Bil Enes, Dilbaz Berna, Cirik Derya Akdag, Ozelci Runa, Ozkaya Enis, Dilbaz Serdar
Department of Reproductive Medicine and Infertility, Ankara Etlik Zubeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey.
J Obstet Gynaecol Res. 2016 Jul;42(7):837-43. doi: 10.1111/jog.12985. Epub 2016 Apr 13.
It is unknown which phenotype of polycystic ovary syndrome (PCOS) has a greater metabolic risk and how to detect this risk. The aim of this study was therefore to compare the incidence of metabolic syndrome (MetS) and metabolic risk profile (MRP) for different phenotypes.
A total of 100 consecutive newly diagnosed PCOS women in a tertiary referral hospital were recruited. Patients were classified into four phenotypes according to the Rotterdam criteria, on the presence of at least two of the three criteria hyperandrogenism (H), oligo/anovulation (O) and PCO appearance (P): phenotype A, H + O + P; phenotype B, H + O; phenotype C, H + P; phenotype D, O + P. Prevalence of MetS and MRP were compared among the four groups.
Based on Natural Cholesterol Education Program Adult Treatment Panel III diagnostic criteria, MetS prevalence was higher in phenotypes A and B (29.6% and 34.5%) compared with the other phenotypes (10.0% and 8.3%; P < 0.001). Although the prevalence of obesity was similar, the number of patients with homeostatic model assessment insulin resistance index (HOMA-IR) >3.8 was significantly higher in androgenic PCOS phenotypes. After logistic regression analysis, visceral adiposity index (VAI) was the only independent predictor of MetS in PCOS (P = 0.002). VAI was also significantly higher in phenotype B, when compared with the others (P < 0.01).
Phenotypes A and B had the highest risk of MetS among the four phenotypes, and VAI may be a predictor of metabolic risk in PCOS women.
多囊卵巢综合征（PCOS）的哪种表型具有更高的代谢风险以及如何检测这种风险尚不清楚。因此，本研究的目的是比较不同表型的代谢综合征（MetS）发病率和代谢风险谱（MRP）。
在一家三级转诊医院连续招募了100例新诊断的PCOS女性患者。根据鹿特丹标准，依据高雄激素血症（H）、稀发/无排卵（O）和多囊卵巢（P）这三个标准中至少具备两项将患者分为四种表型：A表型，H+O+P；B表型，H+O；C表型，H+P；D表型，O+P。比较四组中MetS和MRP的患病率。
根据美国国家胆固醇教育计划成人治疗小组第三次报告（NCEP ATP III）诊断标准，A表型和B表型的MetS患病率较高（分别为29.6%和34.5%），高于其他表型（分别为10.0%和8.3%；P<0.001）。尽管肥胖患病率相似，但雄激素性PCOS表型中稳态模型评估胰岛素抵抗指数（HOMA-IR）>3.8的患者数量显著更多。经逻辑回归分析后，内脏脂肪指数（VAI）是PCOS中MetS的唯一独立预测指标（P=0.002）。与其他表型相比，B表型的VAI也显著更高（P<0.01）。
在四种表型中，A表型和B表型的MetS风险最高，VAI可能是PCOS女性代谢风险的一个预测指标。
