Rizzo Manfredi, Berneis Kaspar, Hersberger Martin, Pepe Ilenia, Di Fede Gaetana, Rini Giovam Battista, Spinas Giatgen A, Carmina Enrico
Department of Internal Medicine and Emerging Diseases, University of Palermo, Via del Vespro, 141, 90127 Palermo, Italy.
Hum Reprod. 2009 Sep;24(9):2286-92. doi: 10.1093/humrep/dep121. Epub 2009 May 19.
Dyslipidemia is common in women with polycystic ovary syndrome (PCOS) but its prevalence in different PCOS phenotypes is still largely unknown.
We measured plasma lipids and lipoproteins in 35 anovulatory PCOS (age: 25 +/- 6 years, BMI: 28 +/- 6 kg/m(2)), 15 ovulatory PCOS (age: 30 +/- 6 years, BMI: 25 +/- 3 kg/m(2)) and 27 healthy women (controls) age- and BMI-matched with ovulatory PCOS. PCOS was diagnosed by the presence of clinical or biologic hyperandrogenism associated with chronic anovulation and/or polycystic ovaries at ultrasound. In women with normal menses chronic anovulation was indicated by low serum progesterone levels (<9.54 nmol/l) during midluteal phase (days 21-24) in two consecutive menstrual cycles.
Total cholesterol, triglycerides and low-density lipoprotein (LDL)-cholesterol levels increased and high-density lipoprotein (HDL)-cholesterol decreased from controls to ovulatory and then to anovulatory PCOS (all P < 0.05). Levels of lipoprotein(a) (Lp(a)) and small, dense LDL increased (P < 0.0001 for both) and LDL size reduced (P < 0.005) between groups. Insulin resistance (by HOMA) showed a positive correlation with triglycerides and small, dense LDL and an inverse correlation with HDL-cholesterol and LDL size (P < 0.05 for all) in both PCOS phenotypes. No significant correlations were found with testosterone levels. At multivariate analysis, insulin resistance was independently associated with HDL-cholesterol and small, dense LDL in both PCOS phenotypes and with triglyceride concentrations in ovulatory PCOS only.
Women with ovulatory PCOS showed milder forms of atherogenic dyslipidemia than anovulatory PCOS and this seemed to be related to the extent of insulin resistance. Future prospective studies are needed to assess the relative contribution of such alterations on cardiovascular risk.
血脂异常在多囊卵巢综合征（PCOS）女性中很常见，但其在不同PCOS表型中的患病率仍大多未知。
我们测量了35例无排卵型PCOS（年龄：25±6岁，体重指数：28±6kg/m²）、15例排卵型PCOS（年龄：30±6岁，体重指数：25±3kg/m²）以及27例年龄和体重指数与排卵型PCOS匹配的健康女性（对照组）的血浆脂质和脂蛋白。PCOS通过存在与慢性无排卵和/或超声检查发现的多囊卵巢相关的临床或生物学高雄激素血症来诊断。在月经周期正常的女性中，连续两个月经周期的黄体中期（第21 - 24天）血清孕酮水平低（<9.54nmol/l）表明存在慢性无排卵。
从对照组到排卵型PCOS再到无排卵型PCOS，总胆固醇、甘油三酯和低密度脂蛋白（LDL） - 胆固醇水平升高，高密度脂蛋白（HDL） - 胆固醇水平降低（所有P < 0.05）。各组间脂蛋白（a）（Lp（a））水平和小而密LDL增加（两者均P < 0.0001），LDL大小减小（P < 0.005）。在两种PCOS表型中，胰岛素抵抗（通过HOMA）与甘油三酯和小而密LDL呈正相关，与HDL - 胆固醇和LDL大小呈负相关（所有P < 0.05）。未发现与睾酮水平有显著相关性。在多变量分析中，胰岛素抵抗在两种PCOS表型中均与HDL - 胆固醇和小而密LDL独立相关，仅在排卵型PCOS中与甘油三酯浓度相关。
与无排卵型PCOS相比，排卵型PCOS女性的动脉粥样硬化性血脂异常形式较轻，这似乎与胰岛素抵抗程度有关。未来需要进行前瞻性研究以评估这些改变对心血管风险的相对贡献。
