【摘要】：目的基于鹿特丹標(biāo)準(zhǔn),依據(jù)美國國立衛(wèi)生院(National Institutes of Health,NIH)最新指南推薦,探討不同亞型多囊卵巢綜合征(polycystic ovary syndrome,PCOS)患者臨床、內(nèi)分泌代謝等相關(guān)指標(biāo)特征,以指導(dǎo)臨床治療。方法募集2014年12月至2015年5月在首都醫(yī)科大學(xué)附屬北京婦產(chǎn)醫(yī)院內(nèi)分泌科就診的PCOS患者647例,測定人體學(xué)指標(biāo)、性激素及血脂、血糖、胰島素及陰道B超等,依據(jù)NIH指南推薦將其四型分為4組:A組409例〔O+HA+P:無排卵或稀發(fā)排卵(oligo-ovulation,O),雄激素水平升高的臨床和(或)生化表現(xiàn)(hyperandrogeoism,HA),卵巢多囊樣改變(polycystic ovary,P)〕;B組58例(O+HA);C組101例(HA+P);D組79例(O+P),另選同期就診的基礎(chǔ)體溫雙相的輸卵管因素不孕癥患者60例為對照組,分別評估臨床及激素代謝指標(biāo)。結(jié)果 647例患者,4個(gè)亞型的患病率分別為:A組63.2%,B組9%,C組15.6%,D組12.9%,647例患者中有高雄表現(xiàn)或血雄激素濃度高的發(fā)生率為87.8%。A組與B組:高雄血癥、腰圍、胰島素抵抗及三酰甘油均明顯增高,但A組最重,B組次之。C組與A、B兩組相比,臨床和內(nèi)分泌代謝特征溫和,但與對照組相比,黃體生成素(luteinizing hormone,LH)、黃體生成素/卵泡刺激素(LH/follicle stimulating hormone,FSH)均明顯增高(P0.05)。D組與對照組間體質(zhì)量指數(shù)(body mass index,BMI)、腰圍、臀圍、Ferryman-Gallwey評分結(jié)果相似。部分特殊化指標(biāo)質(zhì)量濃度各組間差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論 1)基于鹿特丹診斷標(biāo)準(zhǔn)的PCOS分型方法可反映疾病的基本特征。2)高雄激素血癥和/或多毛評分是區(qū)分PCOS不同亞型最主要的依據(jù),可能是代謝障礙嚴(yán)重程度不同的結(jié)果。與標(biāo)準(zhǔn)組(Ⅰ型和Ⅱ型相比),正常排卵組和非高雄組可代表PCOS相對溫和的表型。而非高雄組PCOS可能有不同的致病途徑。因此對于不同分型PCOS患者的治療也應(yīng)該個(gè)體化。
[Abstract]:Objective to investigate the clinical, endocrine and metabolic characteristics of patients with different subtypes of polycystic ovary syndrome (polycystic ovary syndromes) according to the Rotterdam standard and the latest guidelines of the National Institutes of Health (NIH), so as to guide the clinical treatment. Methods from December 2014 to May 2015, 647 patients with PCOS were enrolled in the Department of Endocrinology, Beijing Obstetrics and Obstetrics Hospital affiliated to Capital Medical University. The indexes of human body, sex hormone, blood lipid, blood glucose, insulin and vaginal B ultrasound were measured. According to the recommendations of NIH guidelines, the four types were divided into 4 groups: group A: 409 cases of (O HA: anovulation or oligo-ovulationo, hyperandrogeoismHA, polycystic ovaries P); Group B, 58 cases of (O HA); Group C, 101 cases; Group B, 101 cases; Group C, 58 cases; Group B, Group B; Group B; Group B, 58 cases; Group B, Group B; Group B; Group B; Group B; Group B; Group B; Group B; Group B; (HA P) D group (n = 79) and (O P), group (n = 79) were randomly divided into two groups: 60 patients with sterility due to tubal factors with basic body temperature in the same period were selected as control group. The clinical and hormone metabolic indexes were evaluated. Results the prevalence rates of 4 subtypes in 647 patients were as follows: 63.2% in group A and 63.2in group B, respectively. The incidence of hyperandrogenemia and waist circumference in group A and group B were 87.8% and 87.8% respectively, and those in group C, and the incidence of high androgen concentration were 87.8% and 87.8%, respectively. Insulin resistance and triacylglycerol were significantly increased, but the clinical and endocrine metabolic characteristics were mild in group A, group B, and group A. Luteinizing hormone LH, luteinizing hormone / follicle stimulating hormone (LH/follicle stimulating hormonetine FSH) were significantly increased (P0.05). Group D was significantly higher than control group (P 0.05). The score of Ferryman-Gallwey score of waist circumference and hip circumference was similar between group D and control group. There was no significant difference in the mass concentration of some special indexes among groups (P0.05). Conclusion 1) the PCOS typing method based on Rotterdam diagnostic criteria can reflect the basic characteristics of the disease. 2) Hyperandrogenemia and / or hirsutism score are the most important basis for distinguishing different subtypes of PCOS, and may be the result of different severity of metabolic disorders. Compared with the standard group (type 鈪，

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