Division of Endocrinology, Dept. of Internal Medicine, Centre for Applied Biomedical Research (C.R.B.A.), S. Orsola-Malpighi Hospital, University Alma Mater Studiorum of Bologna, Via Massarenti 9, 40138 Bologna, Italy.
Nutr Metab Cardiovasc Dis. 2009 Dec;19(11):797-804. doi: 10.1016/j.numecd.2009.01.007. Epub 2009 Apr 9.
The main objective was to evaluate the prevalence of the metabolic syndrome in Caucasian women with PCOS, using either of the currently proposed definitions (NCEP/ATPIII, IDF and AHA/NHLBI) and, therefore, to estimate the concordance between these three classifications. Secondary objectives were to evaluate: i) which individual criterion of the metabolic syndrome is most strongly associated with PCOS; and ii) whether the severity of hyperandrogenemia, hyperinsulinemia and insulin resistance may influence the presence of the metabolic syndrome in PCOS women.
The metabolic syndrome was assessed in 200 Caucasian women with PCOS and in 200 Caucasian controls, matched for age and BMI, considering the NCEP/ATPIII, IDF and AHA/NHLBI definitions. PCOS women had an increased prevalence of the metabolic syndrome compared with controls: 32 versus 23% with the NCEP/ATPIII, 39 versus 25% with the IDF and 37 versus 24% with the AHA/NHLBI, respectively (Cohen's Kappa index between the three classifications, P < 0.001). Multivariate logistic regressions revealed that among the individual criteria of the metabolic syndrome, only low HDL-cholesterol levels were significantly associated with PCOS (P < 0.001) which, in turn, are related to insulin(AUC) (P = 0.029) but not to androgens.
This case-control study indicates a high prevalence of the metabolic syndrome in Caucasian PCOS women that is independent of the diagnostic classification used. Furthermore, it shows that low HDL-cholesterol is the criterion which best explains the high prevalence of the metabolic syndrome in PCOS subjects which, in turn, is influenced by hyperinsulinemia, rather than by hyperandrogenemia.
本研究的主要目的是评估使用目前提出的三种定义（NCEP/ATPIII、IDF 和 AHA/NHLBI）评估患有 PCOS 的白种女性代谢综合征的患病率，并因此估计这三种分类之间的一致性。次要目的是评估：i）代谢综合征的哪个个体标准与 PCOS 相关性最强；ii）高雄激素血症、高胰岛素血症和胰岛素抵抗的严重程度是否会影响 PCOS 女性代谢综合征的存在。
评估了 200 名患有 PCOS 的白种女性和 200 名年龄和 BMI 匹配的白种对照组中代谢综合征的情况，考虑了 NCEP/ATPIII、IDF 和 AHA/NHLBI 定义。与对照组相比，PCOS 女性代谢综合征的患病率更高：NCEP/ATPIII 为 32%比 23%，IDF 为 39%比 25%，AHA/NHLBI 为 37%比 24%（三种分类之间的 Cohen's Kappa 指数，P < 0.001）。多变量逻辑回归显示，在代谢综合征的个体标准中，只有低 HDL 胆固醇水平与 PCOS 显著相关（P < 0.001），而这与胰岛素（AUC）相关（P = 0.029），但与雄激素无关。
这项病例对照研究表明，白种人 PCOS 女性代谢综合征的患病率很高，与使用的诊断分类无关。此外，它表明低 HDL 胆固醇是解释 PCOS 患者代谢综合征高患病率的最佳标准，而代谢综合征反过来又受高胰岛素血症影响，而不是高雄激素血症影响。
