Royal College of Surgeons in Ireland Bahrain, Adliya, Kingdom of Bahrain.
Academic Endocrinology, Diabetes and Metabolism, Hull York Medical School, Hull, UK.
Clin Endocrinol (Oxf). 2023 Jun;98(6):796-802. doi: 10.1111/cen.14904. Epub 2023 Mar 8.
Obese women with polycystic ovary syndrome (PCOS) exhibit a hypercoagulable state, with the suggestion that this may be obesity-driven rather than an intrinsic facet of PCOS; however, this has not yet been definitively determined since body mass index (BMI) is so highly correlated with PCOS. Therefore, only a study design where obesity, insulin resistance and inflammation are matched can answer this question.
This was a cohort study. Patients Weight and aged-matched nonobese women with PCOS (n = 29) and control women (n = 29) were included. Measurements Plasma coagulation pathway protein levels were measured. Circulating levels of a panel of nine clotting proteins known to differ in obese women with PCOS were determined by Slow Off-rate Modified Aptamer (SOMA)-scan plasma protein measurement.
Women with PCOS showed a higher free androgen index (FAI) and anti-Müllerian hormone, but measures of insulin resistance, and C reactive protein (as a marker of inflammation), did not differ between the nonobese women with PCOS and the control women. Seven pro-coagulation proteins (plasminogen activator inhibitor-1, fibrinogen, fibrinogen gamma chain, fibronectin, d-dimer, P-selectin and plasma kallikrein) and two anticoagulant proteins (vitamin K-dependent protein-S and heparin cofactor-II) known to be elevated in obese women with PCOS did not differ from controls in this cohort.
This novel data show that clotting system abnormalities do not contribute to the intrinsic mechanisms underlying PCOS in this nonobese noninsulin resistant population of women with PCOS matched for age and BMI, and without evidence of underlying inflammation, but rather the clotting factor changes are an epiphenomenon coincident with obesity; therefore, increased coagulability is unlikely in these nonobese PCOS women.
患有多囊卵巢综合征（PCOS）的肥胖女性表现出高凝状态，这表明这种状态可能是由肥胖引起的，而不是 PCOS 的内在特征；然而，由于体重指数（BMI）与 PCOS 高度相关，因此尚未明确确定这一点。因此，只有在肥胖、胰岛素抵抗和炎症相匹配的研究设计中才能回答这个问题。
这是一项队列研究。纳入了体重和年龄匹配的肥胖 PCOS 患者（n=29）和对照组女性（n=29）。
测量了血浆凝血途径蛋白水平。通过慢释放修饰适体（SOMA）扫描血浆蛋白测量，确定了肥胖的 PCOS 女性中已知存在差异的凝血蛋白的循环水平。
PCOS 患者的游离雄激素指数（FAI）和抗苗勒管激素较高，但胰岛素抵抗和 C 反应蛋白（作为炎症标志物）的测量值在非肥胖 PCOS 患者和对照组女性之间没有差异。已知在肥胖的 PCOS 女性中升高的七种促凝蛋白（纤溶酶原激活物抑制剂-1、纤维蛋白原、纤维蛋白原γ链、纤维连接蛋白、D-二聚体、P 选择素和血浆激肽释放酶）和两种抗凝蛋白（维生素 K 依赖性蛋白-S 和肝素辅因子-II）在该队列中与对照组没有差异。
这些新数据表明，在年龄和 BMI 匹配的非肥胖非胰岛素抵抗 PCOS 女性中，凝血系统异常不会导致 PCOS 的内在机制，并且没有潜在炎症的证据，但凝血因子的变化是与肥胖同时发生的继发现象；因此，这些非肥胖 PCOS 女性的凝血能力不太可能增加。
