本文選題：多囊卵巢綜合征 + 胰島素抵抗��； 參考：《吉林大學(xué)》2015年碩士論文

【摘要】：背景 多囊卵巢綜合征（polycystic ovary syndrome, PCOS）作為女性無排卵性不孕最常見的病因，是育齡期婦女最為常見的生殖紊亂疾病，發(fā)病率逐年增加［1］。PCOS在臨床表現(xiàn)上具有高度的異質(zhì)性，主要表現(xiàn)為嚴(yán)重的代謝紊亂及激素水平失調(diào)，其中肥胖在PCOS的臨床癥狀中影響顯著，且與PCOS患者的不孕存在相關(guān)性，也增加了PCOS患者發(fā)生代謝綜合征（MS）和心血管疾病的風(fēng)險(xiǎn)［2］。目前已有研究指出脂肪分布模式是心血管及代謝性疾病獨(dú)立存在的危險(xiǎn)因素，脂肪含量可影響女性內(nèi)分泌代謝，使育齡期婦女生殖功能減低，從而增加?jì)D科疾病發(fā)生的危險(xiǎn)［3］。 目的 分析PCOS患者糖、脂、激素水平、骨代謝特征及脂肪分布，探究PCOS患者中脂肪分布、骨代謝與胰島素抵抗的關(guān)系，為PCOS臨床治療提供理論依據(jù)。方法 選取PCOS患者56例，健康育齡期婦女39例，在月經(jīng)周期的第3-5天或者月經(jīng)不規(guī)律者在B超檢查未見優(yōu)勢卵泡時(shí)，清晨空腹采集靜脈血。同時(shí)測量體重、身高、腰圍、臀圍，計(jì)算體重指數(shù)（body mass index，，BMI）及腰臀比，并以BMI為標(biāo)準(zhǔn)將PCOS組分為18例正常體重組，38例超重及肥胖組。測定空腹血糖（FPG）、甘油三酯（TG）、總膽固醇（TC）、高密度脂蛋白膽固醇（HDL-C）、低密度脂蛋白膽固醇（LDL-C）、空腹胰島素（FINS）、促黃體生成素（LH）、促卵泡激素(FSH)、孕酮（P）、睪丸酮(T)、泌乳素(PRL)、雌二醇(E2)，計(jì)算出穩(wěn)態(tài)模型胰島素抵抗指數(shù)（HOMA-IR=（FPG×FINS）/22.5）和LH/FSH。應(yīng)用雙能X線骨密度儀（DXA）進(jìn)行全身掃描，測量全身及局部的骨密度（BMD）、骨礦物質(zhì)含量（BMC）、表示骨密度水平的T值及Z值；雙上肢、軀干、雙下肢、腹部、臀部及全身的脂肪重量（Fat mass）、無脂肪重量（Lean mass+BMC）、腹部脂肪/臀部及大腿脂肪比率（Android/Gynoid）、各部分及全身的脂肪率（Fat%）等。使用SPSS19.0統(tǒng)計(jì)軟件進(jìn)行分析統(tǒng)計(jì)，以P0.05判定為有統(tǒng)計(jì)學(xué)差異。 結(jié)果 1、PCOS組與健康對照組相比，PCOS組體重、BMI、腰圍（WC）、腰臀比（WHR）、FPG、FINS、HOMA-IR、TG、TC、LDL-C、LH、LH/FSH、T均明顯高于健康對照組（P＜0.05）；健康對照組HDL-C明顯高于PCOS組（P＜0.05），差異均有統(tǒng)計(jì)學(xué)意義。 2、PCOS組左上肢的BMC、右上肢的BMC及BMD、全身BMC及BMD和表示骨密度水平的Z值較健康對照組高（P＜0.05），差異均有統(tǒng)計(jì)學(xué)意義。 3、PCOS組全身、右上肢、軀干及腹部脂肪重量、無脂肪重量及脂肪率均顯著高于健康對照組（P＜0.05），差異有統(tǒng)計(jì)學(xué)意義。兩組雙下肢及臀部脂肪重量無差異；PCOS組雙下肢及臀部無脂肪重量高于健康對照組（P＜0.05）、臀部脂肪率低于健康對照組（P＜0.05）、Android/Gynoid脂肪含量的比率高于健康對照組（P＜0.01），差異均有統(tǒng)計(jì)學(xué)意義。 4、PCOS超重及肥胖組全身BMD與BMI、HOMA-IR呈正相關(guān)（r分別為0.530、0.456，（P＜0.01））。PCOS正常體重組全身BMC與T呈負(fù)相關(guān)（r=-0.688，P＜0.01）；PCOS超重及肥胖組全身BMC與BMI、HOMA-IR呈正相關(guān)（r分別為0.352、0.560，（P＜0.05））。 