Szlendak-Sauer Katarzyna, Jakubik Daniel, Kunicki Michał, Skórska Jolanta, Smolarczyk Roman
Department of Gyneacological Endocrinology, Medical University of Warsaw, Ul. Karowa 2, 00-315 Warsaw, Poland.
Department of Gyneacological Endocrinology, Medical University of Warsaw, Ul. Karowa 2, 00-315 Warsaw, Poland; INVICTA Fertility and Reproductive Centre, 00-019 Warsaw, Poland.
Eur J Obstet Gynecol Reprod Biol. 2016 Aug;203:61-5. doi: 10.1016/j.ejogrb.2016.05.023. Epub 2016 May 20.
Autoimmune polyglandular syndrome type 3 - (APS-3), is defined as the coexistence of autoimmune thyroiditis with other non-ovarian autoimmune diseases without primary adrenal insufficiency. Additionally the definition of APS-3 also includes primary ovarian insufficiency (POI) coexistence with autoimmune thyroiditis. The main goal of that study is to assess the prevalence of APS-3 defined as coexistence of autoimmune thyroiditis with POI in population of 46 XX karyotype women with primary ovarian insufficiency (POI). The second goal is to investigate hormonal profile and insulin sensitivity in women with POI and subgroups of women with APS-3 - POI/APS-3(+) and without APS 3 - POI/APS-3(-).
Anthropometric measurements, coexistence of autoimmune diseases, androgens, fasting glucose and insulin, glucose and insulin at 60' and 120' of oral glucose tolerance test (OGTT) and homeostasis model for insulin resistance (HOMA-IR), were determine in 98 patients aged between 18 and 39 with spontaneous 46 XX primary ovarian insufficiency (POI), in 33 POI/APS-3(+), 65 POI/APS-3(-), and 75 healthy controls.
Continuous data were summarized by the mean±standard deviation (SD), and categorical data by number (percentages). Data were checked for normality using Shapiro-Wilk test, the comparison between groups were performed using non-parametric Mann-Whitney or Kruskall-Wallis test. Pearson's correlation coefficient was used to assess the relationships between parameters. Statistical significance was defined as p values <0.05. Autoimmune thyroid disease (ATD) was presented in 33/98 (33.7%) patients with POI. The groups did not differ significantly in respect to age and body mass index (BMI). Women with POI, POI/APS-3(+) and POI/APS-3(-) showed significantly lower serum androgens in comparison to controls. Additionally women with POI/APS-3(+) showed hyperinsulinemia after 1h of OGTT; No significant differences in serum fasting glucose, insulin and during 2h OGTT between groups were observed.
The prevalence of APS-3 is 33.7% in patients with spontaneous 46 XX primary ovarian insufficiency. Women with POI, POI/APS-3(+) and POI/APS-3(-) feature lower testosterone, androstendione, dehydroepiandrostendione sulphate in comparison to controls. Women with POI/APS-3(+) could have hyperinsulinemia and should be carefully evaluated for metabolic disorders.
3型自身免疫性多腺体综合征（APS - 3）定义为自身免疫性甲状腺炎与其他非卵巢自身免疫性疾病并存且无原发性肾上腺功能不全。此外，APS - 3的定义还包括原发性卵巢功能不全（POI）与自身免疫性甲状腺炎并存。该研究的主要目的是评估在46 XX核型的原发性卵巢功能不全（POI）女性人群中，定义为自身免疫性甲状腺炎与POI并存的APS - 3的患病率。第二个目的是研究POI女性以及APS - 3 - POI/APS - 3（+）和无APS 3 - POI/APS - 3（ - ）女性亚组的激素谱和胰岛素敏感性。
对98例年龄在18至39岁之间的46 XX自发原发性卵巢功能不全（POI）患者、33例POI/APS - 3（+）患者、65例POI/APS - 3（ - ）患者和75例健康对照者进行人体测量、自身免疫性疾病并存情况、雄激素、空腹血糖和胰岛素、口服葡萄糖耐量试验（OGTT）60分钟和120分钟时的血糖和胰岛素以及胰岛素抵抗稳态模型（HOMA - IR）测定。
连续数据用均值±标准差（SD）汇总，分类数据用数量（百分比）汇总。使用Shapiro - Wilk检验检查数据是否呈正态分布，组间比较采用非参数Mann - Whitney或Kruskall - Wallis检验。Pearson相关系数用于评估参数之间的关系。统计学显著性定义为p值<0.05。98例POI患者中有33例（33.7%）患有自身免疫性甲状腺疾病（ATD）。各组在年龄和体重指数（BMI）方面无显著差异。与对照组相比，POI、POI/APS - 3（+）和POI/APS - 3（ - ）女性的血清雄激素显著降低。此外，POI/APS - 3（+）女性在OGTT 1小时后出现高胰岛素血症；各组之间在血清空腹血糖、胰岛素以及OGTT 2小时期间未观察到显著差异。
在46 XX自发原发性卵巢功能不全患者中，APS - 3的患病率为33.7%。与对照组相比，POI、POI/APS - 3（+）和POI/APS - 3（ - ）女性的睾酮、雄烯二酮、硫酸脱氢表雄酮水平较低。POI/APS - 3（+）女性可能有高胰岛素血症，应仔细评估其代谢紊乱情况。
