多囊卵巢综合征与血清脂联素水平相关性的病例对照研究

摘要

Objective To compare the difference of serum adiponectin levels between polycystic ovary syndrome (PCOS) patients and age, boby mass index (BMI) and insulin-resistance index matched controls, and explore its influence factors.Methods Case-control study, involving 97 women with PCOS and 116 age, BMI, fasting plasma glucose and insulin levels, homeostasis model assessment-insulin resistance index (HOMA-IR) matched controls.Hormone profiles, and serum adiponectin levels were measured and compared.Hormone profiles and serum adiponectin levels were compared among the four PCOS phenotypes.Multiple regression analysis was used to evaluate the factors affecting serum adiponectin levels.Results (1) Serum adiponectin level was significantly lower in PCOS group [(21 ± 16) mg/L] than controls [(25± 13) mg/L, P=0.038], and the same result in stratified analysis on weight height ratio (WHR, ≥0.8 and ＜0.8).(2) There was statistical differences in testosterone among different four PCOS phenotypes (P=0.001), there were no statistical differences in FSH, LH, WHR and serum adiponectin levels among four PCOS phenotypes (P＞0.05).(3) WHR and PCOS status were independent determinants of serum adiponectin levels (P＜0.05).Conclusions Low serum adiponectin levels in the women with PCOS is correlated with PCOS per se, independent of insulin resistance and obese.This fact supports the further study of the effect of adiponection in the pathophysiology of PCOS and its log-term impact.%目的 在均衡年龄、体质指数(BMI)、胰岛素抵抗(IR)影响的情况下,比较多囊卵巢综合征(PCOS)患者与健康对照妇女间血清脂联素水平的差异及其影响因素.方法 本研究为病例对照研究.于2011年1月至2012年4月在中山大学孙逸仙纪念医院,比较97例PCOS患者(PCOS组)与年龄、BMI、空腹血糖、空腹胰岛素、稳态模型评估法计算的胰岛素抵抗指数(HOMA-IR)均匹配的116例健康体检妇女(对照组)之间的性激素水平及血清脂联素水平,并比较PCOS组患者4个亚型间的性激素水平及血清脂联素水平.多元逐步回归分析筛选血清脂联素水平的影响因素.结果 (1)PCOS患者血清脂联素水平为(21±16) mg/L,显著低于对照组的(25±13) mg/L,两组比较,差异有统计学意义(P=0.038).以腰臀比≥0.8和＜0.8进行分层分析,PCOS组患者血清脂联素水平均低于对照组,WHR＜0.8时,PCOS组和对照组分别为(23±17)、(27±13) mg/L,两组比较,差异有统计学意义(P=0.040);WHR≥0.8时,PCOS组和对照组分别为(19±15)、(23±13) mg/L,两组比较,差异也有统计学意义(P=0.040).(2)PCOS组患者4个亚型的血清脂联素水平分别为(22±18)、(19±12)、(16±14)、(27±17) mg/L,4个亚型间血清联素水平无差异(P=0.114);不同PCOS亚型之间仅睾酮有差异(P=0.001),FSH、LH、腰臀比均无差异(P＞0.05).(3)多元逐步回归分析显示,腰臀比及PCOS状态是血清脂联素水平的独立影响因素(P＜0.05).结论 PCOS本身可使其患病女性呈现低水平血清脂联素状态,并且这种状态独立于其IR及肥胖,对脂联素在PCOS发病机制及其并发症发生中的作用值得进一步研究.