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目的 :探讨肥胖型多囊卵巢综合征(polycystic ovary syndrome,PCOS)患者的超声特征及其与内分泌指标间的相关性。方法:共纳入126例PCOS患者,以体质量指数(BMI)≥25 kg/m2诊断为肥胖,分为PCOS肥胖组(45例)和PCOS非肥胖组(81例)。经腔内超声测量患者的卵巢和子宫灰阶及彩色多普勒二维超声参数,并检测性激素及血脂等相关内分泌指标,进行2组间比较,分析各超声参数与内分泌指标间的相关性。结果:PCOS肥胖组与非肥胖组比较,肥胖组患者的卵巢卵泡数、卵巢体积、卵巢间质面积与总面积之比(stromal area/ovarian total area,SA/TA)、子宫动脉阻力指数(resistance index,RI)及游离睾酮、三酰甘油、胰岛素抵抗指数(the extent of insulin resistance and hyperandrogenism,HOMA-IR)、餐后2 h血糖、空腹血浆胰岛素、餐后2 h胰岛素、空腹血糖水平均明显增高(P均<0.05),而卵巢间质动脉RI、性激素结合球蛋白、高密度脂蛋白胆固醇则均明显降低(P均<0.05);非肥胖组的黄体生成素(luteinizing hormone,LH)和卵泡刺激素(follicle stimulating hormone,FSH)明显较高(P<0.05)。PCOS肥胖组中,卵泡数与BMI、LH/FSH呈正相关(r=0.31、0.46,P均<0.01),卵巢体积与BMI、空腹血糖、糖化血红蛋白、HOMA-IR、餐后2 h血糖呈正相关(r=0.44、0.50、0.79、0.44、0.39,P均<0.05),卵巢SA/TA与BMI呈正相关(r=0.37,P<0.01),子宫动脉RI与雄烯二酮呈正相关(r=0.52,P<0.05);而卵巢间质动脉RI与BMI呈负相关(r=-0.28,P<0.05)。PCOS非肥胖组中,卵泡数与LH/FSH呈正相关(r=0.38,P<0.05);卵巢体积与游离睾酮呈正相关(r=0.46,P<0.05)。结论:PCOS肥胖患者的超声参数具有一定特征性,且与内分泌指标间有一定相关性,而按BMI对患者进行分型,对评估其病情、发生代谢综合征风险及预防远期并发症有一定参考价值。
Objective: To investigate the ultrasound features of obese patients with polycystic ovary syndrome (PCOS) and its correlation with endocrine parameters. METHODS: A total of 126 PCOS patients were enrolled in this study. Obesity was diagnosed by body mass index (BMI) ≥25 kg / m2, divided into PCOS obesity group (n = 45) and PCOS non-obesity group (n = 81). The ovarian and uterine gray scales and color Doppler ultrasound parameters of the patients were measured by intra-uterine ultrasound, and the related endocrine indexes such as sex hormones and blood lipids were measured. The correlation between the parameters of ultrasound and endocrine indexes was analyzed. Results: Compared with the non-obese group, the ovarian total area (SA / TA), ovarian follicle number, ovarian volume, the ratio of ovarian total area index, RI) and free testosterone, triglyceride, the extent of insulin resistance and hyperandrogenism (HOMA-IR), postprandial 2-hour blood glucose, fasting plasma insulin, fasting plasma glucose (All P <0.05), while RI, sex hormone binding globulin and high density lipoprotein cholesterol in ovarian interstitial artery were significantly decreased (all P <0.05). Luteinizing hormone (LH) in non-obese group and Follicle stimulating hormone (FSH) was significantly higher (P <0.05). PCOS obesity group, the number of follicles and BMI, LH / FSH was positively correlated (r = 0.31,0.46, P <0.01), ovarian volume and BMI, fasting blood glucose, glycosylated hemoglobin, HOMA-IR, 2 h postprandial blood glucose (r = 0.44,0.50,0.79,0.44,0.39, P <0.05). There was a positive correlation between ovarian SA / TA and BMI (r = 0.37, P <0.01), RI of uterine artery was positively correlated with androstenedione (r = 0.52, P <0.05). The RI of ovarian interstitial artery was negatively correlated with BMI (r = -0.28, P <0.05). PCOS non-obese group, the number of follicles and LH / FSH was positively correlated (r = 0.38, P <0.05); ovarian volume and free testosterone was positively correlated (r = 0.46, P <0.05). Conclusion: The ultrasound parameters of obese patients with PCOS have some characteristics, and there is some correlation with the endocrine index, and according to BMI, the patients are classified to assess their condition, the risk of developing metabolic syndrome and the prevention of long-term complications Reference value.