多囊卵巢综合征女性血脂异常的患病率及预测因素

Prevalence and predictors of dyslipidemia in women with polycystic ovary syndrome.

作者信息

Legro R S, Kunselman A R, Dunaif A

机构信息

Department of Obstetrics and Gynecology, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA.

出版信息

Am J Med. 2001 Dec 1;111(8):607-13. doi: 10.1016/s0002-9343(01)00948-2.

DOI:10.1016/s0002-9343(01)00948-2

PMID:11755503

Abstract

PURPOSE

Women with polycystic ovary syndrome are hyperandrogenemic and insulin resistant, which are associated with alterations in circulating lipid and lipoprotein levels. We sought to determine the prevalence of, and risk factors for, lipid abnormalities in these women.

SUBJECTS AND METHODS

Non-Hispanic white women with polycystic ovary syndrome (n = 195) and ethnically matched control women (n = 62) had fasting blood obtained for hormone and lipid levels. Subjects were categorized by body mass index (nonobese <27 kg/m(2), obese > or =27 kg/m(2)), and analyses were adjusted for age.

RESULTS

Total cholesterol and low-density lipoprotein cholesterol (LDL-C) levels increased significantly in obese women with polycystic ovary syndrome (n = 153) compared with obese control women (n = 35; mean difference in total cholesterol level = 29 mg/dL; 95% confidence interval [CI]: 14 to 45 mg/dL; P <0.001; mean difference in LDL-C level = 16 mg/dL; 95% CI: 4 to 30 mg/dL; P = 0.006). Similarly, total cholesterol and LDL-C levels increased significantly in nonobese women with polycystic ovary syndrome (n = 42) compared with nonobese control women (n = 27; mean difference in total cholesterol = 32 mg/dL; 95% CI: 13 to 52 mg/dL; P <0.001; mean difference in LDL-C level = 32 mg/dL; 95% CI: 15 to 52 mg/dL; P <0.001). In obese women, high-density lipoprotein cholesterol (HDL-C) and triglyceride levels increased significantly in women with polycystic ovary syndrome compared with control women (mean difference in HDL-C level = 6 mg/dL; 95% CI: 2 to 12 mg/dL; P = 0.002; mean difference in triglyceride level = 34 mg/dL; 95% CI: 1 to 77 mg/dL; P = 0.04). Differences in LDL-C and HDL-C levels, but not triglyceride levels, remained significant after adjusting for alcohol intake, smoking, and exercise. Although age, body mass index, and polycystic ovary syndrome status were significant predictors of lipid levels, these factors accounted for no more than 25% of the variance.

CONCLUSIONS

In this large study of non-Hispanic white women, elevations in LDL-C levels were the predominant lipid abnormality in women with polycystic ovary syndrome, independent of obesity. The characteristic dyslipidemia of insulin resistance was absent. Indeed, obese women with polycystic ovary syndrome had relatively elevated HDL-C levels, which may confer some protection against cardiovascular disease.

摘要

目的

多囊卵巢综合征女性存在高雄激素血症和胰岛素抵抗，这与循环脂质和脂蛋白水平的改变有关。我们试图确定这些女性脂质异常的患病率及危险因素。

对象与方法

选取患有多囊卵巢综合征的非西班牙裔白人女性（n = 195）和种族匹配的对照女性（n = 62），采集空腹血以检测激素和脂质水平。根据体重指数对受试者进行分类（非肥胖者<27 kg/m²，肥胖者≥27 kg/m²），并对年龄进行分析调整。

结果

与肥胖对照女性（n = 35）相比，肥胖的多囊卵巢综合征女性（n = 153）的总胆固醇和低密度脂蛋白胆固醇（LDL-C）水平显著升高（总胆固醇水平的平均差异 = 29 mg/dL；95%置信区间[CI]：14至45 mg/dL；P<0.001；LDL-C水平的平均差异 = 16 mg/dL；95%CI：4至30 mg/dL；P = 0.006）。同样，与非肥胖对照女性（n = 27）相比，非肥胖的多囊卵巢综合征女性（n = 42）的总胆固醇和LDL-C水平也显著升高（总胆固醇的平均差异 = 32 mg/dL；95%CI：13至52 mg/dL；P<0.001；LDL-C水平的平均差异 = 32 mg/dL；95%CI：15至52 mg/dL；P<0.001）。在肥胖女性中，与对照女性相比，多囊卵巢综合征女性的高密度脂蛋白胆固醇（HDL-C）和甘油三酯水平显著升高（HDL-C水平的平均差异 = 6 mg/dL；95%CI：2至12 mg/dL；P = 0.002；甘油三酯水平的平均差异 = 34 mg/dL；95%CI：1至77 mg/dL；P = 0.04）。在调整酒精摄入、吸烟和运动因素后，LDL-C和HDL-C水平的差异仍然显著，但甘油三酯水平差异不显著。尽管年龄、体重指数和多囊卵巢综合征状态是脂质水平的重要预测因素，但这些因素解释的变异不超过25%。