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目的探讨青春期多囊卵巢综合征(polycystic ovary syndrome,PCOS)患者的临床表现及内分泌代谢特征。方法选择2010-01/2012-10月间就诊于南京医科大学附属南京医院妇产科门诊的青春期PCOS患者50例,记录其身高、体质量、月经情况,完善盆腔超声检查,检测性激素水平、空腹血糖、胰岛素、血脂水平并行葡萄糖耐量试验(oral glucose tolerance test,OGTT)。根据是否合并肥胖、胰岛素抵抗、睾酮升高进行分组,比较各组之间激素及代谢水平的差异。结果 1青春期PCOS患者中月经稀发或闭经的发生率达90%;至少一侧卵巢多囊样改变者占90%;肥胖、胰岛素抵抗、高睾酮的发生率分别为36%,30%,20%;糖耐量减低患者7例(14%),血脂代谢异常患者2例(4%)。2肥胖组较非肥胖组空腹胰岛素(fasting insulin,FINS)、胰岛素抵抗指数(insulin resistance index,IR)、甘油三酯(triglyceride,TG)、低密度脂蛋白(low density lipoprotein,LDL)、OGTT2h血糖均显著升高,而黄体生成素(luteinizing hormone,LH)、黄体生成素/卵泡刺激素(the ratio of luteinizing hormone and follicle stimulating hormone,LH/FSH)、高密度脂蛋白(high density lipoprotein,HDL)则显著降低;胰岛素抵抗组较非胰岛素抵抗组体质量指数(body mass index,BMI)、FINS、TG、LDL、OGTT2h血糖均显著升高,而HDL则显著降低;高睾酮组较非高睾酮组IR、OGTT2h血糖均显著升高。结论月经失调是青春期PCOS患者最常见的临床表现;糖脂代谢障碍,肥胖、高睾酮是加重胰岛素抵抗及糖代谢的高危因素,肥胖、胰岛素抵抗是影响脂代谢的高危因素。
Objective To investigate the clinical manifestations and endocrine and metabolic characteristics of adolescent patients with polycystic ovary syndrome (PCOS). Methods 50 patients with adolescent PCOS attending obstetrics and gynecology clinic of Nanjing Hospital Affiliated to Nanjing Medical University from January 2010 to October 2012 were enrolled. The height, body mass and menstruation were recorded. The pelvic ultrasonography was performed. The levels of sex hormones, fasting hormone Blood Glucose, Insulin, Lipid Levels Parallel oral glucose tolerance test (OGTT). According to whether the combination of obesity, insulin resistance, elevated testosterone were grouped to compare the differences in hormone and metabolic levels among the groups. Results 1 Adolescent PCOS patients with menstrual rare or amenorrhea incidence of 90%; at least one side of the ovarian polycysticoid like changes accounted for 90%; obesity, insulin resistance, high testosterone were 36%, 30%, 20 %; Impaired glucose tolerance in 7 patients (14%), dyslipidemia in 2 patients (4%). In the obesity group, the fasting insulin (FINS), insulin resistance index (IR), triglyceride (TG), low density lipoprotein (LDL), OGTT2h blood glucose (P <0.05), while Luteinizing hormone (LH), the ratio of luteinizing hormone and follicle stimulating hormone (LH / FSH), high density lipoprotein (HDL) (P <0.05), but significantly lower in insulin resistance group than that in non-insulin resistance group (P <0.05), body fat index (BMI), FINS, TG, LDL and OGTT2h were significantly increased IR, OGTT2h blood glucose were significantly increased. Conclusions Menstrual disorders are the most common clinical manifestation in adolescent patients with PCOS. Glucose and lipid metabolism, obesity and high testosterone are the risk factors of aggravating insulin resistance and glucose metabolism. Obesity and insulin resistance are the risk factors of lipid metabolism.