Wang Ying, Mao Wen-wei, Chen Yong-jian, Li Mei-zhi, Qiao Jie, Wang Li-na
Reproductive Medical Center, Peking University Third Hospital, Beijing 100083, China.
Zhonghua Fu Chan Ke Za Zhi. 2007 Nov;42(11):756-60.
To study the relationship of abnormal family history in the first degree relatives and the clinical phenotype of patients with polycystic ovary syndrome (PCOS).
Clinical data of first degree relatives of 139 women with PCOS were collected by questionnaires, including body mass index (BMI), waist hip ratio (WHR), and hursutism score. Follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), testosterone (T), androstenedione (A), oral glucose tolerance test (OGTT) and insulin releasing test were measured.
(1) Compared with patients with a negative family history of diabetes mellitus, for women with a positive family history, WHR (0.99 +/- 0.10 vs 0.79 +/- 0.08) and score of hirsutism (1.9 +/- 1.2 vs 1.8 +/- 1.2) were increased, the duration of menstruation was longer [(108 +/- 10) vs (92 +/- 19) days]; A [(11 +/- 6) vs (8 +/- 5) nmol/L], homeostasis model assessment of insulin resistance (HOMA-IR, 3.5 +/- 2.0 vs 2.7 +/- 1.6), area under curve (AUC) glucose [(836 +/- 245) vs (748 +/- 139) nmol.L(-1).min(-1)], AUC insulin [(9670 +/- 4582) vs (7330 +/- 4311) mIU.L(-1).min(-1)], fasting glucose [(5.0 +/- 1.1) vs (4.8 +/- 0.5) mmol/L] and fasting insulin [(15 +/- 8) vs (11 +/- 8) mIU/L] were increased, while early insulin secretion function index (DeltaI60/DeltaG60, 32 +/- 22 vs 52 +/- 30), insulin sensitive index (ISI, 0.019 +/- 0.011 vs 0.033 +/- 0.014) and disposition index (DI, 18 +/- 10 vs 30 +/- 22; P < 0.05) were decreased. (2) For women with a positive family history of menstrual disorder, WHR and score of hirsutism (0.99 +/- 0.09 vs 0.80 +/- 0.10 and 1.9 +/- 1.0 vs 1.6 +/- 1.1) were increased respectively, the duration of menstruation [(105 +/- 28) vs (84 +/- 31) days] was longer, HOMA-IR (3.6 +/- 2.4 vs 2.5 +/- 1.7) and fasting insulin level [(15 +/- 14) vs (12 +/- 11) mIU/L] were increased, while HOMA-beta (178 +/- 134 vs 207 +/- 175), ISI (0.017 +/- 0.009 vs 0.033 +/- 0.012) and DI (23 +/- 18 vs 28 +/- 19, P < 0.05) were decreased. (3) For women with a positive family history of premature balding, BMI and the score of hirsutism [(26 +/- 4) vs (23 +/- 5) kg/m(2) and 2.1 +/- 1.1 vs 1.7 +/- 1.3] were increased respectively, while DI (20 +/- 11 vs 30 +/- 23, P < 0.05) was decreased. (4) DeltaI60/DeltaG60 (34 +/- 27 vs 50 +/- 30) was decreased and fasting insulin [FINS, (13 +/- 10) vs (10 +/- 9) mIU/L] was increased in PCOS women with a family history of hypertension (P < 0.05). (5) For women with or without a family history of coronary heart disease, they did not have any difference in every parameter mentioned before.
The family history of diabetes mellitus has the most effect on the clinical phenotype in women with PCOS. The family history of other diseases such as menstrual disorder, premature balding and hypertension play less significant roles. A family history of positive coronary heart disease does not affect the clinical phenotype of such patients.
研究多囊卵巢综合征(PCOS)患者一级亲属的异常家族史与临床表型之间的关系。
通过问卷调查收集139例PCOS女性患者一级亲属的临床资料,包括体重指数(BMI)、腰臀比(WHR)和多毛评分。检测促卵泡生成素(FSH)、促黄体生成素(LH)、催乳素(PRL)、睾酮(T)、雄烯二酮(A)、口服葡萄糖耐量试验(OGTT)和胰岛素释放试验。
(1)与糖尿病家族史阴性的患者相比,糖尿病家族史阳性的女性,WHR(0.99±0.10 vs 0.79±0.08)和多毛评分(1.9±1.2 vs 1.8±1.2)升高,月经持续时间更长[(108±10)vs(92±19)天];A[(11±6)vs(8±5)nmol/L]、胰岛素抵抗稳态模型评估(HOMA-IR,3.5±2.0 vs 2.7±1.6)、葡萄糖曲线下面积(AUC)[(836±245)vs(748±139)nmol·L⁻¹·min⁻¹]、AUC胰岛素[(9670±4582)vs(7330±4311)mIU·L⁻¹·min⁻¹]、空腹血糖[(5.0±1.1)vs(4.8±0.5)mmol/L]和空腹胰岛素[(15±8)vs(11±8)mIU/L]升高,而早期胰岛素分泌功能指数(DeltaI60/DeltaG60,32±22 vs 52±30)、胰岛素敏感指数(ISI,0.019±0.011 vs 0.033±0.014)和处置指数(DI,18±10 vs 30±22;P<0.05)降低。(2)月经紊乱家族史阳性的女性,WHR和多毛评分(0.99±0.09 vs 0.80±0.10和1.9±1.0 vs 1.6±1.1)分别升高,月经持续时间[(105±28)vs(84±31)天]更长,HOMA-IR(3.6±2.4 vs 2.5±1.7)和空腹胰岛素水平[(15±14)vs(12±11)mIU/L]升高,而HOMA-β(178±134 vs 207±175)、ISI(0.017±0.009 vs 0.033±0.012)和DI(23±18 vs 28±19,P<0.05)降低。(3)早秃家族史阳性的女性,BMI和多毛评分[(26±4)vs(23±5)kg/m²和2.1±1.1 vs 1.7±1.3]分别升高,而DI(20±11 vs 30±23,P<0.05)降低。(4)有高血压家族史的PCOS女性,DeltaI60/DeltaG60(34±27 vs 50±30)降低,空腹胰岛素[FINS,(13±10)vs(10±9)mIU/L]升高(P<0.05)。(5)有或无冠心病家族史的女性,上述提及的各项参数均无差异。
糖尿病家族史对PCOS女性的临床表型影响最大。月经紊乱、早秃和高血压等其他疾病的家族史作用较小。冠心病家族史阳性不影响此类患者的临床表型。