多囊卵巢综合征患者糖代谢水平对卵巢超声特征的影响

丁延华; 周青雪; 朱晓玲; 程艳; 姚继芹

doi:10.16766/j.cnki.issn.1674-4152.003036

多囊卵巢综合征患者糖代谢水平对卵巢超声特征的影响

doi: 10.16766/j.cnki.issn.1674-4152.003036

1.
杭州市妇产科医院超声心电科，浙江杭州 310008
2.
杭州市妇产科医院检验科

基金项目:

浙江省医药卫生科技计划项目 2018KY618

详细信息

通讯作者:
丁延华，E-mail: dyh52066@126.com

中图分类号: R445.1 R446
计量
- 文章访问数: 226
- HTML全文浏览量: 89
- PDF下载量: 3
- 被引次数: 0
出版历程
- 收稿日期: 2022-12-13
- 网络出版日期: 2023-08-26

Influence of glucose metabolism level on ovarian ultrasound characteristics in patients with polycystic ovary syndrome

1.
Department of Ultrasonic Cardiology, Hangzhou Obstetrics and Gynecology Hospital, Hangzhou, Zhejiang 310008, China

摘要

摘要: 目的观察不同糖代谢水平多囊卵巢综合征(PCOS)患者卵巢超声特征差异，分析PCOS患者糖代谢水平对卵巢超声特征的影响。方法选择2019年1月—2022年10月于杭州市妇产科医院妇科就诊的200例PCOS患者为研究对象，依据血糖代谢水平不同分为血糖正常(NBG)组(44例)、空腹糖耐量受损(IFG)组(61例)、糖尿病前期(PDM)组(57例)和糖尿病(DM)组(38例)，所有研究对象均进行经阴道三维能量超声检查，分析各组PCOS患者年龄、体重指数、空腹胰岛素含量(FINS)、胰岛素抵抗指数(HOMA-IR)、空腹三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白(LDL)和高密度脂蛋白(HDL)等，观察各组卵巢超声指标差异。结果各组PCOS患者年龄、BMI和HDL差异无统计学意义(均P>0.05)，HOMA-IR、TC、TG和LDL等随PCOS患者糖代谢异常程度的加剧而升高，且IFG组、PDM组和DM组FINS均显著高于NBG组，而DM组FINS显著低于IFG组和PDM组(均P < 0.05)。NBG组、IFG组、PDM组、DM组卵巢体积分别为(11.53±1.49)cm²，(13.16±1.52)cm²，(14.82±1.61)cm²，(16.04±1.64)cm²，差异有统计学意义(F=14.359，P＜0.001)；各组血流指数(FI)、血管化指数(VI)和血管化血流指数(VFI)等超声检测数值均随PCOS患者糖代谢异常程度的加剧而增加(均P < 0.05)。结论 PCOS患者血糖水平持续升高，会导致脂代谢功能紊乱及胰岛素抵抗程度加剧，同时导致卵巢超声特征改变，主要表现为卵巢体积增大、卵巢血液流速加快、卵巢微血管数量增多。
- 多囊卵巢综合征 /
- 糖代谢功能 /
- 胰岛素抵抗 /
- 超声特征
Abstract: Objective To observe the differences of ovarian ultrasound characteristics in polycystic ovary syndrome (PCOS) patients with different glucose metabolism levels, and to analyze the effect of glucose metabolism level on ovarian ultrasound characteristics in PCOS patients. Methods A total of 200 patients with PCOS who were treated in the Department of Obstetrics and Gynecology in Hangzhou Obstetrics and Gynecology Hospital from January 2019 to October 2022 were taken as the research objects. They were divided into normal blood glucose group (NBG, 44 cases), impaired fasting glucose tolerance group (IFG, 61 cases), pre diabetes group (PDM, 57 cases) and diabetes group (DM, 38 cases) according to the level of blood glucose metabolism. All the research objects were examined by transvaginal three-dimensional energy ultrasound. The age, body mass index (BMI), fasting insulin content (FINS), insulin resistance index (HOMA-IR), fasting triacylglycerol (TG), total cholesterol (TC), low density lipoprotein (LDL) and high density lipoprotein (HDL) of PCOS patients in each group were analyzed, and the differences of ovarian ultrasound indexes in each group were observed. Results There was no statistically significant difference in age, BMI and HDL of PCOS patients in each group (all P>0.05). HOMA-IR, TC, TG, and LDL increased with the aggravation of the abnormal degree of glucose metabolism in PCOS patients. The FINS values in IFG group, PDM group and DM group were significantly higher than that in NBG group, while the FINS values in DM group were significantly lower than those in IFG group and PDM group (all P < 0.05). The ovarian volume of NBG group, IFG group, PDM group and DM group were (11.53±1.49) cm², (13.16±1.52) cm², (14.82±1.61) cm², (16.04±1.64) cm², respectively, and the difference was statistically significant (F=14.359, P < 0.001). The values of flow index (FI), vascularity index (VI) and vascularization flow index (VFI) in each group increased with the severity of abnormal glucose metabolism in PCOS patients (all P < 0.05). Conclusion With the continuous increase of blood glucose level in PCOS patients, it will lead to lipid metabolism disorder and the intensification of insulin resistance. At the same time, it will lead to changes in ovarian ultrasound characteristics, mainly manifested as an increase in the volume of ovaries, the acceleration of ovarian blood flow, and the increase in the number of ovarian blood vessels.
- Polycystic ovary syndrome /
- Sugar metabolism function /
- Insulin resistance /
- Ultrasonic characteristics

