不同高雄激素血症表型多囊卵巢综合征患者临床特征分析

摘要

目的:探讨不同高雄激素血症表型多囊卵巢综合征(PCOS)患者的临床、代谢特征及其意义.方法:回顾性分析2013年4月至2017年7月在黑龙江中医药大学附属第一医院门诊就诊的683例PCOS患者,根据血清雄烯二酮(AND)和睾酮(T)水平分为4个亚组:高AND伴高T组(A组);单纯高AND组(B组);单纯高T组(C组);非高T组(D组).另选取50例健康体检女性作为对照组(NC组).对5组受试者临床和生化指标进行特征性分析.结果:PCOS患者4个亚组的黑棘皮、痤疮和溢脂发生率、多毛评分、黄体生成激素(LH)、LH/血清卵泡刺激素(FSH)显著高于对照组(P＜0.05),伴高AND水平(A组和B组)的PCOS患者的游离雄激素指数(FAI)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)、低密度脂蛋白(LDL)、总胆固醇(TC)较对照组明显升高(P＜0.05),且伴高AND水平(A组和B组)的PCOS患者与非高T的PCOS患者(D组)相比LH、LH/FSH、性激素结合球蛋白(SHBG)、硫酸脱氢表雄酮(DHEAS)、FAI差异有统计学意义(P＜0.05).结论:PCOS患者合并高雄激素血症更易出现性激素异常、高胰岛素血症(HI)、胰岛素抵抗(IR)和脂代谢紊乱,且伴有高AND的患者激素水平异常和代谢紊乱更为严重,临床对血清AND的检测应予以重视.%Objective:To investigate the clinical and metabolic characteristics of PCOS patients with different phenotypes of hyperandrogenism.Methods:A retrospective analysis from April 2013 to July 2017 of 683 PCOS patients treated in our hospital,according to the serum AND and T levels were divided into 4 subgroups:high AND with high T group(group A);only high AND group (group B);only high T group (group C);non-hyperandrogenism group(group D).Fifty healthy women were selected as control group (group NC).The clinical and biochemical indexes of the five groups were analyzed.Results:Acanthosis,acne and incidence of seborrheic hirsutism score,LH、LH/FSH in the PCOS patients were significantly higher than the control group(P ＜ 0.05),patients with high AND(A,B group) showed higher levels of FAI,FINS,HOMA-IR,LDL,TC than the control group (P ＜0.05),and the level of LH 、LH/FSH、SHBG 、DHEAS、FAI in the PCOS patients with high AND(A,B group) were significantly different with the non-hyperandrogenism PCOS group (D group) (P ＜ 0.05).Conclusions:PCOS patients with hyperandrogenism are more likely to have reproductive hormone abnormalities,HI,IR and lipid metabolism.The hormone levels and abnormal metabolic disorder in patients with high AND is more serious.We should pay more attention to the detection of serum AND.