非痰湿型多囊卵巢综合征患者临床特征及生化水平相关分析
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摘要
目的:对非痰湿型多囊卵巢综合征(PCOS)患者进行临床特征与生化水平的基线及相关性分析,为临床防治提供依据。方法:对365例PCOS患者进行年龄、身高、体重、腰围、臀围及多毛、痤疮、黑棘皮评分的记录,并计算体重指数(BMI)和腰臀比(WHR)。于自然月经周期或孕激素撤退出血的第3～5天空腹采血,测定性激素及糖脂代谢水平。结果:(1)非痰湿型PCOS患者年龄分布主要集中在20～30岁,占总例数的70.41%。(2)365例非痰湿型PCOS患者,中心性肥胖发生率为34.25%,多毛的发生率为30.14%,痤疮的发生率为56.44%,黑棘皮的发生率为41.37%。(3)性激素水平基线分析中,LH/FSH>2发生率为41.37%;T高值水平者占35.62%,DHEAS水平升高者占4.65%,AND水平升高者占53.70%;SHBG水平降低者占总例数的27.95%;FINS水平升高者占44.38%,IR的发生率为42.47%,TG水平升高者占29.59%,TC水平升高者占12.88%,LDL水平升高者占36.44%,HDL水平降低者占4.66%。(4)相关性分析中,年龄与PRL呈负相关,与TG、TC、LDL、FPG、HOMA-IR呈正相关;BMI与TC呈正相关;WHR与T、TG、TC、LDL、FPG、FINS和HOMA-IR呈正相关,与SHBG、HDL水平呈负相关;痤疮评分与TC、FINS、HOMA-IR呈正相关,与FSH呈负相关;多毛评分与DHEAS、FINS、HOMA-IR呈正相关,与SHBG呈负相关;黑棘皮评分与LH、E2、T、TG、TC、LDL、FINS和HOMA-IR呈正相关,与FSH、SHBG、HDL呈负相关;T与TG、TC、LDL、FPG、FINS和HOMA-IR呈正相关;PRL与TC呈负相关;DHEAS与TG呈负相关;SHBG与HDL呈正相关,与TG、TC、LDL、FPG、FINS和HOMA-IR呈负相关。结论:对于体重指数正常的非痰湿型PCOS患者,虽尚未出现肥胖体征,但亦存在糖脂水平代谢异常,并且临床特征及生化水平方面存在一定的相关性,因此在临床中,应检测糖脂代谢水平,以更全面的治疗,预防疾病的进一步发展。
Objective:To analyze the baseline and correlation of clinical characteristics and biochemical levels in patients with non-phlegm-damp polycystic ovary syndrome(PCOS),and provide a evidence for clinical prevention and treatment. Methods:Recording age,height,weight,waist circumference,hip circumference,hairy,acne,and acanthosis nigricans score in 365 patients with PCOS,then calculating the body mass index(BMI)and the waist to hip ratio(WHR). Blood was collected from the 3-5 days of the natural menstrual cycle or the withdrawal of progesterone,and the level of sex hormones and glucose and lipid metabolism was measured. Results:(1)The age distribution of non-phlegm-damp PCOS patients was mainly 20-30 years old,accounting for 70.41% of the total number;(2)In 365 non-phlegm-damp PCOS patients,the incidence of central obesity was 34.25%,the incidence of hairy was 30.14%,the incidence of acne was 56.44%,the incidence of acanthosis nigricans was 41.37%;(3)In the baseline analysis of sex hormone levels,the incidence of LH/FSH > 2 was 41.37%,the high level of T was 35.62%,the high level of DHEAS was 4.65%,the high level of AND was 53.70%,the low level of SHBG was 27.95%,the high level of FINS was 44.38%,the incidence of IR was 42.47%,the high level of TG was 29.59%,the high level of TC was 12.88%,and the high level of LDL was 36.44% and 4.66% of HDL level decreased;(4)In correlation analysis,age was negatively correlated with PRL,and positive correlation with TG,TC,LDL,FPG and HOMA-IR;BMI was positively correlated with TC;WHR was positively correlated with T,TG,TC,LDL,FPG and HOMA-IR and negatively correlated with SHBG and HDL. Acne was positively correlated with TC,FINS and HOMA-IR,negatively correlated with E2. Hairy was positively correlated with DHEAS,FINS,HOMA-IR and negatively correlated with SHBG. acanthosis nigricans was positively correlated with LH,E2,T,TG,TC,LDL,FINS and HOMA-IR and negatively correlated with FSH,SHBG,HDL. T was positively correlated with TG,TC,LDL,FPG,FINS and HOMA-IR. PRL was negatively correlated with TC;DHEAS was negatively correlated with TG. SHBG was positively correlated with HDL,and negatively correlated with TG,TC,LDL,FPG,FINS and HOMA-IR. Conclusion:For the non-phlegmdamp PCOS patients with normal body mass index,although there is no obesity sign,there is also abnormal glucose and lipid metabolism,and there is a certain correlation between the clinical characteristics and the biochemical level. Therefore,in the treatment,the level of glycolipid metabolism should be detected so as to comprehensive treatment to prevent further development of disease.
