Goverde A J, van Koert A J B, Eijkemans M J, Knauff E A H, Westerveld H E, Fauser B C J M, Broekmans F J
Department of Reproductive Medicine and Gynaecology, University Medical Centre, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
Hum Reprod. 2009 Mar;24(3):710-7. doi: 10.1093/humrep/den433. Epub 2008 Dec 17.
Polycystic ovary syndrome (PCOS) is associated with metabolic abnormalities. It is debated whether all women with PCOS should be screened for metabolic abnormalities as these may vary with PCOS phenotype, age and ethnicity. The aims of this study were to assess the prevalence of metabolic abnormalities in Dutch anovulatory PCOS women and to define criteria for metabolic screening.
Anovulatory patients, diagnosed with PCOS according to the Rotterdam consensus criteria, underwent metabolic screening. Through stepwise multivariate analysis patient characteristics associated with metabolic syndrome (MetS) and insulin resistance (IR) were evaluated for their use as selection parameters for metabolic screening.
Overall, prevalence of MetS and IR was 15.9% (n = 25) and 14% (n = 22), respectively, in 157 PCOS women (age 29.0 +/- 4.8 years, BMI 26.1 +/- 6.7 kg/m(2)). Anovulatory hyperandrogenic women (with or without polycystic ovaries) had more often MetS and IR (with, 20.8 and 19.8%; without, 100 and 40%, respectively) than non-hyperandrogenic PCOS women (0 and 1.8%; P < 0.001). Waist circumference >83.5 cm along with increased free androgen index (FAI) had the most powerful association with the presence of MetS and IR (area under the receiver operating characteristic curve 0.912) and offered a reduction in the necessity of screening for metabolic derailments of about 50%.
The hyperandrogenic PCOS phenotypes are highly linked to the presence of MetS and IR in Dutch PCOS women. Waist circumference combined with FAI was identified as an efficient combination test to select those PCOS women who should be screened for the presence of MetS and/or IR.
多囊卵巢综合征（PCOS）与代谢异常相关。对于是否应对所有PCOS女性进行代谢异常筛查存在争议，因为这些异常可能因PCOS表型、年龄和种族而异。本研究的目的是评估荷兰无排卵性PCOS女性中代谢异常的患病率，并确定代谢筛查的标准。
根据鹿特丹共识标准诊断为PCOS的无排卵患者接受代谢筛查。通过逐步多变量分析，评估与代谢综合征（MetS）和胰岛素抵抗（IR）相关的患者特征，以用作代谢筛查的选择参数。
总体而言，157例PCOS女性（年龄29.0±4.8岁，体重指数26.1±6.7kg/m²）中，MetS和IR的患病率分别为15.9%（n = 25）和14%（n = 22）。无排卵性高雄激素女性（有或无多囊卵巢）比非高雄激素PCOS女性更常出现MetS和IR（有，分别为20.8%和19.8%；无，分别为100%和40%）（非高雄激素PCOS女性为0和1.8%；P<0.001）。腰围>83.5cm以及游离雄激素指数（FAI）升高与MetS和IR的存在关联最为密切（受试者工作特征曲线下面积为0.9），并可将代谢紊乱筛查的必要性降低约50%。
在荷兰PCOS女性中，高雄激素PCOS表型与MetS和IR的存在高度相关。腰围与FAI相结合被确定为一种有效的联合检测方法，用于选择那些应筛查是否存在MetS和/或IR的PCOS女性。
