Department of Endocrinology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China.
Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Gynecol Endocrinol. 2024 Dec;40(1):2312895. doi: 10.1080/09513590.2024.2312895. Epub 2024 Mar 6.
To investigate the differences in the metabolic indicators and sex hormones between obese and non-obese patients with polycystic ovary syndrome (PCOS), and their impacts on endometrial receptivity (ER).
We selected 255 individuals with PCOS, and categorized them into the obese groups, including the OP group (obese patients with PCOS) and the ON group (obese patients without PCOS), and selected 64 individuals who were categorized in the non-obese groups, namely, the control groups, which comprise the NP group (non-obese patients with PCOS) and the NN group(non-obese patients without PCOS). The one-way analysis of variance (ANOVA) and Mann-Whitney U tests were used to compare the metabolic indicators, and sex hormone-associated and ER-associated indicators between the groups. The correlation between the aforementioned clinical markers and ER was analyzed using the Pearson's correlation coefficient.
(1) In comparison with the NP group, the OP group exhibited higher levels ( < .01) of free androgen index (FAI), anti-müllerian hormone (AMH), fasting insulin (FINS), insulin level within 60 min, 120 min, and 180 min-60minINS, 120minINS, and 180minINS, respectively, fasting blood glucose (FBG), blood glucose level within two hours (2hGlu), homeostatic model assessment for insulin resistance (HOMA-IR), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), waist-to-hip ratio (WHR), waist circumference, hip circumference, the ratio of the maximum blood flow velocity of the uterine artery during systole to the blood flow velocity of the uterine artery at the end of diastole (uterine artery S/D), and blood flow resistance index (RI) of the uterine artery. In comparison with the NP group, the OP group exhibited lower levels ( < .01) of sex hormone binding globulin (SHBG), dehydroepiandrosterone (DHEA), high molecular weight adiponectin (HMWA), and high-density lipoprotein cholesterol (HDL-C). (2) In the PCOS group, RI was significantly positively correlated with FAI, FINS, 120minINS, HOMA-IR, and WHR ( < .01), and significantly negatively correlated with SHBG, HDL-C, and HMWA ( < .01); uterine artery S/D was significantly positively correlated with FAI, FINS, 2hGlu, HOMA-IR, LDL-C, and WHR ( < .01), significantly positively correlated with 120minINS and FBG ( < .05), and significantly negatively correlated with SHBG and HMWA ( < .01).
(1) The OP group exhibited obvious metabolic disorders and poor ER, which was manifested as low levels of SHBG and HMWA, and high levels of FAI, HOMA-IR, WHR, uterine artery S/D, and RI. (2) In patients with PCOS, there was a substantial correlation between ER-associated indicators RI and uterine artery S/D and FAI, FINS, 120minINS, HOMA-IR, WHR, SHBG, and HMWA.
探讨多囊卵巢综合征(PCOS)肥胖患者与非肥胖患者之间代谢指标和性激素的差异,及其对子宫内膜容受性(ER)的影响。
选择 255 例 PCOS 患者,分为肥胖组,包括 OP 组(肥胖 PCOS 患者)和 ON 组(肥胖非 PCOS 患者),以及 64 例非肥胖患者,分别为 NP 组(非肥胖 PCOS 患者)和 NN 组(非肥胖非 PCOS 患者)。采用单因素方差分析(ANOVA)和曼-惠特尼 U 检验比较组间代谢指标和性激素相关及 ER 相关指标。采用 Pearson 相关系数分析上述临床标志物与 ER 的相关性。
(1)与 NP 组相比,OP 组游离雄激素指数(FAI)、抗苗勒管激素(AMH)、空腹胰岛素(FINS)、60min、120min 和 180min-60minINS、120minINS 和 180minINS、空腹血糖(FBG)、餐后 2 小时血糖(2hGlu)、胰岛素抵抗指数(HOMA-IR)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、腰臀比(WHR)、腰围、臀围、子宫动脉收缩期最大血流速度与舒张末期血流速度比值(uterine artery S/D)和子宫动脉血流阻力指数(RI)更高(均 P<0.01);与 NP 组相比,OP 组性激素结合球蛋白(SHBG)、脱氢表雄酮(DHEA)、高分子量脂联素(HMWA)和高密度脂蛋白胆固醇(HDL-C)水平更低(均 P<0.01)。(2)在 PCOS 组中,RI 与 FAI、FINS、120minINS、HOMA-IR 和 WHR 呈显著正相关(均 P<0.01),与 SHBG、HDL-C 和 HMWA 呈显著负相关(均 P<0.01);子宫动脉 S/D 与 FAI、FINS、2hGlu、HOMA-IR、LDL-C 和 WHR 呈显著正相关(均 P<0.01),与 120minINS 和 FBG 呈显著正相关(均 P<0.05),与 SHBG 和 HMWA 呈显著负相关(均 P<0.01)。
(1)OP 组表现出明显的代谢紊乱和 ER 不良,表现为 SHBG 和 HMWA 水平降低,FAI、HOMA-IR、WHR、子宫动脉 S/D 和 RI 水平升高。(2)在 PCOS 患者中,ER 相关指标 RI 和子宫动脉 S/D 与 FAI、FINS、120minINS、HOMA-IR、WHR、SHBG 和 HMWA 之间存在显著相关性。