Centre for Endocrinology, Diabetes, and Metabolism (M.W.O., A.E.T., B.A.H., R.K.C., P.M.S., J.W.T., W.A.), School of Clinical and Experimental Medicine, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom; Department of Nuclear Medicine (N.J.C.), University Hospitals Birmingham, Edgbaston, and National Institute of Health Research/Wellcome Trust Clinical Research Facility (F.C.), University Hospitals Birmingham National Health Service Foundation Trust, Birmingham B15 2TH, United Kingdom; and University of Leeds (P.M.S.), Leeds, LS2 9NL, United Kingdom.
J Clin Endocrinol Metab. 2014 Mar;99(3):1027-36. doi: 10.1210/jc.2013-3399. Epub 2014 Jan 1.
Polycystic ovary syndrome (PCOS) is a triad of anovulation, insulin resistance, and hyperandrogenism. Androgen excess may correlate with metabolic risk and PCOS consensus criteria define androgen excess on the basis of serum T. Here we studied the utility of the androgen precursor serum androstenedione (A) in conjunction with serum T for predicting metabolic dysfunction in PCOS.
Eighty-six PCOS patients fulfilling Rotterdam diagnostic consensus criteria and 43 age- and body mass index-matched controls underwent measurement of serum androgens by tandem mass spectrometry and an oral glucose tolerance test with homeostatic model assessment of insulin resistance and insulin sensitivity index calculation. We analyzed 24-hour urine androgen excretion by gas chromatography/mass spectrometry.
PCOS patients had higher levels of serum androgens and urinary androgen metabolites than controls (all P < .001). Within the PCOS cohort, both serum A and T were positively correlated with the free androgen index (T × 100/SHBG) and total androgen metabolite excretion (all P < .001). All subjects with T above the normal reference range [high T (HT)] also had high A (HA/HT group, n = 56). However, the remaining 30 patients had normal T levels, either in the presence of HA (HA/NT; n = 20) or normal A (NA/NT; n = 10). The groups did not differ in age or BMI. The HA/HT and HA/NT groups had higher total androgen excretion than NA/NT (P < .01 and P < .05, respectively). Multiple linear regression showed a strong negative association between serum androstenedione and insulin sensitivity. The incidence of dysglycemia according to an oral glucose tolerance test increased with the severity of androgen phenotype (NA/NT, 0%; HA/NT, 14%; HA/HT, 25%, P = .03).
Simultaneous measurement of serum T and A represents a useful tool for predicting metabolic risk in PCOS women. HA levels are a sensitive indicator of PCOS-related androgen excess.
多囊卵巢综合征（PCOS）是排卵障碍、胰岛素抵抗和高雄激素血症的三联征。高雄激素血症可能与代谢风险相关，而 PCOS 共识标准基于血清 T 定义高雄激素血症。本研究旨在研究雄激素前体血清雄烯二酮（A）与 T 联合检测在预测 PCOS 代谢功能障碍中的作用。
符合鹿特丹诊断共识标准的 86 例 PCOS 患者和 43 名年龄和体重指数匹配的对照组接受串联质谱法检测血清雄激素和口服葡萄糖耐量试验，同时计算稳态模型评估的胰岛素抵抗和胰岛素敏感指数。我们通过气相色谱/质谱法分析 24 小时尿雄激素排泄。
PCOS 患者的血清雄激素和尿雄激素代谢物水平均高于对照组（均 P<.001）。在 PCOS 队列中，血清 A 和 T 均与游离雄激素指数（T×100/SHBG）和总雄激素代谢物排泄呈正相关（均 P<.001）。所有 T 高于正常参考范围[高 T（HT）]的患者也存在高 A（HA/HT 组，n=56）。然而，其余 30 例患者 T 水平正常，要么存在 HA（HA/NT；n=20），要么 A 正常（NA/NT；n=10）。两组在年龄或 BMI 上无差异。HA/HT 和 HA/NT 组的总雄激素排泄量高于 NA/NT 组（P<.01 和 P<.05）。多元线性回归显示，血清雄烯二酮与胰岛素敏感性呈强烈负相关。根据口服葡萄糖耐量试验，血糖异常的发生率随雄激素表型的严重程度而增加（NA/NT，0%；HA/NT，14%；HA/HT，25%，P=.03）。
同时检测血清 T 和 A 是预测 PCOS 女性代谢风险的有用工具。HA 水平是 PCOS 相关高雄激素血症的敏感指标。
