Reid Sara Pittenger, Kao Chia-Ning, Pasch Lauri, Shinkai Kanade, Cedars Marcelle I, Huddleston Heather G
Center for Reproductive Health, University of California at San Francisco, 2356 Sutter Street, San Francisco, 94115 CA USA.
Dermatology, University of California at San Francisco, 1701 Divisadero, San Francisco, 94115 CA USA.
Fertil Res Pract. 2017 May 30;3:8. doi: 10.1186/s40738-017-0035-z. eCollection 2017.
Polycystic ovary syndrome (PCOS) is a very common disorder well known to be associated with insulin resistance and metabolic disease. Insulin resistance is likely involved in the promotion of the PCOS reproductive phenotype and may mediate some of the ovarian morphology seen in the disorder. The phenotype of each individual woman with PCOS can vary widely as can her metabolic risk.
This is a cross-sectional study of patients seen in a multidisciplinary PCOS clinic at the University of California at San Francisco between 2006 and 2014. All participants underwent systematic evaluation with anthropometric measurements, comprehensive skin exam, transvaginal ultrasound and laboratory studies at the time of their initial visit to the clinic. Serum samples were stored and androgen studies were carried out on all stored samples at the University of Virginia. Logistic regression was employed to evaluate the association between ovarian volume or follicle number and metabolic parameters (fasting insulin, HOMA-IR, fasting glucose, 2 h glucose, waist circumference) and hyperandrogenism (free testosterone, total testosterone, DHEAS, acanthosis nigricans), controlling for age.
Three-hundred thirteen patients seen during the study period met Rotterdam criteria for PCOS and had sufficient measurements for inclusion in our analysis. The odds ratio of elevated HOMA-IR for patients with a maximum ovarian volume >10 cc was 1.9 compared to those with a maximum ovarian volume of ≤10 cc (95% CI 1.0-3.4). The odds ratio of abnormal fasting insulin for patients with higher ovarian volume was 1.8 (95% CI 1.0-3.4) compared with those with lower ovarian volume. Follicle number was not significantly associated with any metabolic parameters.
Increased ovarian volume is associated with markers of insulin resistance in PCOS. In concordance with prior studies, we did not find follicle number to be predictive of metabolic risk. Ovarian volume may serve as a useful tool to aid clinicians in their risk stratification and counseling of patients with PCOS.
多囊卵巢综合征（PCOS）是一种非常常见的疾病，众所周知与胰岛素抵抗和代谢性疾病有关。胰岛素抵抗可能参与了PCOS生殖表型的促进过程，并可能介导该疾病中所见的一些卵巢形态。每个患有PCOS的女性的表型差异很大，其代谢风险也是如此。
这是一项对2006年至2014年间在加利福尼亚大学旧金山分校多学科PCOS诊所就诊的患者进行的横断面研究。所有参与者在首次就诊时均接受了人体测量、全面的皮肤检查、经阴道超声检查和实验室检查等系统评估。血清样本被储存起来，并在弗吉尼亚大学对所有储存样本进行雄激素研究。采用逻辑回归评估卵巢体积或卵泡数量与代谢参数（空腹胰岛素、HOMA-IR、空腹血糖、2小时血糖、腰围）和高雄激素血症（游离睾酮、总睾酮、硫酸脱氢表雄酮、黑棘皮症）之间的关联，并对年龄进行校正。
研究期间就诊的313名患者符合PCOS的鹿特丹标准，并有足够的测量数据纳入我们的分析。最大卵巢体积>10 cc的患者与最大卵巢体积≤10 cc的患者相比，HOMA-IR升高的比值比为1.9（95%CI 1.0-3.4）。卵巢体积较大的患者与卵巢体积较小的患者相比，空腹胰岛素异常的比值比为1.8（95%CI 1.0-3.4）。卵泡数量与任何代谢参数均无显著关联。
PCOS患者卵巢体积增加与胰岛素抵抗标志物有关。与先前的研究一致，我们未发现卵泡数量可预测代谢风险。卵巢体积可能是帮助临床医生对PCOS患者进行风险分层和咨询的有用工具。
