糖尿病与肥胖/脂代谢异常

　　【摘要】 目的 探讨多囊卵巢综合征(PCOS)伴非酒精性脂肪性肝病(NAFLD)患者血清睾酮(T)水平的改变。 方法 选取PCOS伴NAFLD(PCOS+NAFLD)组104例、单纯PCOS组142例、单纯NAFLD组40例和健康对照(NC)组52名，比较各组临床指标水平，并对PCOS伴NAFLD患者的影响因素、血清T与其他指标的相关性及血清T的影响因素进行分析。 结果 与NC、PCOS、NAFLD组相比，PCOS+NAFLD组BMI[(22.90±1.80)、(25.40±3.10)、(24.30±4.40) vs (28.30±4.20)kg/m2]、WHR[(0.74±0.06)、(0.82±0.09)、(0.81±0.16) vs (0.95±0.16)]、FPG[(5.18±0.32)、(5.96±0.46)、(5.10±0.48) vs (6.24±1.08)mmol/L]、FIns[(7.90±3.80)、(10.80±4.10)、(8.30±4.20) vs (12.30±5.70)mU/L]、TG[(1.40±0.90)、(2.00±1.80)、(2.30±1.60) vs (3.10±2.10)mmol/L]、T[(0.50±0.30)、(0.70±0.20)、(0.60±0.20) vs (1.10±0.60)μg/L]、胰岛素抵抗指数(HOMA-IR)升高[(1.90±1.30)、(3.10±0.60)、(3.40±0.90) vs (5.20±1.10)]，HDL-C降低[(1.69±0.40)、(1.44±0.33)、(1.12±0.38) vs (0.96±0.47)mmol/L](P<0.05或P<0.01)。WHR、TG、HDL-C、HOMA-IR和T是PCOS伴发NAFLD的影响因素。BMI、FPG、FIns、HOMA-IR和LH是血清T水平的影响因素。 结论 PCOS和NAFLD存在相关性，高雄激素血症是导致PCOS伴发NAFLD的危险因素，及早重视雄激素干预对防治PCOS伴发NAFLD有重要意义。

　　【关键词】 多囊卵巢综合征;非酒精性脂肪性肝病;胰岛素抵抗;高雄激素血症

　　【Abstract】 Objective To investigate the change of serum testosterone (T) level in polycystic ovary syndrome (PCOS) patients with non-alcoholic fatty liver disease (NAFLD). Methods The clinical data of 102 PCOS patients with NAFLD (PCOS+NAFLD group), 142 PCOS patients without NAFLD (PCOS group), 40 NAFLD patients without PCOS (NAFLD group) and 52 control subjects without both PCOS and NAFLD (NC group) were collected. The clinical data of four groups were compared. Logistic analysis of influential factors for NAFLD genesis was performed in PCOS+NAFLD group. Multiple regression analysis of T level forthe correlative factors was carried out. Results Compared with NC, PCOS and NAFLD group, PCOS+ NAFLD group showed significantly higher levels of BMI [(28.30±4.20) vs (22.90±1.80), (25.40±3.10), (24.30±4.40)kg/m2], of WHR [(0.95±0.16) vs (0.74±0.06), (0.82±0.09), (0.81±0.16)], of FPG [(6.24±1.08) vs (5.18±0.32), (5.96±0.46), (5.10±0.48)mmol/L], of FIns [(12.30±5.70) vs (7.90±3.80), (10.80±4.10), (8.30±4.20)mU/L], of TG [(3.10±2.10) vs (1.40±0.90), (2.00±1.80), (2.30±1.60)mmol/L], of T [(1.10±0.60) vs (0.50±0.30), (0.70±0.20), (0.60±0.20)μg/L], of HOMA-IR [(5.20±1.10) vs (1.90±1.30), (3.10±0.60), (3.40±0.90)] , and significantly lower HDL-C [(0.96±0.47) vs (1.69±0.40), (1.44±0.33), (1.12±0.38)mmol/L] (P<0.05 or P<0.01). BMI, WHR, FPG, FIns, TG, LH and HOMA-IR were the influencing factors for T level. Conclusion PCOS and NAFLD have clinical correlation, hyperandrogenemiaisa risk factor of PCOS with NAFLD, early treatment of androgen is of important significance for preventing PCOS with NAFLD.

　　【Key words】Polycystic ovary syndrome (PCOS);Non-alcoholic fatty liver disease (NAFLD);Insulin resistance (IR);Hyperandrogenemia