摘要
背景 近年来多囊卵巢综合征(PCOS)女性的脂质代谢紊乱发生率较高,与肥胖、胰岛素抵抗(IR)的关系密切.BMI正常的PCOS女性也有较高的脂质代谢水平,但目前对该类人群中血脂异常的研究较少.目的 探讨BMI正常的PCOS女性发生高脂血症的影响因素.方法 基于"针刺和克罗米芬对多囊卵巢综合征妇女活产率的影响(PCOSAct)"临床试验数据,选取基线较完整且符合研究标准的受试者 428 例.判断高脂血症的评价标准:总胆固醇(TC)≥6.22 mmol/L和/或三酰甘油(TG)≥2.26 mmol/L和/或低密度脂蛋白(LDL)≥4.14 mmol/L和/或高密度脂蛋白(HDL)<1.04 mmol/L,并据此进行分组.比较两组患者在人体测量学、性激素、糖脂代谢以及心肌酶、肝功能方面的差异,采用多因素Logistic回归分析探究BMI正常的PCOS女性高脂血症的影响因素.结果 BMI正常的PCOS女性合并高脂血症的发生率为 32.24%(138/428),最常见的血脂异常类型是HDL水平降低;单一表型异常率较高[21.73%(93/428)].高脂血症组138例、无高脂血症组290例.高脂血症组年龄、糖尿病家族史占比、体质量、腰围、BMI、腰臀比(WHR)较大,尝试妊娠时间较长,游离雄激素指数、空腹胰岛素、胰岛素抵抗指数(HOMA-IR)、LDL、TC、TG、载脂蛋白B、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、乳酸脱氢酶(LDH)水平比无高脂血症组高,性激素结合球蛋白、抗米勒管激素、HDL、载脂蛋白A、总胆红素、直接胆红素水平较无高脂血症组低(P<0.05).多因素Logistic回归分析发现年龄、BMI、HOMA-IR、LDH是正常BMI的PCOS患者发生高脂血症的独立危险因素(OR=1.170、1.348、1.172、1.009),性激素结合球蛋白是独立保护因素(OR=0.979,P<0.05).结论 BMI正常的PCOS女性合并高脂血症发生率为 32.24%,年龄、BMI、HOMA-IR、LDH、SHBG均是PCOS女性发生高脂血症的影响因素,临床上应该根据各诱因采取相应措施防治及延缓PCOS女性高脂血症的发生与发展.
Abstract
Background In recent years,women with polycystic ovary syndrome(PCOS)have had a higher prevalence of lipid metabolism disorders,which are strongly associated with obesity and insulin resistance(IR).Higher levels of lipid metabolism have been also found in PCOS women with normal body mass index(BMI),but there are fewer studies on dyslipidemia in this population.Objective To investigate the factors influencing the development of hyperlipidemia in PCOS women with normal BMI.Methods Based on the data of the clinical trial Effect of Acupuncture and Clomiphene on Live Birth Rate in Women with Polycystic Ovary Syndrome(PCOSAct),a total of 428 subjects with complete baseline data and meeting the study criteria were selected.The evaluation criteria for determining hyperlipidemia included total cholesterol(TC)6.22 mmol/L and/or triglycerides(TG)2.26 mmol/L and/or low-density lipoprotein(LDL)4.14 mmol/L and/or high-density lipoprotein(HDL)<1.04 mmol/L,which was used to divide patients into the hyperlipidemia group(n=138 patients)and no hyperlipidemia group(n=290 patients).The demographic characteristics,sex hormones,glucose and lipid metabolism,as well as cardiac enzymes and liver function were compared between patients with hyperlipidemia and those without hyperlipidemia,and multivariate logistic regression analysis was used to explore the factors influencing hyperlipidemia in PCOS women with normal BMI.Results The prevalence of combined hyperlipidemia in PCOS women with normal BMI was 32.24%(138/428),and the most common type of dyslipidemia was reduced HDL levels with a high prevalence(21.73%,93/428)of a single phenotype.There were 138 cases in the hyperlipidemia group and 290 cases in the no hyperlipidemia group.The hyperlipidemic group had higher age,proportion of family history of diabetes,body mass,waist circumference,BMI,WHR,longer duration of attempted pregnancy,higher levels of free androgen index,fasting insulin,insulin resistance index(HOMA-IR),LDL,TC,TG,apolipoprotein B,alanine aminotransferase,aspartate aminotransferase,LDH than the no hyperlipidemia group,and higher levels of sex hormone binding globulin,anti-mullerian hormone,HDL,apolipoprotein A,total bilirubin,and direct bilirubin lower than the no hyperlipidemia group(P<0.05).Multivariate logistic regression analysis revealed that age,BMI,HOMA-IR,and LDH were independent risk factors for the development of hyperlipidemia in PCOS patients with normal BMI(OR=1.170,1.348,1.172,1.009),and sex hormone binding globulin was independent protective factor(OR=0.979,P<0.05).Conclusion The incidence of hyperlipidemia in PCOS women with normal BMI was 32.24%.Age,BMI,HOMA-IR,LDH,and SHBG are influencing factors of the development of hyperlipidemia in women with PCOS,and clinical measures should be taken to prevent or delay the occurrence and development of hyperlipidemia in women with PCOS according to the causative factors.
基金项目
国家重点研发计划中医药现代化研究重点专项(2019YFC1709500)
2019年度黑龙江中医药大学科研基金-博士创新基金(2019BS09)
黑龙江省中医药学会 2022-2024年度青年人才托举工程项目(2022-QNRC1-02)
黑龙江省中医药管理局 202中医药科研课题(ZHY2022-124)
徐州市引进临床医学专家团队项目(2019TD005)
维普
万方数据