多囊卵巢综合征患者的血脂代谢异常及与胰岛素抵抗的关系分析

目的:探讨多囊卵巢综合征(PCOS)患者血脂代谢异常及与胰岛素抵抗(IR)的关系,以期为血脂代谢异常PCOS患者的临床管理提供参考。方法:回顾性分析507例PCOS患者的临床资料,分析血脂代谢异常及其与腰臀比、体重指数(BMI)、IR指数、性激素水平等指标的相关关系。结果:PCOS患者IR的发生率为38.1%;与非IR的患者相比,伴有IR的患者具有较高的甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白(LDL)和较低的高密度脂蛋白(HDL)(1.83±1.19vs1.12±0.70mmol/L、5.23±1.06vs4.91±0.90mmol/L、3.25±0.98vs2.88±0.79mmol/L、1.41±0.40vs1.64±0.36mmol/L,P<0.001)。总体血脂异常的发生率为24.7%,IR组显著高于非IR组(39.9%vs15.3%,P<0.001);TG、TC、LDL水平与胰岛素稳态模型-IR指数(HOMA-IR)值呈正相关,HDL水平与HOMA-IR值呈负相关。在控制BMI的影响后,TG与HDL水平仍与HOMA-IR值呈显著相关性。总体上,随着HOMA-IR值的增大,血脂异常的发生率逐渐增加。结论:PCOS患者胰岛素抵抗和血脂异常的发生率均较高,血脂异常与胰岛素抵抗呈相关性,推测临床上使用胰岛素增敏剂可能通过改善IR进而改善PCOS患者的血脂代谢异常。

The Prevalence of Dyslipidemia in Women with Polycystic Ovary Syndrome and Its Relationship with Insulin Resistance

Objective:To investigate the prevalence of dyslipidemia in women with polycystic ovary syndrome(PCOS) and its relationship to insulin resistance(IR).Methods:A retrospective study was performed in 507 PCOS patients.Anthropometric indices of hormonal,adiposity,metabolic variables were measured,and their relationships were analyzed.Results:The prevalence of IR was 38.1% in our subjects.The mean fasting total triglyceride,LDL cholesterol and total cholesterol levels were found significantly higher(1.83±1.19 vs 1.12±0.70 mmol/L,5.23±1.06 vs.4.91±0.90 mmol/L,3.25±0.98 vs.2.88±0.79 mmol/L,P<0.001),and the mean HDL cholesterol level was significantly lower(1.41±0.40 vs 1.64±0.36 mmol/L,P<0.001) in IR group than in Non-IR group.The prevalence of dyslipidemia was 24.7% in PCOS patients,which was significantly higher in IR group than in NIR group(39.9% vs 15.3%,P<0.001).Homeostasis model assessment(HOMA) index was found positively correlated with TG,TC and LDL,but negatively correlated with HDL.TG and HDL level remained significantly correlated with HOMA even after adjustment of BMI.Generally,the prevalence of various patterns of dyslipidemia in PCOS patients increased with HOMA value together.Conclusions:Both of the prevalence of IR and dyslipidemia were found high in PCOS women in this study.Lipid abnormality was demonstrated to be associated with IR in PCOS women,which suggested that insulin sensitizer might ameliorate dyslipidemia through improving IR in PCOS women.