study of the pathogenesis of PCOS; 5) Analysis of PCOS patients with endocrine, metabolic characteristics and the correlation with insulin resistance; 6) To investigate the clinical feature and treatments of the puberty polycystic ovary syndrome (PCOS) in obesity, To study the efficacy and safety of compound Cyproterone Acetate and Metformin in the treatment of the puberty PCOS between the Uighurs and Hans.
Method:Part I:1) 3010 childbearing age women in the survey, Check out the PCOS patients from them, 1:1 matched with normal women as control group at the same time. To find the distribution characters of PCOS; 2) To compare the different clinical manifestations of PCOS patients in Uighur and Han; 3) Analysis the diffence about the menstrual cycle、clinical hyperandrogenism in Uighur and Han and find out the changes with ageing; 4) To compare the differences characteristics in Uighur and Han with or without obese in PCOS patients with obesity, insulin resistance (IR), glucose and lipid metabolism's disorders; 5) To investigate the family history of diabetes (DM) and menstrual disorders, alopecia (NA) in patients with PCOS, PCOS patients with birth weight (BW), eating habits, exercise habits and to find out the relationship with PCOS; 6) Part II:166 cases came from outpatient department. The age was 18～45 years old, the mean age was (24.44±6.89) years old, A fasting blood sample was drawn on day five of menstrual cycle from each subjects. To detect sex hormone, hormone binding globulin (SHBG), oral glucose tolerance test (OGTT), Insulin releasing test (IRT). Use these combinations to evaluate the relation between PCOS and insulin resistance; 7) Part III: 105 patients (including the Uighur 45 patients and Han 60 patients) were proved the puberty PCOS in obesity were examed and received compound Cyproterone Acetate and Metformin for 6 cycles. Serum sex hormone, transvaginal pelvic ultrasonography, the clinical feature were determined before and after 6 cycles treatment. To observe the effective and safety on the clinical management.
Result: Part I:1) 3010 survey questionnaires were issued,2867 questionnaires were recovered. The response rate were 95.25%.217 cases PCOS patients were diagnosed (126 cases of Han,91 cases of Uighur). The total PCOS diagnosed rate were 7.57%,6.93%and 8.68%in Uighur and Han respectively. The average age of 217 patients were (25.44±5.35) years old; All the patients were divided into 6 groups, The mainly distributes PCOS population is≤35 childbearing age Women, that was 94.01% in all, and 92.86%,95.60% in Han and Uighur respectively; 2) To investigate the difference of clinical symptoms of PCOS patients with Uighur and Han:The main manifestations in Uighure PCOS patients were oligo-ovulation, hyperandrogenism、hirsutism and obesity, The main performance of Han were LH/FSH>2 and acne. And the different races have different characteristics in distribution of hirsutism:hirsutism in Uighur PCOS patients showed that the hair were more in abdominal midline, pubic and armpit hair, in particularly, Showed a male pattern of pubic hair distribution, even extended to perianal and inguinal or ventral midline, while the Han Chinese patients with PCOS showed in face, surrounding of brest、lower jaw and ventral midline at a small amount of long and thickening hair (ranging from 3 to 10). The rate of oligo-ovulation were:in all 79.72%, in Han 76.98%, in Uighur 83.52%(P<0.05); ultrasound examination showed no difference in polycystic ovarian follicle performance in Uighur and Han; The rate of hyperandrogenism were:in all 58.99%,in Han 45.24%, in Uighur 78.02%(P<0.05); In this survey PCOS patients' F-G score more than 6 points the rate were:26.27% in all,50.55% in Uighur,8.73% in Han; F-G score more than 2 points the rate were:32.72% in all,53.85% in Uighur,17.46% in Han; Other specific PCOS clinical signs of hyperandrogenism is acne, PCOS patients had acne were: 30.88% in all, 36.51% in Han,23.08% in Uighurs (P<0.05). This group of patients the acne appears since puberty to be persistent till our survery. In this investigation the rate was 30.88%,52 cases of acne had been treated. 15 cases have disappeared. The average BMI were (23.12±3.26) (kg/m2) in PCOS patients, obese [BMI≥25 (kg/m2)] were 33.18% in all, 24.60% in Han Chinese, 45.05% in Uighur (P<0.05); LH/FSH>2 were 49.77% in all, 53.97% of them were Han,43.95% in Uighur (P<0.05).3) Compared with Uighur and Han patients aged 21 to 25, their menstrual cycles were longer than the other groups,the differences were statistically significant (P<0.05), The menstrual cycle shortening with ageing. In the Han and Uighur control group age between 26 to 30 years old, T high, SHBG lower, FAI higher than other age, the difference has statistically significant (P< 0.05), Uighur group F-G score higher than the Han group (P<0.05). Compared with other age patients between 18 to 25 years old, T, FAI were higher (P<0.05); Uighur PCOS patients' F-G score, T, FAI were higher than Han (P<0.05); and SHGB in the Uighur, Han was no significant difference between them (P>0.05). PCOS patients'high F-G score decreased with ageing; In Uighur PCOS groups'E2, LH, T, FAI higher than the Han, LH/FSH were lower, the difference were statistically significant (P<0.05). Compared with PCOS and control group, E2, LH, LH/FSH, T, FAI were higher, SHBG were lower than control group (P<0.05); 4) Compared with obese and non-obese PCOS patients of metabolism in Han and Uiger, metabolism indicators were significant differences (P<0.05); Compared with the control obese group, WHR, FNS, HOMA-IR were higher and ISI lower than control group (P<0.05), but in Uigers their have the same characteristic with Hans,Besides the TG, TC, LDL were higher than control groups. In non-obese group the PCOS patients WHR, FNS, FBG, HOMA-IR were higher, ISI lower than control group (P<0.05). Compared difference of PCOS on ovarian volume, number of small ovarian follicles were larger and more than control group (P<0.05). 5) BW, dietary habits, BMI, diabetes (Diabetes mellitus, DM) and menstrual disorders as family history have relation with PCOS (P<0.05); There were no relation among PCOS and exercise habits, alopecia in family history. BMI was negatively correlated with BW (r=-1.371, P<0.05). Part II:The manifestation of metabolic syndrome in PCOS:In IR group BMI, WHR were higher (P<0.05); but in non-IR group LH was higher (P<0.05); Compare with non-IR group, each OGTT and insulin level were different in IR group (P <0.05). TG was higher in non-IR group (P<0.05), Compare with non-obesity group the age, TC HOMA-IR and LH were higher (P<0.05), each OGTT and insulin level were higher in obesity group (P<0.05), Compare with non-hyperandrogenic group WHR, LH were higher in hyperandrogenic group (P<0.05), each OGTT and insulin level have no change in non-hyperandrogenic group and hyperandrogenic group (P>0.05), but in hyperandro-genic group TC, LDL were higher (P<0.05). In PCOS HOMA-IR and BMI, waistine, TG, have positive correlation; And have negative correlation with LH, There were no correlation with TC and T. BMI have negative correlation with LH.
Part III:Compared with the normal women the menarche is as same as the puberty PCOS patients; but the major criterion is different. Hirsute in the Uighurs is much more than Hans (P<0.05). and acne is less than Hans (P<0.05). Menstrual cycle is longer than Hans (P<0.05).72 patients had regular uterine bleeding during compound Cyproterone Acetate and Metformin therapy their Hirsute and acne score decreased significantly (P<0.05). Serum estradiol (E2), luteinizing hormone (LH), follicle stimulating hormone (FSH), LH/FSH, Testosterone (T) and free androgen index (FAI) decreased significantly (P<0.05), while sex hormone binding globin (SHBG) increased significantly (P<0.05). Bilateral ovarian volumes shrunk and follicle numbers decreased significantly (P<0.05). Serum high density lipoprotein (HDL) increased significantly (P <0.05), Serum total cholesterol (TC) decreased significantly (P<0.05). Serum ISI decreased significantly (P<0.05).
Conclusion:1) The mainly distributes PCOS population is≤35 childbearing age Women; PCOS occurs constituent ratio for the overall, Uighur and Han were 7.57%, 6.93%,8.68%; 2) The main manifestations in Uighure PCOS patients were oligo-ovulatio、hyperandrogenism、hirsutism and obesity,Han's were LH/FSH> 2 and acne. Different races have different distribution hirsutism. 3) The main manifestations in 21 to 25 were oligo-ovulation and become shorter with ageing, In 18 to 25 hyperandrogenism and clinical signs of androgen were the main performance and sex hormone binding globulin (SHBG) decreased; polycystic ovary syndrome patients and PCOS patients of different ages F-G score decreased with aging, and Uighur patients' F-G score still higher than Han. This may be related to difference of the ethnic; 4) PCOS obese patients have metabolic changes, but there are some difference between Uighur and Han, The characteristic of Han patients performance in abdominal obesity and insulin resistance,Besides these Uighur's characterized by hyperlipidemia. 5) PCOS were relevant with patients with birth weight (BW), body mass index (BMI), family history of diabetes, family history of menstrual disorders and so on. 6) Obesity, especially abdominal obesity, lipid metabolism have relation with insulin resistance in PCOS patients. Hyperandrogenism and high LH have not relevant with insulin resistance; 7) adolescent obesity PCOS patients in the Uighur, Han have some differences between the clinical manifestations. Compound Cyproterone Acetate and Metformin may well improve the adolescents with polycystic ovary syndrome in patients with symptoms of androgen and the endocrine status, have a certain effect on the resumption of ovulation. The side effects were small.
