Li Li, Feng Qiong, Ye Ming, He Yaojuan, Yao Aling, Shi Kun
a Department of Gynecology and Obstetrics , Guangzhou Women and Children's Medical Center, Guangzhou Medical University , Guangzhou , China.
b Department of Biostatistics , Southern Medical University , Guangzhou , China.
J Obstet Gynaecol. 2017 Nov;37(8):1036-1047. doi: 10.1080/01443615.2017.1318840. Epub 2017 Jun 28.
This meta-analysis provides an updated and comprehensive estimate of the effects of obesity on metabolic disorders in adolescent polycystic ovary syndrome (PCOS). Relevant articles consistent with the search terms published up to 31 January 2014 were retrieved from PubMed, EMBASE, PsycINFO and CENTRAL. Thirteen articles (16 independent studies) conformed to the inclusion criteria. The evaluated outcomes were the metabolic parameters of obese adolescents with PCOS (case group) relative to normal-weight adolescents with PCOS, or obese adolescents without PCOS. Compared with normal-weight adolescents with PCOS, the case group had significantly lower sex hormone-binding globulin and high-density lipoprotein cholesterol, and significantly higher triglycerides, leptin, fasting insulin, low-density lipoprotein cholesterol and free testosterone levels. Relative to obese adolescents without PCOS, the case group had significantly higher fasting insulin, low-density lipoprotein cholesterol, free testosterone levels and 2-h glucose during the oral glucose tolerance test. These results indicate that metabolic disorders in adolescent PCOS are worsened by concomitant obesity. This study highlights the importance of preventing obesity during the management of adolescent PCOS. Impact statement What is already known about this subject: Obesity and PCOS share many of the same metabolic disorders, for example, hyperandrogenism and hyperinsulinemia with subsequent insulin resistance. Knowledge regarding metabolic features in obese adolescents with PCOS is limited, and there is concern whether obesity and PCOS are related. What do the results of this study add: Relative to PCOS adolescents of normal weight, obese adolescents with PCOS (the case group) had significantly lower SHBG and HDL-C, and significantly higher triglycerides, leptin, fasting insulin, LDL-C and free testosterone levels. The results indicate that metabolic disorders in adolescent PCOS are worsened by concomitant obesity. What are the implications of these findings for clinical practice and/or further research: Obesity, metabolic disorders and PCOS in adolescents are associated. Obesity exacerbates metabolic disorders in adolescent PCOS. This study highlights the importance of preventing obesity during the management of adolescent PCOS. Therapeutic intervention combined with lifestyle modification may provide better treatment for adolescent PCOS. The aetiologies of PCOS combined with obesity in adolescents require further investigation.
本荟萃分析对肥胖对青少年多囊卵巢综合征（PCOS）代谢紊乱的影响进行了更新且全面的评估。从PubMed、EMBASE、PsycINFO和CENTRAL中检索截至2014年1月31日发表的与检索词相符的相关文章。13篇文章（16项独立研究）符合纳入标准。评估的结果是患有PCOS的肥胖青少年（病例组）相对于体重正常的PCOS青少年或无PCOS的肥胖青少年的代谢参数。与体重正常的PCOS青少年相比，病例组的性激素结合球蛋白和高密度脂蛋白胆固醇显著降低，甘油三酯、瘦素、空腹胰岛素、低密度脂蛋白胆固醇和游离睾酮水平显著升高。相对于无PCOS的肥胖青少年，病例组的空腹胰岛素、低密度脂蛋白胆固醇、游离睾酮水平以及口服葡萄糖耐量试验期间的2小时血糖显著升高。这些结果表明，青少年PCOS中的代谢紊乱因合并肥胖而恶化。本研究强调了在青少年PCOS管理过程中预防肥胖的重要性。影响声明关于该主题已知的信息：肥胖和PCOS存在许多相同的代谢紊乱，例如高雄激素血症和高胰岛素血症以及随后的胰岛素抵抗。关于患有PCOS的肥胖青少年代谢特征的知识有限，人们担心肥胖与PCOS是否相关。本研究的结果增加了什么：相对于体重正常的PCOS青少年，患有PCOS的肥胖青少年（病例组）的SHBG和HDL-C显著降低，甘油三酯、瘦素、空腹胰岛素、LDL-C和游离睾酮水平显著升高。结果表明，青少年PCOS中的代谢紊乱因合并肥胖而恶化。这些发现对临床实践和/或进一步研究有何影响：青少年肥胖、代谢紊乱和PCOS相互关联。肥胖会加剧青少年PCOS中的代谢紊乱。本研究强调了在青少年PCOS管理过程中预防肥胖的重要性。治疗干预与生活方式改变相结合可能为青少年PCOS提供更好的治疗。青少年PCOS合并肥胖的病因需要进一步研究。