Objective:To analyze the baseline and correlation of clinical characteristics and biochemical levels in patients with non-phlegm-damp polycystic ovary syndrome(PCOS),and provide a evidence for clinical prevention and treatment. Methods:Recording age,height,weight,waist circumference,hip circumference,hairy,acne,and acanthosis nigricans score in 365 patients with PCOS,then calculating the body mass index(BMI)and the waist to hip ratio(WHR). Blood was collected from the 3-5 days of the natural menstrual cycle or the withdrawal of progesterone,and the level of sex hormones and glucose and lipid metabolism was measured. Results:(1)The age distribution of non-phlegm-damp PCOS patients was mainly 20-30 years old,accounting for 70.41% of the total number;(2)In 365 non-phlegm-damp PCOS patients,the incidence of central obesity was 34.25%,the incidence of hairy was 30.14%,the incidence of acne was 56.44%,the incidence of acanthosis nigricans was 41.37%;(3)In the baseline analysis of sex hormone levels,the incidence of LH/FSH > 2 was 41.37%,the high level of T was 35.62%,the high level of DHEAS was 4.65%,the high level of AND was 53.70%,the low level of SHBG was 27.95%,the high level of FINS was 44.38%,the incidence of IR was 42.47%,the high level of TG was 29.59%,the high level of TC was 12.88%,and the high level of LDL was 36.44% and 4.66% of HDL level decreased;(4)In correlation analysis,age was negatively correlated with PRL,and positive correlation with TG,TC,LDL,FPG and HOMA-IR;BMI was positively correlated with TC;WHR was positively correlated with T,TG,TC,LDL,FPG and HOMA-IR and negatively correlated with SHBG and HDL. Acne was positively correlated with TC,FINS and HOMA-IR,negatively correlated with E2. Hairy was positively correlated with DHEAS,FINS,HOMA-IR and negatively correlated with SHBG. acanthosis nigricans was positively correlated with LH,E2,T,TG,TC,LDL,FINS and HOMA-IR and negatively correlated with FSH,SHBG,HDL. T was positively correlated with TG,TC,LDL,FPG,FINS and HOMA-IR. PRL was negatively correlated with TC;DHEAS was negatively correlated with TG. SHBG was positively correlated with HDL,and negatively correlated with TG,TC,LDL,FPG,FINS and HOMA-IR. Conclusion:For the non-phlegmdamp PCOS patients with normal body mass index,although there is no obesity sign,there is also abnormal glucose and lipid metabolism,and there is a certain correlation between the clinical characteristics and the biochemical level. Therefore,in the treatment,the level of glycolipid metabolism should be detected so as to comprehensive treatment to prevent further development of disease.
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].Human Reproduction,2013,28(9):2562.
[2]唐培培,谈勇.多囊卵巢综合征证型及证候要素分布规律的文献研究[J].江苏中医药,2017,49(1):66-68.