临床上胰岛素抵抗虽然不是诊断多囊卵巢综合征的指标,但是,由于它引起的远期并发症对PCOS患者的危害严重影响患者的生活质量,因此,对于PCOS患者,要重视寻找胰岛素抵抗的征象如：黑棘皮征、腹型肥胖、高血压等,注意PCOS患者家族中2型糖尿病和高血压病等代谢性疾病史。
目前对PCOS的治疗没有统一的方案。强调根据不同的年龄阶段治疗目标的不同的个性化治疗；治疗的重点不仅要改善患者高雄激素血症所致的多毛、痤疮和不孕,还要重视由于胰岛素抵抗所致的远期并发症的防治。根据患者不同阶段的治疗目的制定不同的治疗方案。把针对减轻体重和保持足够的运动等改变生活方式的治疗作为长期治疗的基础。治疗策略分为四个部分,其中的三部分是针对调整并规律月经、治疗多毛、痤疮和不孕症等的近期治疗或称为“急性治疗”,这一部分的治疗可以随着不同年龄时期患者的需求不同进行改变；非常重要的远期治疗即“长期治疗”是指对胰岛素抵抗引起的远期并发症的治疗。
PCOS发病机制仍不明确,很多研究认为PCOS可能是一种多基因遗传病,其发生可能是遗传因素和环境因素交互作用的结果。新疆地区是一个多民族聚集的地区,目前缺乏相关疾病的研究,由于维吾尔族和汉族在生活习惯、饮食习惯、生活地域等方面存在差异。因此,我们希望通过调查和分析PCOS在维吾尔族、汉族不同种族中的临床表型的差异,为进一步研究该病的发病机制的提供线索；通过采用干预措施观察维吾尔族、汉族PCOS患者的临床表现及血清激素水平、生化指标的变化在不同种族间的差别,为疾病的治疗提供理论依据。
目的：1)通过问卷调查获取新疆部分地区维吾尔族、汉族多囊卵巢综合征患者的发病分布情况,高发人群年龄段,为进一步研究不同民族PCOS病人发病情况差异的奠定基础。2)根据鹿特丹专家会议诊断标准,分析维吾尔族、汉族PCOS组患者之间临床、内分泌及代谢特征的差别；同时评估随年龄变化各项特征变化的趋势。3)调查环境因素及遗传因素对PCOS发病的可能作用。4)比较维吾尔族、汉族肥胖PCOS患者的糖、脂代谢差异,为进一步探讨维吾尔族、汉族PCOS患者的发病机制奠定基础。5)分析PCOS患者内分泌、代谢特征与胰岛素抵抗的相关关系；6)分析维吾尔族、汉族肥胖青春期多囊卵巢综合征的临床特点及用复方醋酸环丙孕酮及二甲双胍治疗的疗效和安全性。
方法：本研究第一部分：1)按照2003年鹿特丹专家会议进行PCOS的诊断,抽取新疆部分地区的3010名育龄期妇女为调查对象,检查出PCOS患者,与同期进行调查的正常妇女按照1：1配对,选出对照组。获取PCOS发生的分布情况；2)比较所检出的维吾尔族、汉族PCOS患者临床表现的不同；3)按照年龄分组,分析维吾尔族、汉族PCOS患者月经周期,与临床高雄激素有关指标的差别并评估随年龄变化临床特征的变化趋势；4)比较维吾尔族、汉族肥胖和非肥胖PCOS患者的胰岛素抵抗(IR)、糖、脂代谢在不同民族之间的差异及特征；5)调查PCOS患者家族中糖尿病(DM)及女性月经失调、家族中男性秃顶(NA)的患病情况、PCOS患者出生体重(BW)、饮食习惯、运动习惯等与PCOS发病的关系；6)本研究第二部分对2008年4月至2009年9月在新疆医科大学妇科门诊就诊的166例PCOS患者,年龄为18～45岁,平均(24.44±6.89)岁,测定血清性激素水平、性激素结合球蛋白(SHBG)、口服糖耐量试验(OGTT)、血清胰岛素释放试验(IRT)、血脂检查、测量其身高、体重,计算体重指数(BMI),测量臀围、腰围,计算臀围比(WHR)、计算游离睾酮指数(FAI)；测定空腹胰岛素(FNS)、空腹血糖(FBG),计算胰岛素抵抗指数(HOMA-IR);胰岛素敏感指数(ISI)；根据这些指标不同的组合分析各指标与PCOS患者胰岛素抵发生的相关性；7)本研究的第三部分对105例肥胖青春期多囊卵巢综合征患者,其中维吾尔族45例,汉族60例,分析维吾尔族、汉族青春期肥胖PCOS患者临床特征及用复方醋酸环丙孕酮、二甲双胍治疗6个周期前、后,临床特征、血清性激素水平、卵巢超声检查的变化情况以及用药的安全性,同时观察停药后的相应临床症状及体征的变化。
结果：第一部分：1)本调查共发出问卷3010份调查问卷,收回有效问卷2867份,反馈率为95.25%。共诊断PCOS患者217例(汉族126例,维吾尔族91例),PCOS发生构成比在总体为7.57%,汉族为6.93%,维吾尔族为8.68%;平均年龄(25.44±5.35)岁；所有患者按年龄分为6个年龄组,年龄≤35岁者占94.01%(204/217),汉族患者117例,占92.86%(117/126)；维吾尔族患者87例占95.60%(87/91)；2)调查的PCOS患者临床症状维吾尔族、汉族的差异为：维吾尔族患者以月经稀发、高雄激素血症、多毛、肥胖为主要表现；汉族以黄体生成素/促卵泡素(LH/FSH)>2、痤疮为主要表现。且不同种族的多毛特征有所不同：维吾尔族PCOS患者多毛以腹正中线,性毛(阴毛和腋毛)浓密、增粗为主,尤其是阴毛分布呈男性型,甚至下延及肛周,上及腹股沟或腹中线,而汉族PCOS患者的多毛分布于面部口周、乳周、下颌、腹正中线处的少量(通常为3-10根不等)长、粗毛为主。具体指标为：月经稀发占79.72%(173/217),其中汉族占76.98%(97/126),维吾尔族占83.52%(76/91)(P<0.05)；超声检查卵巢内卵泡呈多囊表现维吾尔族、汉族无差异;高雄激素表现占58.99%(128/217),其中汉族占45.24%(57/126)维吾尔族占78.02%(71/91)(P<0.05)；本调查PCOS组F-G评分大于6分者57例占26.27%(57/217),46例为维吾尔族占50.55%(46/91),11例为汉族占8.73%(11/126)(P<0.05)；F-G评分大于2分者占71例占32.72%(71/217),其中汉族为22例占17.46%(22/126),维吾尔族为49例占53.85%(49/91)(P<0.05)。