肥胖多囊卵巢综合征患者血脂异常的相关危险因素分析

目的比较肥胖多囊卵巢综合征(PCOS)与肥胖非PCOS患者血脂水平及体脂分布差异,探究肥胖PCOS患者脂代谢异常的特点及影响因素。方法回顾性分析2017年12月至2018年6月就诊于盛京医院内分泌科的86例门诊患者,其中56例肥胖PCOS患者为肥胖PCOS组,30例匹配年龄、体重指数(BMI)的肥胖非PCOS患者为肥胖非PCOS组。检测身高、体重、内脏脂肪面积、血脂、性激素、甲状腺功能、hsCRP、空腹血糖及胰岛素水平,比较两组患者的代谢相关指标及激素水平,并做指标间的相关性分析。结果肥胖PCOS组血浆总胆固醇(TC)、低密度脂蛋白(LDL)、载脂蛋白B(ApoB)、LH、FSH、LH/FSH、睾酮(T)、游离雄激素指数(FAI)高于肥胖非PCOS组,血清游离甲状腺素(FT4)低于肥胖非PCOS组,均有统计学差异(P<0.05)。T、FAI、LH、FSH与TC呈正相关,T、LH与LDL呈正相关,T与ApoB呈正相关(P均<0.05)。肥胖PCOS组内脏脂肪面积、BMI与腰围之间两两呈正相关,腰围、BMI均与胰岛素抵抗指数(HOMA-IR)、超敏C反应蛋白(hsCRP)呈正相关,内脏脂肪面积与T呈正相关,甘油三酯(TG)与FAI呈正相关,HDL与hsCRP呈负相关(P均<0.05)。结论肥胖PCOS患者血脂异常程度比普通肥胖患者更严重,血清TC、LDL、ApoB水平显著升高,高雄激素可能是导致血脂差异的重要原因之一。与肥胖相关的慢性炎症状态也在一定程度上引起脂代谢紊乱,可以通过减重有效缓解肥胖PCOS患者的血脂异常。

Correlated risk factors analysis of dyslipidemia in obese patients with polycystic ovary syndrome

Objective:To investigate the characteristics and influence factors of lipid metabolism abnormality in obese PCOS patients through comparing the differences of serum lipid level and body fat distribution between obese PCOS and obese non-PCOS patients.Methods:The data of 86 outpatients were retrospectively analyzed.The patients were divided to two groups:56 obese PCOS patients and 30 obese non-PCOS patients with matched age and BMI.The patients’height,body weight,visceral fat area,lipid,sex hormones,hsCRP,fasting blood glucose and insulin levels were tested.The metabolic related indexes and hormone levels were compared between the two groups,and the correlation among the indicators was analyzed.Results:TC,LDL,ApoB,LH,FSH,LH/FSH,T,FAI in the obese PCOS patients were significantly higher than those in the obese non-PCOS patients,while FT4 was significantly lower.(all P<0.05).T,FAI,LH,FSH were positively correlated with TC(P<0.05).T&LH were positively correlated with LDL(P<0.05).T was positively correlated with ApoB(P<0.05).In the obese PCOS patients,there was a positive correlation between visceral fat area&BMI and waist circumference(P<0.05).Waist circumference&BMI were positively correlated with HOMA-IR&hsCRP(P<0.05),and visceral fat area was positively correlated with T(P<0.05).TG was positively correlated with FAI(P<0.05),and HDL was negatively correlated with hsCRP(P<0.05).Conclusions:The degree of dyslipidemia in obese PCOS patients is more serious than that in normal obese patients.The levels of serum TC,LDL and ApoB were significantly increased,and hyperandrogen may be one of the important causes of blood lipid differences.The inflammatory state associated with obesity can also cause dyslipidemia.Weight loss may be an effective method to relieve the dyslipidemia in obese PCOS patients.