HTML全文

表 1 各组PCOS患者一般资料情况比较(x±s)

Table 1. Comparison of general data of PCOS patients in each group (x±s)

组别	例数	年龄(岁)	BMI	FINS (mU/L)	HOMA-IR	TC (mmol/L)	TG (mmol/L)	LDL (mmol/L)	HDL (mmol/L)
NBG组	44	31.62±3.25	24.82±1.59	9.25±1.64	2.21±0.37	1.28±0.35	1.31±0.39	2.74±0.41	1.42±0.35
IFG组	61	31.94±3.16	25.03±1.65	23.98±2.53^a	2.94±0.42^a	1.36±0.37	1.42±0.42	2.85±0.46	1.39±0.33
PDM组	57	32.16±3.41	24.96±1.67	24.53±2.67^a	4.37±0.51^ab	1.85±0.43^ab	1.82±0.41^ab	3.26±0.51^ab	1.49±0.32
DM组	38	31.75±3.32	25.17±1.72	18.15±2.18^abc	5.09±0.64^abc	2.31±0.46^abc	2.26±0.47^abc	3.43±0.52^ab	1.51±0.37
F值		0.852	0.749	26.741	20.318	17.685	14.529	12.284	1.143
P值		0.316	0.428	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	0.216
注：与NBG组比较，^aP < 0.05；与IFG组比较，^bP < 0.05；与PDM组比较，^cP < 0.05。

下载: 导出CSV

表 2 各组PCOS患者卵巢三维超声指标比较(x±s)

Table 2. Comparison of ovarian three-dimensional ultrasound parameters in PCOS patients of each group (x±s)

组别	例数	卵巢体积(cm²)	RI	PI	FI	VI	VFI
NBG组	44	11.53±1.49	0.59±0.06	0.81±0.09	31.85±3.41	6.31±0.72	2.38±0.34
IFG组	61	13.16±1.52^a	0.62±0.08	0.79±0.08	32.94±3.62^a	7.79±0.87^a	2.66±0.36^a
PDM组	57	14.82±1.61^ab	0.58±0.07	0.78±0.08	37.26±3.91^ab	8.62±0.93^ab	2.98±0.39^ab
DM组	38	16.04±1.64^abc	0.61±0.08	0.82±0.10	42.69±4.17^abc	9.74±1.13^abc	3.27±0.41^abc
F值		14.359	0.528	0.493	22.517	18.436	15.951
P值		＜0.001	0.613	0.642	＜0.001	＜0.001	＜0.001
注：与NBG组比较，^aP < 0.05；与IFG组比较，^bP < 0.05；与PDM组比较，^cP < 0.05。

下载: 导出CSV

参考文献(18)