PCOS患者的临床高雄激素征象中,有痤疮的PCOS患者67例,占30.88%(67/217),其中汉族占36.51%(46/126),维吾尔族占23.08%(21/91)(P<0.05)。本组患者自青春期即出现痤疮至进行本调查时痤疮持续出现的患者67例,痤疮持续出现率为30.88%(67/217)；曾出现痤疮经过治疗的患者52例,至进行本调查时痤疮已消失的患者15例。此外,调查发现PCOS组平均BMI (23.12±3.26) (kg/m2),肥胖[BMI≥25(kg/m2)]占33.18%(72/217),其中汉族占24.60%(31/126),维吾尔族占45.05%(41/91) (P<0.05); LH/FSH>2者占(108/217)49.77%,其中汉族占53.97%(68/126),维吾尔族占43.95%(40/91)(P<0.05)。3)不同年龄段汉族、维吾尔族妇女月经周期、雄激素相关指标比较：汉族、维吾尔族对照组及PCOS组患者以21-25岁年龄段月经周期较其他各年龄长(P<0.05),随着年龄的增长,月经周期有缩短的趋势。对照组维吾尔族、汉族26～30岁年龄段较其他年龄段睾酮(T)高、性激素结合球蛋白(SHBG)低、游离雄激素指数(FAI)高(P<0.05)：维吾尔族组F-G评分较汉族组高(P<0.05)。维吾尔族、汉族PCOS组患者18～25岁年龄段与其他年龄段相比T、FAI高(P<0.05)；维吾尔族PCOS组患者F-G评分、T、FAI较汉族高(P<0.05)；而SHGB在维吾尔族、汉族在对照组间和病例组间无差异(P>0.05),PCOS病例组不论维吾尔族还是汉族组SHGB均低于对照组(P<0.05)。不同年龄段维吾尔族、汉族PCOS患者F-G分数随年龄增加而降低,但维吾尔族患者评分仍高于汉族(P<0.05)。维吾尔族对照组T较汉族高、SHGB低(P<0.05)；维吾尔族PCOS组比较雌二醇(E2)、LH、T、FAI较汉族PCOS组高(P<0.05),LH/FSH维吾尔族较汉族低(P<0.05); PCOS组和对照组比较维吾尔族、汉族E2、LH、LH/FSH、T、FAI PCOS组均较对照组高(P<0.05), SHBG较对照组低(P<0.05)。4)肥胖及非肥胖PCOS患者的性激素水平及代谢指标的比较：维吾尔族、汉族肥胖PCOS患者与非肥胖患者比较糖、脂代谢各项指标差异均有统计学意义(P<0.05)；汉族肥胖PCOS患者与对照组肥胖组比较,WHR、HOMA-IR较高,胰岛素敏感指数(ISI)较低(P<0.05)；不同的是维吾尔族肥胖PCOS患者与对照组肥胖组比较除了具有汉族患者的特征外其甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白(LDL)也较对照组高(P<0.05)；维吾尔族、汉族PCOS非肥胖组与对照组非肥胖组比较,WHR、HOMA-IR较高,ISI较低(P<0.05)。维吾尔族组PCOS患者BMI、WHR、HOMA-IR、TG、TC较汉族PCOS肥胖组高、ISI低(P<0.05)；汉族、维吾尔族PCOS患者卵巢体积均较对照组大、卵巢内平均小卵泡数均较对照组多(P<0.05)。5)PCOS患病的相关因素：出身体重(BW)、饮食习惯、BMI、家族中糖尿病(DM)及月经紊乱家族史等因素与PCOS患病相关(P<0.05),运动习惯及家族男性秃顶患病率与PCOS患病不相关(P>0.05)。BMI与BW成负相关(r=-1.371,P<0.05)
本研究第二部分结果表明：胰岛素抵抗组BMI、WHR、TG高于非胰岛素抵抗组(P<0.05)；LH水平低于非胰岛素抵抗组(P<0.05)；胰岛素抵抗组与非胰岛素抵抗组比较,各个时点血糖及胰岛素水平均有显著性差异(P<0.05)。肥胖组与非肥胖组比较,肥胖组年龄、HOMA-IR、TG高于非肥胖组(P<0.05)；LH水平低于于非肥胖组(P<0.05)；肥胖组OGTT各时点血糖水平及胰岛素水平高于非肥胖组(P<0.05)。高雄激素血症组WHR、LH、TC及LDL水平高于非高雄激素血症组(P<0.05)；高雄激素血症组与非高雄激素血症组比较,各时点血糖及胰岛素水平均无差异(P>0.05)。PCOS病人HOMA-IR与BMI呈显著正相关；HOMA-IR与腰围呈显著正相关；与TG水平存在正相关关系；与LH水平存在负相关关系,在去除了BMI的影响后,LH水平与HOMA-IR没有相关关系；与血TC、T水平没有相关关系；LH水平与BMI呈现负相关。
本研究第三部分结果表明：维吾尔族、汉族肥胖青春期PCOS患者的初潮年龄与正常女性相同。主要临床症状为闭经、月经稀发及月经不规律等月经异常。其中维吾尔族青春期肥胖患者出现闭经者较汉族多见(P<0.05)；体检发现多毛,维吾尔族患者多毛较汉族多见(P<0.05),多毛特征同第一部分所述。肥胖青春期维吾尔族PCOS以LH/FSH>2多见；痤疮则表现为汉族多于维吾尔族(P<0.05)。月经周期维吾尔族组较汉族组长(P<0.05)。治疗后,72例PCOS患者恢复月经。多毛和痤疮评分明显下降(P<0.05)。血清各性激素水平均有明显下降,E2、LH、FSH、LH/FSH、T、FAI下降(P<0.05), SHBG增加(P<0.05)。双侧卵巢体积及双侧卵泡数目减少(P<0.05)。副反应轻微。