[3]李亚茜,俞超芹,翟东霞,等.基于文献多囊卵巢综合征中医证候规律研究初探[J].中国中医基础医学杂志,2015,21(9):1081-1082.
[4]LIANG S J,HSU C S,TZENG C R,et al.Clinical and biochemical presentation of polycystic ovary syndrome in women between the ages of 20 and 40[J].Human Reproduction,2015,26(12):3443-3449.
[5]余红英.不同年龄段多囊卵巢综合征患者胰岛素抵抗和糖脂代谢的临床分析[D].南昌:南昌大学,2016.
[6]张笑梅,朱燕波,邬宁茜,等.腹型肥胖和全身型肥胖与中医体质类型的关系[J].天津中医药,2014,31(10):603-607.
[7]夏翠翠.痰湿型与非痰湿型青春期多囊卵巢综合征临床及代谢特征分析[D].哈尔滨:黑龙江中医药大学,2015.
[8]邬宁茜.基于不同肥胖指标的肥胖与中医体质类型的关系[D].北京:北京中医药大学,2013.
[9]JI B,QU H,WANG H,et al.Association Between the Visceral Adiposity Index and Homeostatic Model Assessment of Insulin Resistance in Participants With Normal Waist Circumference[J].Angiology,2017,68(8):716.
[10]杨兴燕,邵孟佼,周琴,等.非糖尿病正常体质量人群的腰臀比与胰岛素抵抗的相关性[J].南方医科大学学报,2017,37(11):1540-1544.
[11]王颖,匡洪影,杨艳婷,等.性激素结合球蛋白与多囊卵巢综合征患者代谢综合征的相关性研究[J].医学研究杂志,2017,46(4):40-44.
[12]刘颖华,侯丽辉,徐芳,等.非痰湿型多囊卵巢综合征胰岛素抵抗患者的临床特征分析[J].中华中医药学刊,2016,34(3):589-591.
[2]唐培培,谈勇.多囊卵巢综合征证型及证候要素分布规律的文献研究[J].江苏中医药,2017,49(1):66-68.
[3]李亚茜,俞超芹,翟东霞,等.基于文献多囊卵巢综合征中医证候规律研究初探[J].中国中医基础医学杂志,2015,21(9):1081-1082.
[4]LIANG S J,HSU C S,TZENG C R,et al.Clinical and biochemical presentation of polycystic ovary syndrome in women between the ages of 20 and 40[J].Human Reproduction,2015,26(12):3443-3449.
[5]余红英.不同年龄段多囊卵巢综合征患者胰岛素抵抗和糖脂代谢的临床分析[D].南昌:南昌大学,2016.
[6]张笑梅,朱燕波,邬宁茜,等.腹型肥胖和全身型肥胖与中医体质类型的关系[J].天津中医药,2014,31(10):603-607.
[7]夏翠翠.痰湿型与非痰湿型青春期多囊卵巢综合征临床及代谢特征分析[D].哈尔滨:黑龙江中医药大学,2015.
[8]邬宁茜.基于不同肥胖指标的肥胖与中医体质类型的关系[D].北京:北京中医药大学,2013.
[9]JI B,QU H,WANG H,et al.Association Between the Visceral Adiposity Index and Homeostatic Model Assessment of Insulin Resistance in Participants With Normal Waist Circumference[J].Angiology,2017,68(8):716.
[10]杨兴燕,邵孟佼,周琴,等.非糖尿病正常体质量人群的腰臀比与胰岛素抵抗的相关性[J].南方医科大学学报,2017,37(11):1540-1544.
[11]王颖,匡洪影,杨艳婷,等.性激素结合球蛋白与多囊卵巢综合征患者代谢综合征的相关性研究[J].医学研究杂志,2017,46(4):40-44.
[12]刘颖华,侯丽辉,徐芳,等.非痰湿型多囊卵巢综合征胰岛素抵抗患者的临床特征分析[J].中华中医药学刊,2016,34(3):589-591.