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目的:探讨多囊卵巢综合征(PCOS)患者血清促甲状腺激素(TSH)浓度与临床特征及内分泌代谢指标之间的相关性。方法:选择485例PCOS患者,测量身高、体质量、腰围、臀围,应用电化学发光法分析测定血清TSH、游离甲状腺素(FT4)、游离三碘甲状腺素(FT3)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、极低密度脂蛋白胆固醇(VLDL-C)、高密度脂蛋白胆固醇(HDL-C)、三酰甘油(TG)、载脂蛋白A(apo A)、载脂蛋白B(apo B)、空腹血糖(FBG)、空腹胰岛素(INS)、卵泡刺激素(FSH)、黄体生成素(LH)、睾酮(T)、催乳素(PRL)、雌二醇(E2)、雄稀二酮(A2)和性激素结合球蛋白(SHBG);计算体质量指数(BMI)、腰臀比(WHR)、LH与FSH比值(LH/FSH);采用稳态模型评估的胰岛素抵抗指数(HOMA-IR)。按血清TSH浓度将其分为3组,A组(n=297):TSH<2.5 m IU/L;B组(n=120):TSH为2.5~4.0 m IU/L;C组(n=68):TSH>4.0 m IU/L。比较3组上述各项指标的差异及TSH与各项指标间的相关性。结果:3组患者BMI、腰围、臀围、VLDLC、TG、HDL-C、LH及apo A差异有统计学意义(P<0.05)。C组BMI、腰围、臀围、TG、VLDLC及apo A均高于A组(P<0.05),而HDL及LH均低于A组(P<0.05)。C组BMI及TG均高于B组,差异有统计学意义(P<0.05),而HDL-C低于B组,差异有统计学意义(P<0.05)。B组VLDLC高于A组(P<0.05)。TSH升高与BMI、体质量、腰围、臀围、TG、VLDL-C、HOMA-IR呈正相关,而与HDL-C、LH呈负相关(P<0.05)。与其他相关代谢指标之间无统计学意义(P>0.05)。结论:PCOS患者的TSH与脂代谢指标有相关性,TSH>4 m IU/L时脂代谢发生显著变化。
Objective: To investigate the correlation between serum thyrotropin (TSH) levels and clinical features and endocrine and metabolic indexes in patients with polycystic ovary syndrome (PCOS). Methods: The height, body mass, waist circumference and hip circumference were measured in 485 PCOS patients. Serum TSH, free thyroxine (FT4), free triiodothyronine (FT3) and total cholesterol (TC) were measured by electrochemiluminescence. LDL-C, VLDL-C, HDL-C, triglyceride, apo A, (Apo B), fasting blood glucose (FBG), fasting insulin (INS), follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone (T), prolactin (PRL), estradiol (E2), androstenedione (A2) and sex hormone binding globulin (SHBG) were calculated. The body mass index (BMI), WHR and LH / FSH were calculated. Insulin Resistance Index (HOMA-IR). Group A (n = 297): TSH <2.5 m IU / L; Group B (n = 120): TSH 2.5-4.0 mU / L; Group C (n = 68): TSH> 4.0 m IU / L. The differences among the above three indexes and the correlation between TSH and each index were compared between the three groups. Results: There were significant differences in BMI, waist circumference, hip circumference, VLDLC, TG, HDL-C, LH and apo A between the three groups (P <0.05). The BMI, waist circumference, hip circumference, TG, VLDLC and apo A in group C were significantly higher than those in group A (P <0.05), while the levels of HDL and LH in group C were lower than those in group A (P <0.05). The BMI and TG in group C were significantly higher than those in group B (P <0.05), but HDL-C was lower than that in group B (P <0.05). VLDLC in group B was higher than that in group A (P <0.05). The elevation of TSH was positively correlated with BMI, body mass, waist circumference, hip circumference, TG, VLDL-C and HOMA-IR, but negatively correlated with HDL-C and LH (P <0.05). There was no significant difference with other related metabolic parameters (P> 0.05). CONCLUSIONS: There is a correlation between TSH and lipid metabolism index in patients with PCOS. Lipid metabolism changes significantly when TSH> 4 m IU / L.