结论：1)本调查得出结果35岁以下的育龄妇女是PCOS患者的主要人群,PCOS发生构成比分别为整体、维吾尔族、汉族分别为7.57%、6.93%、8.68%；2)检出的PCOS患者的临床表现维吾尔族患者以月经稀发、高雄激素血症、多毛、肥胖为主要表现；汉族以LH/FSH>2.痤疮为主要表现。且不同种族的多毛特征有所不同。3)按照年龄将所检出的PCOS患者分组PCOS患者21-25岁年龄段者以的稀发排卵为主要表现,而随年龄增长有缩短趋势；18～25岁年龄段者岁以高雄激素血症及临床高雄激素体征为主要表现,而性激素结合球蛋白(SHBG)降低；不同年龄段维吾尔族、汉族PCOS患者F-G分数随年龄增加而降低,但维吾尔族患者评分仍高于同年龄组汉族组(P<0.05),提示维吾尔族患者的多毛表现可能与种族差异有关。4)PCOS肥胖患者存在糖代谢和脂肪代谢方面的改变,汉族患者以腹型肥胖和胰岛素抵抗为特征,而维吾尔族肥胖PCOS患者除了具有汉族的特征外还伴有血脂增高的表现。5)PCOS患者的出生体重(BW)、体重指数(BMI)、糖尿病家族史、月经紊乱家族史与PCOS的发病有关。6)肥胖尤其是腹型肥胖、脂代谢异常与PCOS患者的胰岛素抵抗有关。高雄激素血症及高LH血症与PCOS患者的胰岛素抵抗没有相关性。7)青春期肥胖PCOS患者在维吾尔族、汉族不同族别间临床表现有一定差异。复方醋酸环丙孕酮及二甲双胍可很好改善青春期多囊卵巢综合征患者的高雄激素症状及内分泌状况,对恢复排卵有一定疗效。副反应轻微。
Background:Polycystic ovarian syndrome (PCOS) is an extremely common disorder affecting 5%～10% of women of reproductive age. Despite being heterogeneous in nature, the hallmarks of the disease are hyperandrogenism and chronic anovulation. Nowdays much studies has been learned about the pathophysiology of PCOS from its neuroendocrine underpinnings to an evergrowing understanding of the link between obesity, insulin resistance (IR) and PCOS. Women affected by PCOS also show a higher risk of type 2 diabetes, dyslipidaemia, hypertension and cardiovascular diseases. Besides, Because of chronic anovulation there also show a higher risk of endometrial cancer.
When clinically evaluating a patient for the possibility of PCOS, it is also important to search for signs of IR. Upper-body obesity is a key component of the IR syndrome. Acanthosis nigricans on physical examination is a sign of IR. A personal or family history of type 2 diabetes mellitus or gestational diabetes mellitus, or the presence of hyertension should also be sought in the evaluation. Overall, the criteria for diagnosis of the IR syndrome in women should be evaluated in all patients.
Based on this current understanding of PCOS, it is important that the patient and medical provider approach management not only toward improving the often troublesome hirsutism and infertility but also toward the long-term risks associated with IR. Indeed, the management of the PCOS patient often will vary over time as the patient enters different stages of life with different goals. In contrast, because of the long-term health implications of IR, the importance of lifestyle modification toward weight management and maintaining adequate physical activity should be the one constant in the management of these patients. The