青春期多囊卵巢综合征患者临床、内分泌代谢紊乱特征及诊断初探

目的 了解青春期多囊卵巢综合征患者的临床、内分泌代谢紊乱特征.方法 167例青春期PCOS患者为研究对象,其中肥胖型(OB-PCOS组)90例、非肥胖型(NOB-PCOS组)77例.325例月经正常的15～18岁女中学生为对照组,其中肥胖(OB-CON组)18例,非肥胖(NOB-CON组)307例.问卷调查月经史,并对进行临床体征评分及内分泌、代谢指标测定.结果 (1)正常青春期女性近95%在初潮2年内建立规律月经.对照组激素指标的第95百分位数为生理高限值:总睾酮2.77nmol/L,游离雄激素指数(FAI)4.64,黄体生成素(LH)16.1 IU/L,LH/卵泡刺激素(FSH)1.54,硫酸脱氢表雄酮(DHEA-S)11.02μmol/L;空腹胰岛素(FINS)和HOMA-IR的75%位点值为生理高限值分别是13.13和2.69 mIU/L;青春期PCOS患者月经初潮年龄(12.7岁)较对照组(13.1岁)提前,84.85%的患者未能在初潮后2年内建市规律月经.(2)青春期PCOS患者肥胖的发生率显著高于对照人群,P<0.01.(3)青春期PCOS患者的总睾酮、FAI、DHEA-S均显著高于对照人群,P<0.01;而OB-PCOS组的FAI显著高于NOB-PCOS组;78.44%患者雄激素水平超过正常值高限.(4)青春期PCOS患者FINS、HOMA-IR值均显著高于对照人群,P<0.01;OB-PCOS组空腹胰岛素、HOMA-IR及甘油三酯水平均显著高于NOB-PCOS组;患者中有53.19%FINS、47.52%HOMA-IR水平超过正常值高限.(5)PCOS组LH水平、LH/FSH比值均显著高于对照组:NOB-PCOS组的LH、LH/FSH比值显著高于OB-PCOS组.(6)95.21%的青春期PCOS患者卵巢超声影像多囊性改变符合鹿特丹共识的诊断标准.结论 青春期PCOS的基本特征为月经初潮提前并存在持续性的月经失调;循环中雄激素及空腹胰岛素水平高于正常青春期水平;普遍存在病理性胰岛素抵抗和卵巢多囊性增大;肥胖发生率增高且肥胖型PCOS病情较重;NOB-PCOS组中LH、LH/FSH升高更为明显.

Clinical features, reproductive endocrine and metabolic abnormalities of adolescent girls with polycystic ovary syndrome

Objective To investigate the clinical features,reproductive endocrine and metabolic abnormalities in adolescent girls with polycystic ovary syndrome (PCOS).Methods A total of 325 adolescent girls with normal menstruation,18 obese (OB-CON) and 307 non-abese (NOB-CON),were enrolled as controls from multiple middle schools in Shanghai,China.A total of 167 adolescent girls with PCOS,90 obese (OB-PCOS) and 77 non-obese (NOB-PCOS),were also recruited.All cases were evaluated for their clinical manifestations, reproductive endocrine and metabolic parameters.Hyperandrogenism was determined by serum testosterone (T),free androgen index (FAI) and dehydroepiandrosterone sulfate (DHEA-S).Insulin sensitivity was measured by fasting insulin (FINS) and homeostasis model assessment of insulin resistance (HOMA-IR).Results (1) Menarche Was significantly earlier in adolescent PCOS than in controls.The incidence of obesity Was significantly higher in adolescent PCOS than that in control group.(2) T,FAI and DHEA-S were significantly higher in adolescent PCOS group than those in control group.FAI Was higher in OB-PCOS group than in NOB-PCOS group.LH and LH/FSH were higher in PCOS groups than those in controls.LH and LH/FSH were also much higher in NOB-PCOS group than those in OB-PCOS group.(3) HOMA-IR and FINS were significantly higher in PCOS group than those in control group. Incidence of acanthosis nigricans,FINS,HOMA-IR and triglyceride were significantly higher in OB-PCOS group than those in NOB-PCOS group.(4) 95.21% PCOS girls presented with an ultrasonic morphological evidence of polycystic ovarian.Conclusion The essential features of adolescent PCOS are an earlier onset of menarche,a persistent menstrual disorder over 2 years after menarche,a higher incidence of obesity,marked hyperandrogenism and insulin resistance and disorderly gonadotropine secretion in comparison with control subjects.Hyperandrogenism and insulin resistance are much more severe in obese adolescent PCOS.