Paschou Stavroula A, Palioura Eleni, Ioannidis Dimitrios, Anagnostis Panagiotis, Panagiotakou Argyro, Loi Vasiliki, Karageorgos Georgios, Goulis Dimitrios G, Vryonidou Andromachi
Department of Endocrinology and DiabetesHellenic Red Cross Hospital, Athens, Greece.
Department of Endocrinology and DiabetesSismanoglio-Amalia Fleming Hospital, Athens, Greece.
Endocr Connect. 2017 Nov;6(8):601-606. doi: 10.1530/EC-17-0239. Epub 2017 Sep 14.
The aim of this study was to investigate the impact of adrenal hyperandrogenism on insulin resistance and lipid profile in women with polycystic ovary syndrome (PCOS).
We studied 372 women with PCOS according to the NIH criteria. 232 age- and BMI-matched women served as controls in order to define adrenal hyperandrogenism (DHEA-S >95th percentile). Then, patients with PCOS were classified into two groups: with adrenal hyperandrogenism (PCOS-AH, = 108) and without adrenal hyperandrogenism (PCOS-NAH, = 264). Anthropometric measurements were recorded. Fasting plasma glucose, insulin, lipid profile, sex hormone-binding globulin (SHBG) and androgen (TT, Δ4A, DHEA-S) concentrations were assessed. Free androgen index (FAI) and homeostatic model assessment-insulin resistance (HOMA-IR) index were calculated.
Women with PCOS-AH were younger than PCOS-NAH ( < 0.001), but did not differ in the degree and type of obesity. No differences were found in HOMA-IR, total cholesterol, HDL-c, LDL-c and triglyceride concentrations (in all comparisons, > 0.05). These metabolic parameters did not differ between the two groups even after correction for age. Women with PCOS-AH had lower SHBG (29.2 ± 13.8 vs 32.4 ± 11.8 nmol/L, = 0.025) and higher TT (1.0 ± 0.2 vs 0.8 ± 0.4 ng/mL, = 0.05) and Δ4A (3.9 ± 1.2 vs 3.4 ± 1.0 ng/mL, = 0.007) concentrations, as well as FAI (14.1 ± 8.0 vs 10.2 ± 5.0, < 0.001). These results were confirmed by a multiple regression analysis model in which adrenal hyperandrogenism was negatively associated with age ( < 0.001) and SHBG concentrations ( = 0.02), but not with any metabolic parameter.
Women with PCOS and adrenal hyperandrogenism do not exhibit any deterioration in insulin resistance and lipid profile despite the higher degree of total androgens.
本研究旨在调查肾上腺雄激素过多对多囊卵巢综合征（PCOS）女性胰岛素抵抗和血脂谱的影响。
我们根据美国国立卫生研究院（NIH）标准研究了372例PCOS女性。232例年龄和体重指数（BMI）匹配的女性作为对照，以定义肾上腺雄激素过多（硫酸脱氢表雄酮 - S>DHEA-S第95百分位数）。然后，PCOS患者被分为两组：有肾上腺雄激素过多组（PCOS - AH，n = 108）和无肾上腺雄激素过多组（PCOS - NAH，n = 264）。记录人体测量数据。评估空腹血糖、胰岛素、血脂谱、性激素结合球蛋白（SHBG）和雄激素（睾酮、Δ4雄烯二酮、硫酸脱氢表雄酮 - S）浓度。计算游离雄激素指数（FAI）和稳态模型评估胰岛素抵抗（HOMA - IR）指数。
PCOS - AH组女性比PCOS - NAH组年轻（P<0.001），但在肥胖程度和类型上无差异。HOMA - IR、总胆固醇、高密度脂蛋白胆固醇（HDL - c）、低密度脂蛋白胆固醇（LDL - c）和甘油三酯浓度在两组间无差异（所有比较中，P>0.05）。即使校正年龄后，两组间这些代谢参数仍无差异。PCOS - AH组女性的SHBG较低（29.2±13.8 vs 32.4±11.8 nmol/L，P = 0.025），睾酮（1.0±0.2 vs 0.8±0.4 ng/mL，P = 0.05）和Δ4雄烯二酮（3.9±1.2 vs 3.4±1.0 ng/mL，P = 0.007）浓度以及FAI较高（14.1±8.0 vs 10.2±5.0，P<0.001）。这些结果在多元回归分析模型中得到证实，其中肾上腺雄激素过多与年龄（P<0.001）和SHBG浓度（P = 0.02）呈负相关，但与任何代谢参数均无关联。
患有PCOS且肾上腺雄激素过多的女性尽管总雄激素水平较高，但胰岛素抵抗和血脂谱并未出现任何恶化。