5、健康對照組全身脂肪重量與BMI、HOMA-IR和WC呈正相關(guān)（r分別為0.827、0.322、0.726，（P＜0.05））；PCOS超重及肥胖組全身脂肪重量與BMI、HOMA-IR和WC呈正相關(guān)（r分別為0.579、0.377、0.513，（P＜0.05））。 6、健康對照組腹部脂肪重量與BMI、HOMA-IR和WC呈正相關(guān)（r分別為0.775、0.400、0.674，（P＜0.05））；PCOS正常體重組腹部脂肪重量與BMI、HOMA-IR和WC呈正相關(guān)（r分別為0.511、0.500、0.483，（P＜0.05））；PCOS超重及肥胖組腹部脂肪重量與BMI、HOMA-IR和WC呈正相關(guān)（r分別為0.530、0.358、0.329，（P＜0.05））。 7、PCOS超重及肥胖組全身骨密度與全身無脂肪重量呈正相關(guān)（r=0.344，P＜0.05）。 結(jié)論 1、PCOS患者多肥胖，伴胰島素抵抗，出現(xiàn)糖、脂代謝異常，存在不同程度的高LH及高雄激素血癥等代謝紊亂征象，表現(xiàn)出代謝綜合征的某些特征。 2、PCOS患者具有較高的骨密度水平，胰島素抵抗或高胰島素水平可能在骨量的維持中起到了保護(hù)作用。維持一定的體重，尤其是增加無脂肪重量，對于骨量的增加與維持是有利的。 3、PCOS患者脂肪主要堆積于腹部，多呈男性特征型脂肪分布特點(diǎn)，腹部脂肪重量與胰島素抵抗、肥胖的關(guān)系密切，全身肥胖程度及腹型肥胖均影響胰島素抵抗。 4、控制體重、減少腹部脂肪量、降低胰島素抵抗可對PCOS的治療提供依據(jù)，對疾病遠(yuǎn)期并發(fā)癥防治有著重大意義。
[Abstract]:background
Polycystic ovary syndrome (PCOS) is the most common cause of anovulatory infertility in women. It is the most common reproductive disorder in women of childbearing age. The incidence of the disease is increasing year by year [1].PCOS is highly heterogeneous in clinical manifestations, mainly characterized by severe metabolic disorder and hormone imbalance. Obesity is significantly affected by the clinical symptoms of PCOS, and is associated with infertility in PCOS patients, and increases the risk of metabolic syndrome (MS) and cardiovascular disease in PCOS patients [2]. Secretory metabolism reduces reproductive function in women of childbearing age, thereby increasing the risk of gynecological diseases [3].
objective
Analysis of PCOS patients sugar, lipid, hormone levels, bone metabolism and fat distribution, explore the relationship between fat distribution, bone metabolism and insulin resistance in PCOS patients, and provide a theoretical basis for the clinical treatment of PCOS.