medical management of PCOS can be broken down into four components, three of which are "acute" issues (control of irregular menses, treatment of hirsutism and management of infertility) and one that is more "chronic". This latter issue may be the most important but least remembered by patients and providers alike management of the IR syndrome. "Acute" issues that need management may changed, however, a continuous life-long management approach is important for the IR of PCOS.
The pathogenesis of PCOS is still not clear, many studies suggest that PCOS may be a polygenic disease, its occurrence may be the interaction of genetic and environmental factor. Xinjiang is a multiethnic gathering region lacking of related study on this diseases, There are a lot of difference between Uighurs and Han,such as living habits, eating habits, living area and so on. Therefore, The investigation and analysis the difference clinical phenotype of PCOS in the Uighurs and Han nationalities is very useful. It can provide some clues on further study on the pathogenesis of PCOS; Use some interventions to observe the difference in Uighur and Han on clinical performance, serum hormone levels, biochemical indicators may provide some theoretical basis on the clinical mangement of PCOS.
Objective: 1) To obtain the distribution incidence of PCOS patients and high risk age groups in child-bearing women by questionnaire between Uighur and Han in some areas of Xinjiang, for the further study on the reasons for differences between PCOS patients in different nationalities; 2) According to the diagnostic criteria of the Rotterdam meeting,To analysis the difference characteristics of clinical, endocrine and metabolic Uighur and Han nationnalities; evaluated the characteristics change with ageing; 3) To investigate the environmental factors and genetic factors on the pathogenesis of PCOS; 4) Compared the differences about glucose and lipid metabolic in Uighur, and Han obese PCOS patients, for the further study of the pathogenesis of PCOS; 5) Analysis of PCOS patients with endocrine, metabolic characteristics and the correlation with insulin resistance; 6) To investigate the clinical feature and treatments of the puberty polycystic ovary syndrome (PCOS) in obesity, To study the efficacy and safety of compound Cyproterone Acetate and Metformin in the treatment of the puberty PCOS between the Uighurs and Hans.
