Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, India.
Department of Medicine, Division of Medical Gastroenterology, Yenepoya Medical College, Mangaluru, Karnataka, India.
Indian J Med Res. 2020 Apr;151(4):333-341. doi: 10.4103/ijmr.IJMR_610_18.
BACKGROUND & OBJECTIVES: There is limited data on non-alcoholic fatty liver disease (NAFLD) among Indian women with polycystic ovary syndrome (PCOS), and there are no data on the utility of fibroscan in its assessment. The objective of this study was thus to investigate the frequency of hepatic steatosis in young women with PCOS and evaluate the utility of transient elastography (TE) in its assessment.
Seventy women diagnosed with PCOS and 60 apparently healthy women (controls) were enrolled in this pilot study. These women were evaluated for clinical, biochemical and hormonal parameters, transabdominal ultrasonography, dual-energy X-ray absorptiometry and fibroscan assessing liver stiffness measure (LSM) and controlled attenuation parameter (CAP). Other indices such as liver fat score (LFS), lipid accumulation product (LAP), fibrosis-4 (FIB-4) and aspartate aminotransferase to platelet ratio index, hepatic steatosis index (HIS) scores were also calculated. The main outcome measures were the presence of NAFLD in women with PCOS and its correlation with CAP and LSM on TE.
Women with PCOS had higher frequency (38.57 vs. 6.67%) of hepatic steatosis than control women as determined by abdominal sonography. The aminotransferases were higher in PCOS group (14.28 vs. 1.7%, P=0.03) even after adjusting for body mass index implying higher non-alcoholic steatohepatitis among young PCOS patients. PCOS women had significantly higher CAP on TE compared to controls (210 vs. 196). CAP had a significant correlation with LFS, LAP and HIS.
INTERPRETATION & CONCLUSIONS: NAFLD is common in young women with PCOS, and fibroscan using TE may be considered as a promising non-invasive diagnostic modality in its early detection.
印度多囊卵巢综合征（PCOS）女性的非酒精性脂肪性肝病（NAFLD）数据有限，其评估中也没有关于 Fibroscan 的应用数据。因此，本研究旨在调查年轻 PCOS 女性肝脂肪变性的频率，并评估瞬态弹性成像（TE）在其评估中的应用价值。
本研究纳入了 70 名 PCOS 女性和 60 名健康对照女性（对照组）。这些女性接受了临床、生化和激素参数、经腹超声、双能 X 射线吸收法和 Fibroscan 检查，评估肝脏硬度测量值（LSM）和受控衰减参数（CAP）。还计算了其他指标，如肝脂肪分数（LFS）、脂质堆积产物（LAP）、纤维化-4（FIB-4）和天冬氨酸转氨酶与血小板比值指数、肝脂肪变性指数（HIS）评分。主要观察指标为 PCOS 女性中 NAFLD 的存在及其与 TE 上的 CAP 和 LSM 的相关性。
腹部超声检查结果显示，PCOS 女性的肝脂肪变性频率（38.57%比 6.67%）高于对照组女性。即使在调整体重指数后，PCOS 组的转氨酶仍较高（14.28%比 1.7%，P=0.03），这表明年轻 PCOS 患者中存在较高的非酒精性脂肪性肝炎。与对照组相比，PCOS 女性的 TE 上的 CAP 值明显更高（210 比 196）。CAP 值与 LFS、LAP 和 HIS 显著相关。
NAFLD 在年轻 PCOS 女性中很常见，使用 TE 的 Fibroscan 可能被视为其早期检测的一种有前途的非侵入性诊断方法。
