四种血清脂蛋白比值对多囊卵巢综合征患者发生代谢综合征的诊断预测价值

摘要

Objective To investigate and compare predictive diagnostic value of the low density lipoprotein-cholesterol( LDL-C)/high density lipoprotein-cholesterol( HDL-C) , apolipoprotein( Apo) B/ApoAI, triglyceride( TG)/HDL-C, total cholesterol( TC)/HDL-C ratios for metabolic syndrome(MS) in patients with polycystic ovary syndrome(PCOS). Methods A total of 441 patients with PCOS were included in this study, whose height, weight, waist circumference were measured. Fasting venous blood specimens were collected on their first to fifth day of menstrual cycle to measure their concentration of sex hormones and metabolic parameters. All patients were devided into two groups according to the international diabetes federation( IDF) diagnostic criteria:MS group and non-MS group. Differences between the two groups were compared, including age, blood pressure, BMI, waist circumference, waist-to hip circumference ratio, fasting glucose, fasting insulin, LDL-C, HDL-C, Lp( a) , triglyceride, total cholesterol etc. Correlations between the 4 ratios and parameters in MS diagnostic criteria mentioned above were analyzed respectively. The whole patients were divided into 6 groups by the number of abnormal component, from 0 component to 5 components. The mean values of 4 ratios were compared between 6 groups. The diagnostic value of 4 ratios were determined and compared by ROC curves. Results Mean values of the 4 serum lipoprotein ratio were increased as increase in the number of abnormal components, and all of the ratios were significantly correlated with parameters in MS criteria. TG/HDL-C obtained the highest area under the curve(AUC) of 0. 941 determined by ROC curves, suggesting that TG/HDL-C has the greatest diagnostic value of MS. The cutoff value of TG/HDL-C was set at 1. 089, with the sensitivity of 0. 864 and the specificity of 0. 891. Conclusion TG/HDL-C has the best diagnostic value for MS among 4 ratios. Patients with PCOS whose TG/HDL-C ratio is over 1. 089 should be informed about the risk of MS, and take medical intervention to prevent MS.%目的：研究并比较低密度脂蛋白胆固醇/高密度脂蛋白胆固醇( low density lipoprotein-cholesterol,LDL-C/high density lipoprotein-cholesterol,HDL-C)、载脂蛋白 B/载脂蛋白 AI ( apolipoprotein B, ApoB/ApoAI )、三酰甘油/高密度脂蛋白胆固醇(triglyceride,TG/HDL-C)、总胆固醇/高密度脂蛋白胆固醇(total cholesterol,TC/HDL-C)4种血清脂蛋白比值对多囊卵巢综合征(polycystic ovary syndrome,PCOS)患者发生代谢综合征(metabolic syndrome,MS)的诊断预测价值。方法选取2014年1月至2015年5月在首都医科大学附属北京妇产医院内分泌科就诊的PCOS患者441例,年龄15~44岁,空腹抽血查性激素、血糖、血脂、胰岛素等,按2005年国际糖尿病联盟的MS诊断标准比较MS组与非MS组在年龄、血压、体质量指数( body mass index, BMI)、腰围、腰臀比等指标的差异。分析LDL-C/HDL-C、ApoB/ApoAI、TG/HDL-C、TC/HDL-C比值与MS各组分的相关性。再根据MS诊断标准中的5个组分将441例患者分为0~5项异常组,分析各组4个比值的均值差异有无统计学意义。 ROC曲线确定4者诊断MS的临界值(cutoff),并比较4者对 PCOS患者发生 MS的诊断预测效果。结果 LDL-C/HDL-C、ApoB/ApoAI、TG/HDL-C、TC/HDL-C均值总体上随代谢综合征异常指标项数的增加而升高,且与代谢综合征各组分均明显相关。4个比值中以TG/HDL-C的 ROC曲线下面积最大为0.941。其cutoff值定为1.089时,诊断代谢综合征的灵敏度为0.864,特异度0.891,此时诊断代谢综合征的价值最大。结论 LDL-C/HDL-C、ApoB/ApoAI、TG/HDL-C、TC/HDL-C均值均随代谢综合征异常组分项数的增多而增加,且与MS各诊断指标相关,以TG/HDL-C对MS的诊断预测价值最大。临床上当TG/HDL-C≥1.089时,应警惕患者已经发生或即将发生MS,及时进行药物和生活方式的干预,避免或延缓MS的发生。