Li Xintong, Min Min, Duan Fangfang, Ruan Xiangyan, Xu Li
Department of Radiology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, PR China.
Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, 100026, PR China.
BMC Womens Health. 2025 Mar 14;25(1):118. doi: 10.1186/s12905-025-03648-9.
Polycystic ovary syndrome (PCOS) is linked to non-alcoholic fatty liver disease (NAFLD). Biochemical, sex hormonal, and anthropometric indicators have been explored for screening NAFLD in PCOS patients. However, the accuracy of NAFLD screening using these indicators in PCOS patients remains uncertain. This study aimed to identify biochemical, sex hormonal, and anthropometric indicators associated with NAFLD in overweight and obese PCOS patients and assess the diagnostic efficacy of combined indicators.
This cross-sectional study (Clinical trial number ChiCTR1900020986; Registration date January 24th, 2019) involved 87 overweight or obese women with PCOS (mean age 29 ± 4 years). Measurements included anthropometric indices, biochemistry, sex hormone levels, and liver proton density fat fraction (PDFF). Correlation analysis, intergroup comparisons, and logistic regression analysis were used to identify risk factors for NAFLD (PDFF > 5.1%). The receiver operating characteristic curve, area under the curve (AUC), sensitivity, specificity, positive predictive value, and negative predictive value were used to determine cut-off values and evaluate diagnostic accuracy.
Liver PDFF was 7.69% (3.93%, 14.80%) in overweight and obese PCOS patients, with 67.8% diagnosed with NAFLD. NAFLD was associated with increased body mass index (BMI), abdominal circumference (AC), and triglyceride, total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), glucose, insulin, and free testosterone (FT) levels, and with decreased high-density lipoprotein-cholesterol (HDL-C) and sex hormone-binding globulin (SHBG) levels (P < 0.05). Risk factors for NAFLD in PCOS included BMI > 26.8 kg/m, AC > 88.3 cm, triglyceride > 1.57 mmol/L, TC > 4.67 mmol/L, LDL-C > 3.31 mmol/L, glucose > 4.83 mmol/L, insulin > 111.35 pmol/L, FT > 7.6 pg/mL and SHBG < 25 nmol/L (β = 1.411-2.667, P < 0.005). A multi-indicator model including triglycerides, LDL-C, glucose, insulin, and SHBG showed higher diagnostic accuracy (AUC = 0.899, P < 0.001) for screening NAFLD in PCOS patients than single indicators (AUC = 0.667-0.761, P < 0.05).
Overweight and obese PCOS patients have higher incidences of liver PDFF and NAFLD. A multi-indicator model including triglycerides > 1.57 mmol/L, LDL-C > 3.31 mmol/L, glucose > 4.83 mmol/L, insulin > 111.35 pmol/L, and SHBG < 25 nmol/L is highly accurate for screening NAFLD in overweight and obese PCOS patients.
多囊卵巢综合征（PCOS）与非酒精性脂肪性肝病（NAFLD）有关。已对生化、性激素和人体测量指标进行了探索，以用于筛查PCOS患者的NAFLD。然而，使用这些指标在PCOS患者中筛查NAFLD的准确性仍不确定。本研究旨在确定超重和肥胖PCOS患者中与NAFLD相关的生化、性激素和人体测量指标，并评估联合指标的诊断效能。
这项横断面研究（临床试验注册号ChiCTR1900020986；注册日期2019年1月24日）纳入了87名超重或肥胖的PCOS女性（平均年龄29±4岁）。测量指标包括人体测量指数、生化指标、性激素水平和肝脏质子密度脂肪分数（PDFF）。采用相关性分析、组间比较和逻辑回归分析来确定NAFLD（PDFF>5.1%）的危险因素。使用受试者工作特征曲线、曲线下面积（AUC）、敏感性、特异性、阳性预测值和阴性预测值来确定临界值并评估诊断准确性。
超重和肥胖PCOS患者的肝脏PDFF为7.69%（3.93%，14.80%），67.8%的患者被诊断为NAFLD。NAFLD与体重指数（BMI）、腹围（AC）增加以及甘油三酯、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、血糖、胰岛素和游离睾酮（FT）水平升高相关，与高密度脂蛋白胆固醇（HDL-C）和性激素结合球蛋白（SHBG）水平降低相关（P<0.05）。PCOS患者中NAFLD的危险因素包括BMI>26.8kg/m、AC>88.3cm、甘油三酯>1.57mmol/L、TC>4.67mmol/L、LDL-C>3.31mmol/L、血糖>4.83mmol/L、胰岛素>111.35pmol/L、FT>7.6pg/mL和SHBG<25nmol/L（β=1.411 - 2.667，P<0.005）。一个包括甘油三酯、LDL-C、血糖、胰岛素和SHBG的多指标模型在筛查PCOS患者的NAFLD方面显示出比单一指标更高的诊断准确性（AUC = 0.899，P<0.001）（AUC = 0.667 - 0.761，P<0.05）。
超重和肥胖PCOS患者肝脏PDFF和NAFLD的发生率较高。一个包括甘油三酯>1.57mmol/L、LDL-C>3.31mmol/L、血糖>4.83mmol/L、胰岛素>111.35pmol/L和SHBG<25nmol/L的多指标模型在筛查超重和肥胖PCOS患者的NAFLD方面具有很高的准确性。
