摘要
目的明确超重及肥胖多囊卵巢综合征（PCOS）患者亚临床甲状腺功能减退（SCH）与生物电阻抗分析（BIA）法所测人体成分以及胰岛素抵抗（IR）的关系。方法回顾性分析2013年4月至2016年4月，在南京大学医学院附属鼓楼医院内分泌科和生殖中心就诊的月经紊乱或不孕不育转诊进行体质量管理的109例超重及肥胖[体质量指数（BMI）≥24kg／m2]PCOS女性临床资料，其中24例SCH，85例甲状腺功能正常（Eu）。通过720人体成分分析仪（Inbody720）进行人体成分测定，同时测定血脂、行75g葡萄糖耐量试验及胰岛素释放试验，并计算稳态模型评估胰岛素抵抗指数（HOMA—IR）。结果SCH检出率为22．02％，自身免疫性甲状腺疾病（Aft）检出率为24．36％。SCH组肥胖程度[（145．19±13．75）％比（153．31±18．15）％，t=-2.032，P=0．045]、内脏脂肪面积（VFA）[（132．48±20．85）cm^2比（147．35±24．26）cm^2，t=-2．730，P=0．007]、体脂肪（BF）[（31．91±5．88）kg比（35．43±6．89）kg，t=-2．274，P=0．025]、体脂百分比（BFP）[（40．92±3．701）％比（43．07±4．26）％，t=-2．241，P=0．027]、体质量指数（BMI）[（30．49±2．88）kg／m2比（32．19±3．81）kg／m2，t=-2．026，P=0．045]和腰围（WC）[（98．34±7．13）am比（102．86±8．74）em，t=-2．324，P：0．022]均低于甲状腺功能正常（EU）组，差异有统计学意义（P均〈0．05）。EU组促甲状腺激素（TSH）水平与肥胖程度、BF、BFP、BMI及臀围（HC）呈正相关（P分别为0．019、0．042、0．025、0．019、0．039），但与VFA不相关（t=1．797，P=0．076）。SCH和EU两组HOMA-IR、胰岛素、血糖、血脂和IR（定义为HOMA．IR≥2．69）检出率差异均无统计学意义（P均〉0．05）。结论PCOS合并SCH组肥胖相关的体成分参数低于EU组，两组IR和血脂水平差异无统计学意义。EU组TSH水平与BMI、BFP有关，但与VFA不相关，尚需进一步扩大样本量研究甲状腺激素对PCOS女性体成分和糖脂代谢的影响及机制。
Objective To determine the association of subclinical hypothyroidism （SCH） with body com- position （measured by body impedance analysis） and insulin resistance （IR） in overweight/obese patients with polycystic ovary syndrome （PCOS）. Methods A retrospective analysis was conducted of the clinical records of 109 overweight or obese [ body mass index （BMI） t〉 24 kg/m2 ] PCOS patients who visited the Department of Endocrinology and Fertility Center of Nanjing Drum Tower Hospital between April 2013 and April 2016 for men-strum disorder or infertility and were referred to receive weight management. 24 of the patients had SCH, and 85 had euthyroid （EU）. We determined the body composition of the patients with Biospace Inbody 720 body compo- sition analyzer, measured the patients＇ serum lipid profiles, conducted in each patient the 75 g oral glucose toler- ance test and the insulin release test, and calculated the homeostasis model assessment of insulin resistance （ HO- MA-IR） indices. Results Patients with SCH and autoimmune thyroiditis （AIT） accounted for 22. 02% and 24.36% of the total. The obesity level [ （145. 19±13.75）% vs. （153.31±18. 15）%, t=-2.032, P=0.045], VFA [ （132.48±20.85） cm2vs. （147.35±24.26） cm2, t=-2.730, P=0.007], body fat （BF） [ （31.91± 5. 88） kg vs. （35.43±6. 89） kg, t=-2. 274, P=0. 025], body fat percentage （BFP） [ （40. 92±3. 701）% vs. （43.07±4.26）%, t=-2.241, P=0.027], body mass index （BMI） [ （30.49±2.88） kg/m2vs. （32.19± 3.81） kg/m2, t=-2.026, P=0.045] and waist circumference （WC） [ （98.34±7.13） cmvs. （102.86± 8. 74） cm, t=-2. 324, P=0. 022] of SCH group were significantly lower than those of euthyroid , with signifi- cant statistical difference. The levels of serum thyroid hormone （TSH） in patients with EU were positively correla- ted with the degree of obesity, the BF, the BFP, the BMI and the hip circumference （P=0. 019, 0. 042, 0. 025, 0. 019, 0. 039）, but not with the VFA （t= 1. 797, P=0. 076）. There were no statistically significant differences （P〉 0. 05） between patients with SCH and those with EU in their HOMA-IR indices, insulin levels, blood glu- cose, blood lipid, and ratio of IR （defined as HOMA-IR I〉 2. 69）. Conclusions Obesity related body composi- tion parameters were lower in PCOS patients with SCH than in those with EU. However, there was no significant difference between the two groups in blood lipid level and the ratio of IR. TSH levels in the EU group were corre- lated with the BMI and the BFP, but not with the VFA. A larger sample is needed to identify how and why thyroid hormones may affect the body composition and glycolipid metabolism of females with PCOS.
出处
《中华临床营养杂志》
CAS
CSCD
2017年第6期366-371,共6页
Chinese Journal of Clinical Nutrition
基金
南京市卫生局科技发展项目（YKK13075）
作者简介
朱大龙，E-mail：zhudalong@nju．edu．cn