56 cases of PCOS patients, 39 healthy childbearing age women, in the 3-5 day of the menstrual cycle, or irregular menstrual cycles, when no dominant follicle was detected in the B-mode ultrasound examination, the venous blood was collected on the morning empty stomach. The body weight, height, waist circumference, hip circumference were measured and the body mass index (body mass index, BMI) and waist hip ratio were calculated, and the group of PCOS was divided into 18 cases in the PCOS group. FPG, triglyceride (TG), triglyceride (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), low density lipoprotein cholesterol (FINS), luteinizing hormone (LH), follicle stimulating hormone (FSH), progesterone (P), testosterone (T), prolactin (PRL) and estradiol (E2) were calculated. The model insulin resistance index (HOMA-IR= (FPG x FINS) /22.5) and LH/FSH. with double energy X-ray bone densitometer (DXA) were used to scan the whole body. The bone mineral density (BMD) and bone mineral content (BMC) were measured, and the T value and Z value of bone mineral density (BMC); the weight of the fat (Fat mass) of the two upper limbs, trunk, lower limbs, abdomen, hip and whole body (Fat mass). Fat weight (Lean mass+BMC), abdominal fat / hip and thigh fat ratio (Android/Gynoid), all parts and body fat rate (Fat%). The SPSS19.0 statistical software was used for analysis and statistics, and the statistical difference was determined by P0.05.
Result
1, compared with the healthy control group, the body weight, BMI, waist circumference (WC), waist to hip ratio (WHR), FPG, FPG, FINS, HOMA-IR, TG, TC, LDL-C, LH, PCOS were all significantly higher than those in the healthy control group, and the health control group was significantly higher than the healthy control group (0.05), the difference was statistically significant.
2, the BMC of the left upper limb of the group PCOS, the BMC and BMD of the right upper limb, the whole body BMC and BMD and the Z value representing the bone density level were higher than those of the healthy control group (P < 0.05), the difference was statistically significant.
3, PCOS group, right upper limb, trunk and abdominal fat weight, fat free weight and fat rate were significantly higher than the healthy control group (P < 0.05), the difference was statistically significant. Two groups of lower limbs and hip fat weight was no difference in group PCOS, the fat free weight of lower limbs and buttocks was higher than that of the healthy control group (P < 0.05), the fat rate of the buttocks was lower than that of the health group. According to the group (P < 0.05), the ratio of Android/Gynoid fat content was higher than that of the healthy control group (P < 0.01), and the difference was statistically significant.
4, the whole body BMD in the overweight and obese group was positively correlated with BMI and HOMA-IR (r was 0.530,0.456, (P < 0.01)). There was a negative correlation between BMC and T in the normal body weight group of.PCOS (r=-0.688, P < 0.01), and there was a positive correlation between the overweight and obesity group.
5, there was a positive correlation between the body fat weight of the healthy control group and BMI, HOMA-IR and WC (R 0.827,0.322,0.726, respectively (P < 0.05)). The body fat weight of the overweight and obese PCOS groups was positively correlated with BMI, HOMA-IR and WC (r was 0.579,0.377,0.513, (0.05)).
6, there was a positive correlation between the weight of abdominal fat in the healthy control group and BMI, HOMA-IR and WC (R respectively 0.775,0.400,0.674, (P < 0.05)). The abdominal fat weight of the normal weight group of PCOS was positively correlated with BMI, HOMA-IR and WC respectively (r was 0.511,0.500,0.483, (0.05)). For 0.530,0.358,0.329, (P < 0.05)).
7, there was a positive correlation between BMD and body fat weight in PCOS overweight and obesity group (r=0.344, P < 0.05).
conclusion
1, PCOS patients are more obese, with insulin resistance, sugar, lipid metabolism abnormalities, the presence of different levels of high LH and Kaohsiung hormone metabolism disorder signs, showing some characteristics of the metabolic syndrome.
2, PCOS patients have a high level of bone density, insulin resistance or high insulin levels may play a protective role in the maintenance of bone mass. Maintaining a certain weight, especially the increase of fat free weight, is beneficial to the increase and maintenance of bone mass.
3, the fat accumulation in the PCOS patients mainly in the abdomen, most of the male characteristic fat distribution characteristics, abdominal fat weight and insulin resistance, obesity is closely related, the degree of obesity and abdominal obesity all affect insulin resistance.
4, controlling body weight, reducing abdominal fat and reducing insulin resistance can provide evidence for the treatment of PCOS, and it is of great significance for prevention and treatment of long-term complications.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R711.75

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