Method:Part I:1) 3010 childbearing age women in the survey, Check out the PCOS patients from them, 1:1 matched with normal women as control group at the same time. To find the distribution characters of PCOS; 2) To compare the different clinical manifestations of PCOS patients in Uighur and Han; 3) Analysis the diffence about the menstrual cycle、clinical hyperandrogenism in Uighur and Han and find out the changes with ageing; 4) To compare the differences characteristics in Uighur and Han with or without obese in PCOS patients with obesity, insulin resistance (IR), glucose and lipid metabolism's disorders; 5) To investigate the family history of diabetes (DM) and menstrual disorders, alopecia (NA) in patients with PCOS, PCOS patients with birth weight (BW), eating habits, exercise habits and to find out the relationship with PCOS; 6) Part II:166 cases came from outpatient department. The age was 18～45 years old, the mean age was (24.44±6.89) years old, A fasting blood sample was drawn on day five of menstrual cycle from each subjects. To detect sex hormone, hormone binding globulin (SHBG), oral glucose tolerance test (OGTT), Insulin releasing test (IRT). Use these combinations to evaluate the relation between PCOS and insulin resistance; 7) Part III: 105 patients (including the Uighur 45 patients and Han 60 patients) were proved the puberty PCOS in obesity were examed and received compound Cyproterone Acetate and Metformin for 6 cycles. Serum sex hormone, transvaginal pelvic ultrasonography, the clinical feature were determined before and after 6 cycles treatment. To observe the effective and safety on the clinical management.
Result: Part I:1) 3010 survey questionnaires were issued,2867 questionnaires were recovered. The response rate were 95.25%.217 cases PCOS patients were diagnosed (126 cases of Han,91 cases of Uighur). The total PCOS diagnosed rate were 7.57%,6.93%and 8.68%in Uighur and Han respectively. The average age of 217 patients were (25.44±5.35) years old; All the patients were divided into 6 groups, The mainly distributes PCOS population is≤35 childbearing age Women, that was 94.01% in all, and 92.86%,95.60% in Han and Uighur respectively; 2) To investigate the difference of clinical symptoms of PCOS patients with Uighur and Han:The main manifestations in Uighure PCOS patients were oligo-ovulation, hyperandrogenism、hirsutism and obesity, The main performance of Han were LH/FSH>2 and acne. And the different races have different characteristics in distribution of hirsutism:hirsutism in Uighur PCOS patients showed that the hair were more in abdominal midline, pubic and armpit hair, in particularly, Showed a male pattern of pubic hair distribution, even extended to perianal and inguinal or ventral midline, while the Han Chinese patients with PCOS showed in face, surrounding of brest、lower jaw and ventral midline at a small amount of long and thickening hair (ranging from 3 to 10). The rate of oligo-ovulation were:in all 79.72%, in Han 76.98%, in Uighur 83.52%(P<0.05); ultrasound examination showed no difference in polycystic ovarian follicle performance in Uighur and Han; The rate of hyperandrogenism were:in all 58.99%,in Han 45.24%, in Uighur 78.02%(P<0.05); In this survey PCOS patients' F-G score more than 6 points the rate were:26.27% in all,50.55% in Uighur,8.73% in Han; F-G score more than 2 points the rate were:32.72% in all,53.85% in Uighur,17.46% in Han; Other specific PCOS clinical signs of hyperandrogenism is acne, PCOS patients had acne were: 30.88% in all, 36.51% in Han,23.08% in Uighurs (P<0.05). This group of patients the acne appears since puberty to be persistent till our survery. In this investigation the rate was 30.88%,52 cases of acne had been treated. 15 cases have disappeared. The average BMI were (23.12±3.26) (kg/m2) in PCOS patients, obese [BMI≥25 (kg/m2)] were 33.18% in all, 24.60% in Han Chinese, 45.05% in Uighur (P<0.05); LH/FSH>2 were 49.77% in all, 53.97% of them were Han,43.95% in Uighur (P<0.05).3) Compared with Uighur and Han patients aged 21 to 25, their menstrual cycles were longer than the other groups,the differences were statistically significant (P<0.05), The menstrual cycle shortening with ageing. In the Han and Uighur control group age between 26 to 30 years old, T high, SHBG lower, FAI higher than other age, the difference has statistically significant (P< 0.05), Uighur group F-G score higher than the Han group (P<0.05). Compared with other age patients between 18 to 25 years old, T, FAI were higher (P<0.05); Uighur PCOS patients' F-G score, T, FAI were higher than Han (P<0.05); and SHGB in the Uighur, Han was no significant difference between them (P>0.05). PCOS patients'high F-G score decreased with ageing; In Uighur PCOS