Chang Wendy Y, Knochenhauer Eric S, Bartolucci Alfred A, Azziz Ricardo
Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California at Los Angeles, California, USA.
Fertil Steril. 2005 Jun;83(6):1717-23. doi: 10.1016/j.fertnstert.2005.01.096.
We tested the hypothesis that the three clinical phenotypes of polycystic ovary syndrome (PCOS) represent forms of the same metabolic disorder.
Prospective cohort analysis.
University-based tertiary care.
PATIENT(S): Three-hundred sixteen untreated consecutive women diagnosed as having PCOS.
INTERVENTION(S): None.
MAIN OUTCOME MEASURE(S): Each subject underwent an evaluation of ovulatory function, body habitus, acne, and hirsutism; serum free and total testosterone (T), 17-hydroxyprogesterone (17-HP), and DHEAS; and fasting plasma glucose and insulin levels. Insulin resistance and beta-cell function were assessed using the homeostatic assessment model equation (HOMA-IR and HOMA-beta-cell, respectively).
RESULT(S): The Oligo+HA+Hirsutism phenotype was present in 48% of subjects, Oligo+HA in 29%, and Oligo+Hirsutism in 23%. The three phenotypes did not differ in mean body mass index, waist-to-hip ratio, racial composition, degree of oligo-ovulation, prevalence of acne, or family history of hyperandrogenic symptomatology. However, subjects demonstrating the Oligo+HA+Hirsutism phenotype were the youngest and had the greatest degrees of hyperandrogenemia, hyperinsulinemia, and beta-cell function; patients with the Oligo+Hirsutism phenotype where the oldest and had the mildest degrees of hyperandrogenemia, hyperinsulinemia, and beta-cell function. Subjects with the Oligo+HA phenotype demonstrated intermediate degrees of hyperandrogenemia and metabolic dysfunction.
CONCLUSION(S): We conclude that the three clinical phenotypes of PCOS do not represent forms of the same metabolic disorder and may be the result of varying degrees of metabolic dysfunction; greater degrees of beta-cell function and circulating insulin levels favored the development of hirsutism and frank hyperandrogenemia.
我们检验了多囊卵巢综合征（PCOS）的三种临床表型代表同一代谢紊乱形式的假设。
前瞻性队列分析。
基于大学的三级医疗保健机构。
316名未经治疗的连续确诊为PCOS的女性。
无。
每位受试者均接受排卵功能、体型、痤疮和多毛症评估；血清游离睾酮和总睾酮（T）、17-羟孕酮（17-HP）和硫酸脱氢表雄酮（DHEAS）；以及空腹血糖和胰岛素水平。使用稳态评估模型方程分别评估胰岛素抵抗和β细胞功能（分别为HOMA-IR和HOMA-β细胞）。
48%的受试者表现为少排卵+高雄激素血症+多毛症表型，29%为少排卵+高雄激素血症，23%为少排卵+多毛症。三种表型在平均体重指数、腰臀比、种族构成、少排卵程度、痤疮患病率或高雄激素症状家族史方面无差异。然而，表现为少排卵+高雄激素血症+多毛症表型的受试者最年轻，且高雄激素血症、高胰岛素血症和β细胞功能程度最高；少排卵+多毛症表型的患者年龄最大，高雄激素血症、高胰岛素血症和β细胞功能程度最轻。少排卵+高雄激素血症表型的受试者表现出中等程度的高雄激素血症和代谢功能障碍。
我们得出结论，PCOS的三种临床表型不代表同一代谢紊乱形式，可能是不同程度代谢功能障碍的结果；更高程度的β细胞功能和循环胰岛素水平有利于多毛症和明显高雄激素血症的发展。
