Department of Obstetrics and Gynecology, Pisa University Hospital of S. Chiara, Azienda Ospedaliera Universitaria, Via Roma 65, 56126, Pisa, Italy.
Department of Endocrinology, Pisa University Hospital of Cisanello, Azienda Ospedaliera Universitaria, Via Paradisa 2, 56124, Pisa, Italy.
J Endocrinol Invest. 2024 Apr;47(4):927-936. doi: 10.1007/s40618-023-02210-4. Epub 2023 Oct 31.
To assess which parameters among hyperandrogenism (total testosterone-tT-or free androgen index-FAI), sex hormone binding globulin (SHBG) or body mass index (BMI) could better predict a worse metabolic profile in women with polycystic ovary syndrome (PCOS).
Five hundred and eighty-six women with PCOS and clinical or biochemical hyperandrogenism were included. Receiver Operating Characteristics (ROC) curves with tT, FAI, SHBG and BMI were performed for metabolic parameters and a cut-off with sensitivity and specificity was obtained for each parameter. The women were then divided into three groups and compared according to their BMI.
Based on the ROC curves, tT proved not to be a good predictor of metabolic alterations. FAI and SHBG resulted to be good predictors of some markers of metabolic damage. The area under the curves (AUC) of SHBG were greater than those of FAI. SHBG levels affects the values of homeostasis model assessment of insulin resistance (HOMA-IR), fasting insulin, high density lipoproteins (HDL), low density lipoproteins (LDL), and total cholesterol also when corrected for BMI. However, the highest AUCs of the ROC curves were observed when BMI was used, which was significantly related to all the metabolic parameters analyzed. Dividing women according to their BMI, BMI between 25.00 and 30.00 kg/m had a worse metabolic profile but still in a normal range, while BMI ≥ 30 kg/m women had a significant metabolic derangement.
BMI is a good predictor factor of metabolic changes in PCOS women at any age, and obesity is associated to the appearance of metabolic complications. Overweight and obese PCOS women should be addressed to perform a complete metabolic assessment.
评估高雄激素血症（总睾酮-tT 或游离雄激素指数-FAI）、性激素结合球蛋白（SHBG）或体重指数（BMI）中的哪些参数能更好地预测多囊卵巢综合征（PCOS）女性的代谢特征恶化。
共纳入 586 例临床或生化高雄激素血症的 PCOS 患者。对 tT、FAI、SHBG 和 BMI 进行代谢参数的受试者工作特征（ROC）曲线分析，并获得每个参数的敏感性和特异性的截断值。然后根据 BMI 将这些女性分为三组并进行比较。
基于 ROC 曲线，tT 并不能很好地预测代谢改变。FAI 和 SHBG 是一些代谢损伤标志物的良好预测指标。SHBG 的曲线下面积（AUC）大于 FAI。SHBG 水平还影响稳态模型评估的胰岛素抵抗（HOMA-IR）、空腹胰岛素、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）和总胆固醇的值，即使校正 BMI 后也是如此。然而，当使用 BMI 时，ROC 曲线的 AUC 最高，且与分析的所有代谢参数均显著相关。根据 BMI 对女性进行分组，BMI 在 25.00 至 30.00 kg/m 之间的女性有更差的代谢特征，但仍在正常范围内，而 BMI≥30 kg/m 的女性则有明显的代谢紊乱。
BMI 是任何年龄 PCOS 女性代谢变化的良好预测因素，肥胖与代谢并发症的出现有关。超重和肥胖的 PCOS 女性应进行全面的代谢评估。
