López-Alarcón Mardia, Vital-Reyes Víctor Saúl, Almeida-Gutiérrez Eduardo, Maldonado-Hernández Jorge, Flores-Chávez Salvador, Domínguez-Salgado Juan Manuel, Vite-Bautista José, Cruz-Martínez David, Barradas-Vázquez Aly S, Z'Cruz-López Ricardo
Unidad de Investigación Médica en Nutrición, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Ciudad de México 06270, Mexico.
Departamento de Medicina Reproductiva, Hospital de Ginecología y Obstetricia, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social (IMSS), Ciudad de México 02990, Mexico.
J Pers Med. 2023 Aug 28;13(9):1319. doi: 10.3390/jpm13091319.
Polycystic ovary syndrome (PCOS) is often accompanied with metabolic disturbances attributed to androgen excess and obesity, but the contribution of each has not been defined, and the occurrence of metabolic disturbances is usually not investigated. Ninety-nine women with PCOS and forty-one without PCOS were evaluated. The clinical biomarkers of alterations related to glucose (glucose, insulin, and clamp-derived glucose disposal - ), liver (aspartate aminotransferase, alanine aminotransferase, and gamma-glutamyl transferase), and endothelium (arginine, asymmetric dymethylarginine, carotid intima-media thickness, and flow-mediated dilation) metabolism were measured; participants were categorized into four groups according to their obesity (OB) and hyperandrogenemia (HA) status as follows: Healthy (no-HA, lean), HA (HA, lean), OB (no-HA, OB), and HAOB (HA, OB). Metabolic disturbances were very frequent in women with PCOS (≈70%). BMI correlated with all biomarkers, whereas free testosterone (FT) correlated with only glucose- and liver-related indicators. Although insulin sensitivity and liver enzymes were associated with FT, women with obesity showed lower M (coef = 8.56 - 0.080(FT) - 3.71(Ob); < 0.001) and higher aspartate aminotransferase (coef = 26.27 + 0.532 (FT) + 8.08 (Ob); = 0.015) than lean women with the same level of FT. Women with obesity showed a higher risk of metabolic disorders than lean women, independent of hyperandrogenemia. Clinicians are compelled to look for metabolic alterations in women with PCOS. Obesity should be treated in all cases, but hyperandrogenemia should also be monitored in those with glucose-or liver-related disturbances.
多囊卵巢综合征（PCOS）常伴有因雄激素过多和肥胖导致的代谢紊乱，但二者各自的作用尚未明确，且通常未对代谢紊乱的发生情况进行研究。对99例PCOS女性和41例非PCOS女性进行了评估。测量了与葡萄糖（葡萄糖、胰岛素和钳夹衍生的葡萄糖处置）、肝脏（天冬氨酸转氨酶、丙氨酸转氨酶和γ-谷氨酰转移酶）以及内皮（精氨酸、不对称二甲基精氨酸、颈动脉内膜中层厚度和血流介导的扩张）代谢相关改变的临床生物标志物；根据参与者的肥胖（OB）和高雄激素血症（HA）状态将其分为四组：健康组（无HA，瘦）、HA组（HA，瘦）、OB组（无HA，肥胖）和HAOB组（HA，肥胖）。PCOS女性中代谢紊乱非常常见（约70%）。体重指数与所有生物标志物相关，而游离睾酮（FT）仅与葡萄糖和肝脏相关指标相关。尽管胰岛素敏感性和肝酶与FT有关，但肥胖女性与FT水平相同的瘦女性相比，M值较低（系数 = 8.56 - 0.080(FT) - 3.71(Ob)；P < 0.001），天冬氨酸转氨酶较高（系数 = 26.27 + 0.532 (FT) + 8.08 (Ob)；P = 0.015）。肥胖女性比瘦女性有更高的代谢紊乱风险，与高雄激素血症无关。临床医生必须关注PCOS女性的代谢改变。所有病例均应治疗肥胖，但对于有葡萄糖或肝脏相关紊乱的患者也应监测高雄激素血症。
