Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
Department of Internal Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
J Endocrinol Invest. 2017 Dec;40(12):1279-1288. doi: 10.1007/s40618-017-0708-9. Epub 2017 Jun 13.
Non-alcoholic fatty liver disease (NAFLD) is an insidious pathologic condition that can manifest from simple steatosis to steatohepatitis (NASH) with potential progression to cirrhosis. Like the polycystic ovary syndrome (PCOS), NAFLD is associated with obesity, diabetes mellitus, insulin resistance and metabolic syndrome. PCOS women have an increased risk of NAFLD, but it is debatable which features of PCOS, either specific (androgen excess) or unspecific (metabolic derangements) affect the NAFLD risk.
We performed a systematic review and meta-analysis of studies that addressed the association of PCOS and NAFLD. We selected 17 studies published between 2007 and 2017 that included 2734 PCOS patients and 2561 controls of similar age and body mass index (BMI).
PCOS patients have increased prevalence of NAFLD (odds ratio 2.54, 95% confidence interval 2.19-2.95). PCOS women with hyperandrogenism (classic phenotype) have a higher prevalence of NAFLD compared to women with PCOS without hyperandrogenism, even after correction for confounding variables. Among women with PCOS, those with NAFLD have higher serum total testosterone (mean difference 0.40 nmol/L, 95% CI 0.29-0.50 nmol/L) and free androgen index (mean difference 4.46, 95% CI 3.53-5.39) than those without NAFLD. The studies that used multivariate analysis controlling for age, BMI, triglycerides, and insulin resistance index confirmed that serum androgens are independent predictors of NAFLD in women with PCOS.
The prevalence of NAFLD is increased in women with PCOS and the presence of NAFLD is associated with high serum androgen levels, in addition to obesity and insulin resistance.
非酒精性脂肪性肝病（NAFLD）是一种隐匿性病理状态，可从单纯性脂肪变性发展为脂肪性肝炎（NASH），并可能进展为肝硬化。与多囊卵巢综合征（PCOS）一样，NAFLD与肥胖、糖尿病、胰岛素抵抗和代谢综合征有关。PCOS 女性患 NAFLD 的风险增加，但 PCOS 的哪些特征（特定的（雄激素过多）或非特定的（代谢紊乱））会影响 NAFLD 的风险尚存在争议。
我们对研究 PCOS 和 NAFLD 相关性的研究进行了系统回顾和荟萃分析。我们选择了 2007 年至 2017 年间发表的 17 项研究，其中包括 2734 名 PCOS 患者和 2561 名年龄和体重指数（BMI）相似的对照组。
PCOS 患者 NAFLD 的患病率增加（比值比 2.54，95%置信区间 2.19-2.95）。与无高雄激素血症的 PCOS 女性相比，具有高雄激素血症（经典表型）的 PCOS 女性 NAFLD 的患病率更高，即使在校正混杂变量后也是如此。在患有 PCOS 的女性中，患有 NAFLD 的女性血清总睾酮（平均差异 0.40 nmol/L，95%CI 0.29-0.50 nmol/L）和游离雄激素指数（平均差异 4.46，95%CI 3.53-5.39）均高于无 NAFLD 的女性。使用多元分析控制年龄、BMI、甘油三酯和胰岛素抵抗指数的研究证实，血清雄激素是 PCOS 女性 NAFLD 的独立预测因子。
PCOS 女性中 NAFLD 的患病率增加，并且存在 NAFLD 与高血清雄激素水平有关，此外还有肥胖和胰岛素抵抗。