[1]	KIM J J. Update on polycystic ovary syndrome[J]. Clin Exp Reprod Med, 2021, 48(3): 194-197. doi: 10.5653/cerm.2020.04329
[2]	郝齐志, 曹辉, 王卫民, 等. 多囊卵巢综合征患者胰岛素敏感性及β细胞功能与体脂的关系[J]. 中华内分泌代谢杂志, 2019, 35(10): 864-866. doi: 10.3760/cma.j.issn.1000-6699.2019.10.010 HAO Q Z, CAO H, WANG W M, et al. Association of insulin sensitivity and β-cell function with body fat in patients with polycystic ovary syndrome[J]. Chinese Journal of Endocrinology and Metabolism, 2019, 35(10): 864-866. doi: 10.3760/cma.j.issn.1000-6699.2019.10.010
[3]	王颖, 侯丽辉, 匡洪影, 等. 不同糖代谢状态多囊卵巢综合征患者胰岛素释放曲线的特征分析[J]. 中华内分泌代谢杂志, 2020, 36(12): 1015-1021. doi: 10.3760/cma.j.cn311282-20200110-00016 WANG Y, HOU L H, KUANG H Y, et al. Analysis on the characteristics of insulin release curve in patients with polycystic ovary syndrome with different glucose metabolism status[J]. Chinese Journal of Endocrinology and Metabolism, 2020, 36(12): 1015-1021. doi: 10.3760/cma.j.cn311282-20200110-00016
[4]	韦怡超, 胡予. 2019 ADA糖尿病医学诊疗标准更新要点解读[J]. 中华老年病研究电子杂志, 2019, 6(4): 1-7. doi: 10.3877/cma.j.issn.2095-8757.2019.04.001 WEI Y C, HU Y. Interpretation of updated main points of "American Diabetes Association: Standards of Medical Care in Diabetes-2019"[J]. Chinese Journal of Geriatrics Research(Electronic Edition), 2019, 6(4): 1-7. doi: 10.3877/cma.j.issn.2095-8757.2019.04.001
[5]	陈锦明, 张芬, 邓姣, 等. 中医体质类型与多囊卵巢综合征相关性的meta分析[J]. 中华全科医学, 2022, 20(4): 691-695. doi: 10.16766/j.cnki.issn.1674-4152.002432 CHEN J M, ZHANG F, DENG J, et al. Correlation between TCM constitution and polycystic ovary syndrome: a meta-analysis[J]. Chinese Journal of General Practice, 2022, 20(4): 691-695. doi: 10.16766/j.cnki.issn.1674-4152.002432
[6]	BARBER T M, FRANKS S. Obesity and polycystic ovary syndrome[J]. Clin Endocrinol (Oxf), 2021, 95(4): 531-541. doi: 10.1111/cen.14421
[7]	ARYA S, HANSEN K R, PECK J D, et al. Metabolic syndrome in obesity: treatment success and adverse pregnancy outcomes with ovulation induction in polycystic ovary syndrome[J]. Am J Obstet Gynecol, 2021, 225(3): 280-281.
[8]	李立峰, 王晓艳, 姜健慧, 等. 多囊卵巢综合征患者重组β细胞营养因子水平对糖代谢的影响[J]. 中华全科医学, 2018, 16(3): 437-440. doi: 10.16766/j.cnki.issn.1674-4152.000122 LI L F, WANG X Y, JIANG J H, et al. Effects of Betatrophin levels on glucose metabolism in patients with polycystic ovary syndrome[J]. Chinese Journal of General Practice, 2018, 16(3): 437-440. doi: 10.16766/j.cnki.issn.1674-4152.000122
[9]	TAVARES A, RÊGO BARROS R C. The prevalence of metabolic syndrome in the different phenotypes of polycystic ovarian syndrome[J]. Rev Bras Ginecol Obstet, 2019, 41(1): 37-43. doi: 10.1055/s-0038-1676568
[10]	FROYMAN W, VAN SCHOUBROECK D, TIMMERMAN D. Automated follicle count using three-dimensional ultrasound in polycystic ovarian morphology[J]. Ultrasound Obstet Gynecol, 2018, 51(1): 147-149. doi: 10.1002/uog.18896
