Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus MC, Erasmus University Medical Center, 3015 GD, Rotterdam, the Netherlands.
Department of Internal Medicine, Erasmus MC, Erasmus University Medical Center, 3015 GD, Rotterdam, the Netherlands.
J Clin Endocrinol Metab. 2024 Nov 18;109(12):3096-3107. doi: 10.1210/clinem/dgae298.
Hierarchical clustering (HC) identifies subtypes of polycystic ovary syndrome (PCOS).
This work aimed to identify clinically significant subtypes in a PCOS cohort diagnosed with the Rotterdam criteria and to further characterize the distinct subtypes.
Clustering was performed using the variables body mass index (BMI), luteinizing hormone (LH), follicle-stimulating hormone, dehydroepiandrosterone sulfate, sex hormone-binding globulin (SHBG), testosterone, insulin, and glucose. Subtype characterization was performed by analyzing the variables estradiol, androstenedione, dehydroepiandrosterone, cortisol, anti-Müllerian hormone (AMH), total follicle count (TFC), lipid profile, and blood pressure. Study participants were girls and women who attended our university hospital for reproductive endocrinology screening between February 1993 and February 2021. In total, 2502 female participants of European ancestry, aged 13 to 45 years with PCOS (according to the Rotterdam criteria), were included. A subset of these (n = 1067) fulfilled the National Institutes of Health criteria (ovulatory dysfunction and hyperandrogenism). Main outcome measures included the identification of distinct PCOS subtypes using cluster analysis. Additional clinical variables associated with these subtypes were assessed.
Metabolic, reproductive, and background PCOS subtypes were identified. In addition to high LH and SHBG levels, the reproductive subtype had the highest TFC and levels of AMH (all P < .001). In addition to high BMI and insulin levels, the metabolic subtype had higher low-density lipoprotein levels and higher systolic and diastolic blood pressure (all P < .001). The background subtype had lower androstenedione levels and features of the other 2 subtypes.
Reproductive and metabolic traits not used for subtyping differed significantly in the subtypes. These findings suggest that the subtypes capture distinct PCOS causal pathways.
层次聚类（HC）可识别多囊卵巢综合征（PCOS）的亚型。
本研究旨在根据鹿特丹标准诊断为 PCOS 的患者队列中识别具有临床意义的亚型，并进一步描述不同的亚型。
使用体重指数（BMI）、促黄体生成激素（LH）、卵泡刺激素、硫酸脱氢表雄酮、性激素结合球蛋白（SHBG）、睾酮、胰岛素和血糖等变量进行聚类。通过分析雌二醇、雄烯二酮、脱氢表雄酮、皮质醇、抗苗勒管激素（AMH）、总卵泡计数（TFC）、血脂谱和血压等变量来描述亚型特征。研究参与者为 1993 年 2 月至 2021 年 2 月期间到我们大学医院进行生殖内分泌筛查的女孩和女性。共纳入 2502 名欧洲裔 PCOS 女性患者（根据鹿特丹标准），年龄 13 至 45 岁。其中一部分（n=1067）符合美国国立卫生研究院标准（排卵功能障碍和高雄激素血症）。主要观察指标包括使用聚类分析确定不同的 PCOS 亚型。评估与这些亚型相关的其他临床变量。
确定了代谢、生殖和背景 PCOS 亚型。除了高 LH 和 SHBG 水平外，生殖亚型的 TFC 和 AMH 水平最高（均 P<.001）。除了高 BMI 和胰岛素水平外，代谢亚型的低密度脂蛋白水平更高，收缩压和舒张压也更高（均 P<.001）。背景亚型的雄烯二酮水平较低，且具有其他 2 种亚型的特征。
用于分型的生殖和代谢特征在各亚型中差异显著。这些发现表明，这些亚型可以捕获不同的 PCOS 因果途径。
