多囊卵巢综合征合并亚临床甲状腺功能减低患者胰岛素水平及血脂变化的研究

摘要

目的 探讨多囊卵巢综合征(PCOS)合并亚临床甲状腺功能减低(SCH)患者胰岛素水平及血脂的变化.方法 采用病例-对照的研究方法,收集2011年10月至2012年6月海军总医院生殖中心就诊的育龄期妇女,年龄在25～35周岁,选取PCOS合并SCH患者54例作为观察组,PCOS不伴有甲状腺疾病功能异常者52例作为对照组,分别测定体重、血压、静息心率、血脂,并进行糖耐量及胰岛素释放试验.采用独立样本t检验及相关分析评价PCOS合并SCH患者血脂及胰岛素变化情况. 结果 (1)PCOS合并SCH组静息心率、空腹胰岛素(FINS)高于PCOS组(P＜0.05),促甲状腺激素(TSH)、甘油三酯(TG)、餐后1h胰岛素(INS-1h)均显著高于PCOS组(P＜0.01)；(2)两组中按照体重指数(BMI)比较分析:PCOS+ SCH组中BMI≥23亚组与PCOS组BMI≥23亚组相比,心率明显增快,TSH与TG显著升高,INS-1h也有明显的升高.PCOS+ SCH组中BMI＜23亚组与PCOS组BMI＜23亚组相比,除TSH有显著升高外,其余指标无显著差异；(3)相关分析显示:TSH与TG、高密度脂蛋白(HDL)、FINS、INS-1h有相关性(r分别为0.360、-0.259、0.408、0.255,P均＜0.01). 结论 PCOS合并SCH患者可能存在更严重的血脂异常及胰岛素水平的改变,TG水平的升高、HDL及胰岛素水平的改变可能成为PCOS合并SCH患者的独立危险因素.%Objective:To investigate the changes of lipid and insulin levels in patients with polycystic ovary syndrome (PCOS)and subclinical hypothyroidism(SCH). Methods: There were 54 patients with PCOS plus SCH as investigation group and 52 women with PCOS as control group in the study. All patients were obtained from Reproductive Medical Center,Navy General Hospital from October 2011 to June 2012. The serum lipids levels, fasting blood glucose, blood glucose after meals,fasting insulin, insulin after meals, body weight, blood pressure and resting heart rate were measured in all the patients,and compared between the two groups. Independent-samples t-test and correlation analysis were used for the statistics analysis. Results: ( 1 ) The resting heart rate and fasting insulin levels in PCOS plus SCH group were significantly higher than those in PCOS group (P <0.05). The thyroid stimulating hormone (TSH), triglyceride(TG) .insulin levels 1 hour after meals in PCOS plus SCH group were significantly higher than those in PCOS group(P<0.01). (2)The resting heart rate,insulin levels 1 hour after meals,TSH and TG in body mass index(BMI)≥23 subgroup of PCOS plus SCH group were significantly higher than those in BMI ≥23 subgroup in PCOS group(P<0.05 or P<0.01). TSH in BMI <23 subgroup of PCOS plus SCH was significantly higher than that in BMI <23 subgroup in PCOS group (P<0.01), and the rest indicators had no difference. (3)TSH in PCOS plus SCH group was significantly correlated with TG,HDL, fasting insulin and insulin 1 hour after meals ( correlation coefficient: r =0.360,-0.259,0.408,0.255, respectively,all P<0.01).Conclusions: The patients with PCOS and subclinical hypothyroidism may have more severe dyslipidemia and significant change of insulin level. The TG, HDL and insulin levels may become independent risk factors for them.