[11]	JARRETT B Y, VANDEN B H, OLDFIELD A L, et al. Ultrasound characterization of disordered antral follicle development in women with polycystic ovary syndrome[J]. J Clin Endocrinol Metab, 2020, 105(11): e3847-e3861. doi: 10.1210/clinem/dgaa515
[12]	丁晓飞, 周秋兰, 梁晓雯, 等. 经阴道超声技术在多囊卵巢综合征诊断中的应用新进展[J]. 中国生育健康杂志, 2022, 33(1): 78-80. https://www.cnki.com.cn/Article/CJFDTOTAL-SYJK202201020.htm DING X F, ZHOU Q L, LIANG X W, et al. New progress in the application of transvaginal ultrasound technology in the diagnosis of polycystic ovary syndrome[J]. Chinese Journal of Reproductive Health, 2022, 33(1): 78-80. https://www.cnki.com.cn/Article/CJFDTOTAL-SYJK202201020.htm
[13]	薛嵘, 石景芳, 陈祥云, 等. 经阴道三维能量多普勒超声联合经阴道三维超声自动容积测量诊断多囊卵巢综合征的应用价值[J]. 中国妇幼保健, 2022, 37(5): 956-959. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB202205052.htm XUE R, SHI J F, CHEN X Y, et al. The application value of transvaginal 3D power doppler ultrasound combined with transvaginal 3D ultrasound automatic volume measurement in the diagnosis of polycystic ovarian syndrome[J]. Maternal and Child Health Care of China, 2022, 37(5): 956-959. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB202205052.htm
[14]	李淑清, 黄艺, 李玲, 等. 三维超声测量卵巢体积与卵泡数诊断多囊卵巢综合征的应用价值[J]. 影像研究与医学应用, 2022, 6(15): 53-55. https://www.cnki.com.cn/Article/CJFDTOTAL-YXYY202215018.htm LI S Q, HUANG Y, LI L, et al. The application value of three-dimensional ultrasound measurement of ovarian volume and follicle number in the diagnosis of polycystic ovary syndrome[J]. Journal of Imaging Research and Medical Applications, 2022, 6(15): 53-55. https://www.cnki.com.cn/Article/CJFDTOTAL-YXYY202215018.htm
[15]	李艾芹. 三维结合能量多普勒超声对多囊卵巢综合征的诊断研究[J]. 中国社区医师, 2022, 38(20): 78-80. https://www.cnki.com.cn/Article/CJFDTOTAL-XCYS202220026.htm LI A Q. Study on Diagnosis of Polycystic Ovary Syndrome by Three-Dimensional and Power Doppler Ultrasound[J]. Chinese Community Doctors, 2022, 38(20): 78-80. https://www.cnki.com.cn/Article/CJFDTOTAL-XCYS202220026.htm
[16]	周红梅. 不同血糖水平多囊卵巢综合征患者的超声特征分析[J]. 中国妇幼保健, 2022, 37(2): 360-363. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB202202051.htm ZHOU H M. Analysis of ultrasound characteristics in patients with polycystic ovary syndrome at different blood glucose levels[J]. Maternal and Child Health Care of China, 2022, 37(2): 360-363. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB202202051.htm
[17]	张美微, 侯丽辉, 李妍. 高雄激素血症与胰岛素抵抗对PCOS患者脂代谢的影响[J]. 河北医学, 2019, 25(10): 1690-1694. https://www.cnki.com.cn/Article/CJFDTOTAL-HCYX201910027.htm ZHANG M W, HOU L H, LI Y. Effects of Hyperandrogenemia and Insulin Resistance on Lipid Metabolism in Patients with PCOS[J]. Hebei Medicine, 2019, 25(10): 1690-1694. https://www.cnki.com.cn/Article/CJFDTOTAL-HCYX201910027.htm
[18]	GARG N, KHAIR H K, KAUR M, et al. A comparative study on quantitative assessment of blood flow and vascularization in polycystic ovary syndrome patients and normal women using three-dimensional power doppler ultrasonography[J]. J Obstet Gynaecol India, 2018, 68(2): 136-141.