多囊卵巢综合征中非酒精性脂肪肝患病情况及相关危险因素分析

目的研究宁夏汉族与少数民族多囊卵巢综合征(PCOS)患者中非酒精性脂肪肝(non-alcoholic fattyliver,NAFLD)患病情况及其发生相关因素。方法对2006年7月-2008年2月就诊我院生殖医学中心的137例血清病毒肝炎标志物阴性、无饮酒嗜好的PCOS患者,按肝脏B超分为非酒精性脂肪肝(NAFLD)与无脂肪肝组(N-NAFLD),比较组间各项临床、生化、代谢指标。结果 (1)PCOS患者中NAFLD发生率为34.31%;不同民族、婚育状况患者NAFLD发生率差异无统计学意义;肥胖患者NAFLD发生率62.96%(34/54)显著高于非肥胖患者15.6%(13/83),χ2=32.48,P<0.01。(2)NAFLD组年龄、不孕年限、BMI、睾酮、空腹胰岛素(FINS)、服糖2h胰岛素(2h-INS)、Homa-IR、甘油三酯(TG)、总胆固醇脂(CHOL)、谷丙、谷草转氨酶(AST、ALT)显著高于N-NAFLD组(t=3.49、2.54、6.81、3.27、4.483、.85、4.52、3.47、2.55、3.68、4.33,P<0.05);肥胖、肝功能异常、高睾酮血症、高TG、低HDL血症、空腹及服糖2h高胰岛素血症NAFLD组显著高于N-NAFLD组(χ2=32.48、25.051、0.70、19.68、8.91、20.47、14.23,P<0.01)。(3)NAFLD中肝功能异常者占31.91%(15/47),其年龄、睾酮、TG显著高于肝功能正常组(t=2.65、2.09、2.65,P<0.05)。结论 (1)PCOS患者NAFLD发生率34.31%;肥胖、胰岛素抵抗、高TG、高睾酮、高龄是PCOS患者发生NAFLD的危险因素;年龄增加、高睾酮、高TG与NAFLD病情进展有关。对所有PCOS包括未婚者,尤其是肥胖患者,均应注意肝脏B超检查,以便及早发现NAFLD,及时干预预防或延缓肝硬化的发生。

Prevalence of Non-alcoholic Fatty Liver Among Patients with Polycystic Ovary Syndrome

Objective To determine the prevalence and characteristics of non-alcoholic fatty liver(NAFLD) among patients with Polycystic ovary syndrome(PCOS)in Ningxia.Methods 137 PCOS patients that excluded alcohol consumption,viral liver disease and diagnosed by revised 2003 ESHRE/ASRM criteria were divided into groups with(NAFLD) and without fatty liver(N-NAFLD) based on abdominal liver ultrasound,.Clinical and metabolic characters were compared between groups.Results(1) Patients with PCOS showed a higher prevalence of NAFLD(34.31%(47/138) than patients without PCOS did.Prevalence of NAFLD showed no difference between Han and minor ethnic group,married and unmarried group.Prevalence was higher in obesity 62.96%(34/54)than that in non-obesity group15.6%(13/83)(χ2=32.48,P<0.01).(2)Compared to patients without NAFLD,NAFLD patients had significant higher age,infertility duration,BMI,triglycerides(TG),Total cholesterol(CHOL),fasting insulin(FINS),insulin level at 120th min after oral administration of 75g glucose(2h-INS),Homa-IR,Aspartate aminotransferase(AST),alanine aminotransferase(ALT) level(t=3.49,2.54,6.81,3.27,4.48,3.85,4.52,3.47,2.55,3.68,4.33;P<0.05)and higher prevalence of obesity,aminotransferases elevation,hyperandrogenism,hypertriglyceridemia,high FINS and 2h-INS(χ2=32.48,25.05,10.70,19.68,8.91,20.47,14.23;P<0.01).(3) 31.91 %(15/47)patients with NAFLD had aspartate and/or alanine aminotransferase elevations who had higher age,To,TG level(t =2.65,2.09,2.65;P<0.05) than patients with normal aminotransferases.Conclusion NAFLD prevalence in patient with PCOS is high.Obesity,insulin resistance,hypertriglyceridemia,hyperandrogenism and age are risk factors of NAFLD;age,hyperandrogenism and hypertriglyceridemia may related with the progress of NAFLD.Patients with PCOS should be screened for liver diseases at their earlier age,especially in patients with obesity.