不同表型多囊卵巢综合征患者人体成分和非传统血脂参数特征及相关性分析

Characterization and correlation of body composition and non-traditional lipid in different phenotypes of polycystic ovary syndrome

摘要

目的 探究不同表型多囊卵巢综合征（PCOS）患者人体成分和非传统血脂参数特征及相关性。方法 纳入2022年7月—2024年5月就诊于兰州大学第二医院的195例PCOS患者，根据鹿特丹标准将其分为4个临床表型组，A 型：排卵功能障碍（OA）+雄激素过多（HA）+多囊卵巢样改变（PCOM）；B 型：OA + HA； C 型：HA+ PCOM；D 型：OA +PCOM，探究各表型间的人体成分和非传统血脂参数特征及其相关性。结果 PCOS患者中A、B、C、D 表型占比分别为36.4%、25.6%、22.1%、15.9%；A 型PCOS 患者的体重指数（BMI）、体脂率（BFP）、腰臀比（WHR）、内脏脂肪面积（VFA）、基础代谢率（BMR）差值、躯干脂肪率（TFP)、空腹血糖（FBG）、空腹胰岛素（FINS）、总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白（LDL）、胰岛素抵抗指数（HOMA-IR）、非高密度脂蛋白（NON-HDL)、TC/HDL、TG/HDL、LDL/HDL、睾酮较B、C、D 型显著升高，蛋白质百分比、矿物质百分比、骨骼肌百分比、高密度脂蛋白（HDL）显著降低；B、C型患者BMI、TFP、睾酮较D型显著升高，差异均具有统计学意义（P < 0.05）。控制潜在混杂因素，Spearman 偏相关分析表明，PCOS 患者的 BMI、BFP、WHR、VFA、TFP、HOMA-IR、NON-HDL、TC/HDL、TG/HDL、LDL/HDL 与睾酮呈正相关关系（P < 0.05）；BMI、BFP、WHR、VFA、TFP 分别与HOMA-IR、NON-HDL、TC/HDL、LDL/HDL 呈正相关关系（P < 0.05）。结论 不同表型PCOS 患者存在不同程度的人体成分和非传统代谢参数的失衡，A型最严重，D型最轻，B、C型居于两者之间，应对PCOS患者进行分类管理。

Abstract

Objective To investigate the characteristics and correlation of body composition and non-traditional lipid parameters in different phenotypes of polycystic ovarian syndrome PCOS). Methods 195 patients with PCOS who attended the Second Hospital of Lanzhou University from July 2022 to May 2024 were included, and PCOS was categorized into four clinical phenotype groups according to the Rotterdam criteria, i.e. phenotype A-anovulation (OA), hyperandrogenism (HA) and polycystic ovarian morphology (PCOM); phenotype B- HA+OA; phenotype C-HA+PCOM; and phenotype D-OA+PCOM. Results The percentages of phenotypes A, B, C and D in PCOS patients are 36.4%, 25.6%, 22.1% and 15.9%; the body mass index (BMI), body fat percentage (BFP), waist-to-hip ratio (WHR), visceral fat area (VFA), basal metabolic rate (BMR) difference, trunk fat percentage (TFP), fasting blood glucose (FBG), fasting insulin (FINS), total cholesterol (TC), triglycerides (TG), low-density lipoprotein (LDL), homeostatic model assessment of insulin resistance (HOMA-IR), non-high-density lipoprotein (NON-HDL), TC/HDL, TG/HDL, LDL/HDL and testosterone were significantly higher compared to types B, C and D, and the percentage of protein, minerals, skeletal muscle and high-density lipoprotein (HDL) were significantly lower; BMI, TFP and testosterone were significantly higher in type B and C PCOS patients compared with type D, and the differences were statistically significant (P < 0.05). Controlling for relevant confounders, Spearman's bias correlation analysis showed that BMI, BFP, WHR, VFA, TFP, HOMA-IR, NON-HDL, TC/HDL, TG/HDL and LDL/HDL in PCOS patients were positively correlated with testosterone (P < 0.05); and BMI, BFP, WHR, VFA and TFP were positively correlated with HOMA-IR, NON-HDL, TC/HDL and LDL/HDL (P < 0.05). Conclusion Patients with different phenotypes of PCOS have varying degrees of imbalances in body composition and non-traditional metabolic parameters, with type A being the most severe, type D the least severe, and types B and C in between, and categorization should be made for management of patients with PCOS.

关键词

多囊卵巢综合征 / 表型 / 人体成分 / 非传统血脂参数 / 相关性分析

Key words

polycystic ovary syndrome / phenotype / body composition / nontraditional lipid parameters / correlation analysis

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基金资助

兰州大学第二医院项目(071100136)