groups'E2, LH, T, FAI higher than the Han, LH/FSH were lower, the difference were statistically significant (P<0.05). Compared with PCOS and control group, E2, LH, LH/FSH, T, FAI were higher, SHBG were lower than control group (P<0.05); 4) Compared with obese and non-obese PCOS patients of metabolism in Han and Uiger, metabolism indicators were significant differences (P<0.05); Compared with the control obese group, WHR, FNS, HOMA-IR were higher and ISI lower than control group (P<0.05), but in Uigers their have the same characteristic with Hans,Besides the TG, TC, LDL were higher than control groups. In non-obese group the PCOS patients WHR, FNS, FBG, HOMA-IR were higher, ISI lower than control group (P<0.05). Compared difference of PCOS on ovarian volume, number of small ovarian follicles were larger and more than control group (P<0.05). 5) BW, dietary habits, BMI, diabetes (Diabetes mellitus, DM) and menstrual disorders as family history have relation with PCOS (P<0.05); There were no relation among PCOS and exercise habits, alopecia in family history. BMI was negatively correlated with BW (r=-1.371, P<0.05). Part II:The manifestation of metabolic syndrome in PCOS:In IR group BMI, WHR were higher (P<0.05); but in non-IR group LH was higher (P<0.05); Compare with non-IR group, each OGTT and insulin level were different in IR group (P <0.05). TG was higher in non-IR group (P<0.05), Compare with non-obesity group the age, TC HOMA-IR and LH were higher (P<0.05), each OGTT and insulin level were higher in obesity group (P<0.05), Compare with non-hyperandrogenic group WHR, LH were higher in hyperandrogenic group (P<0.05), each OGTT and insulin level have no change in non-hyperandrogenic group and hyperandrogenic group (P>0.05), but in hyperandro-genic group TC, LDL were higher (P<0.05). In PCOS HOMA-IR and BMI, waistine, TG, have positive correlation; And have negative correlation with LH, There were no correlation with TC and T. BMI have negative correlation with LH.
Part III:Compared with the normal women the menarche is as same as the puberty PCOS patients; but the major criterion is different. Hirsute in the Uighurs is much more than Hans (P<0.05). and acne is less than Hans (P<0.05). Menstrual cycle is longer than Hans (P<0.05).72 patients had regular uterine bleeding during compound Cyproterone Acetate and Metformin therapy their Hirsute and acne score decreased significantly (P<0.05). Serum estradiol (E2), luteinizing hormone (LH), follicle stimulating hormone (FSH), LH/FSH, Testosterone (T) and free androgen index (FAI) decreased significantly (P<0.05), while sex hormone binding globin (SHBG) increased significantly (P<0.05). Bilateral ovarian volumes shrunk and follicle numbers decreased significantly (P<0.05). Serum high density lipoprotein (HDL) increased significantly (P <0.05), Serum total cholesterol (TC) decreased significantly (P<0.05). Serum ISI decreased significantly (P<0.05).
Conclusion:1) The mainly distributes PCOS population is≤35 childbearing age Women; PCOS occurs constituent ratio for the overall, Uighur and Han were 7.57%, 6.93%,8.68%; 2) The main manifestations in Uighure PCOS patients were oligo-ovulatio、hyperandrogenism、hirsutism and obesity,Han's were LH/FSH> 2 and acne. Different races have different distribution hirsutism. 3) The main manifestations in 21 to 25 were oligo-ovulation and become shorter with ageing, In 18 to 25 hyperandrogenism and clinical signs of androgen were the main performance and sex hormone binding globulin (SHBG) decreased; polycystic ovary syndrome patients and PCOS patients of different ages F-G score decreased with aging, and Uighur patients' F-G score still higher than Han. This may be related to difference of the ethnic; 4) PCOS obese patients have metabolic changes, but there are some difference between Uighur and Han, The characteristic of Han patients performance in abdominal obesity and insulin resistance,Besides these Uighur's characterized by hyperlipidemia. 5) PCOS were relevant with patients with birth weight (BW), body mass index (BMI), family history of diabetes, family history of menstrual disorders and so on. 6) Obesity, especially abdominal obesity, lipid metabolism have relation with insulin resistance in PCOS patients. Hyperandrogenism and high LH have not relevant with insulin resistance; 7) adolescent obesity PCOS patients in the Uighur, Han have some differences between the clinical manifestations. Compound Cyproterone Acetate and Metformin may well improve the adolescents with polycystic ovary syndrome in patients with symptoms of androgen and the endocrine status, have a certain effect on the resumption of ovulation. The side effects were small.
引文
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