肥胖多囊卵巢综合征患者转氨酶升高的影响因素研究

doi:10.12114/j.issn.1007-9572.2021.02.054

摘要/Abstract

摘要： 背景肥胖多囊卵巢综合征（PCOS）患者合并非酒精性脂肪性肝病（NAFLD）的患病率明显高于普通人群，转氨酶是反映NAFLD发生和严重程度的常见指标，目前关于肥胖PCOS患者合并转氨酶升高的影响因素的研究较少。目的探讨肥胖PCOS患者转氨酶升高的相关影响因素。方法纳入2020年1月至2021年6月中国医科大学附属盛京医院内分泌门诊诊治的女性肥胖PCOS患者77例为研究对象（肥胖PCOS组），并纳入同期于该门诊就诊的年龄和体质指数相匹配的女性单纯肥胖患者39例为对照（单纯肥胖组）。回顾性分析两组患者的一般资料、人体成分分析及生化检验结果，比较两组间的差异；分析肥胖PCOS患者合并转氨酶升高的相关因素及独立危险因素。结果肥胖PCOS组的丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、三酰甘油（TG）、总胆固醇（TC）、低密度脂蛋白（LDL）、载脂蛋白B（ApoB）、黄体生成素（LH）、睾酮（T）、空腹胰岛素（FIns）、稳态模型胰岛素抵抗指数（HOMA-IR）、游离雄激素指数（FAI）、LH/卵泡刺激素（FSH）高于单纯肥胖组（P<0.05），肥胖PCOS组的高密度脂蛋白（HDL）、性激素结合球蛋白（SHBG）低于单纯肥胖组（P<0.05），两组年龄、体质指数、腰围、腰臀比、体脂百分比、内脏脂肪面积、空腹血糖、载脂蛋白A1、FSH、泌乳素、孕酮、雌二醇间差异无统计学意义（P>0.05）。Spearman秩相关分析显示转氨酶与TG、TC、LDL、ApoB、T、FIns、HOMA-IR、FAI呈正相关（P<0.05），与HDL呈负相关（P<0.05），与LH、SHBG、LH/FSH无直线相关性（P>0.05）。多因素Logistic回归分析结果显示，T水平升高为肥胖PCOS患者转氨酶升高的独立危险因素〔OR=6.339，95%CI（1.834，21.906），P=0.004〕。结论肥胖PCOS患者的转氨酶升高与脂代谢紊乱、胰岛素抵抗和高雄激素血症相关，其中T水平升高是肥胖PCOS患者转氨酶升高的独立危险因素。

关键词: 多囊卵巢综合征, 肥胖, 转氨酶, 睾酮, 胰岛素抵抗, 脂代谢

Abstract: Background

In comparison to the general population, obese patients with polycystic ovary syndrome (PCOS) have a higher prevalence of nonalcoholic fatty liver disease (NAFLD) . Transaminase is a common indicator for the occurrence and severity of NAFLD. However, there are few studies have investigated associated factors of elevated transaminase in obese PCOS patients.

Objective

To investigate the associated factors of elevated transaminase in female obese PCOS patients.

Methods

One hundred and sixteen female patients were selected from the Endocrine Clinic, Shengjing Hospital of China Medical University from January 2020 to June 2021, comprising 77 obese PCOS patients, and 39 age- and BMI-matched simple obese patients. The demographic data, body composition analysis and biochemical test results of the two groups were comparatively analyzed to explore intergroup differences. The associated factors and independent risk factors for elevated transaminase in obese PCOS patients were explored.

Results

Obese PCOS patients had much higher average levels of ALT, AST, triacylglycerol (TG) , total cholesterol (TC) , low-density lipoprotein (LDL) , apolipoprotein B (ApoB) , luteinizing hormone (LH) , testosterone, fasting insulin (FIns) , homeostatic model assessment for insulin resistance (HOMA-IR) , free androgen index (FAI) and LH/follicle stimulating hormone (FSH) ratio, and much lower average levels of high-density lipoprotein (HDL) and sex hormone binding globulin (SHBG) than simple obese patients (P<0.05) . Two groups had no significant differences in average age, BMI, waist circumference, waist-to-hip ratio, body fat percentage, visceral fat area, fasting blood glucose, apolipoprotein A1, FSH, prolactin, progesterone and estradiol (P>0.05) . Spearman correlation analysis showed that transaminase was positively correlated with TG, TC, LDL, ApoB, testosterone, FIns, HOMA-IR and FAI (P<0.05) . Transaminase was negatively correlated with HDL (P<0.05) . Transaminase had no linear correlation with LH, SHBG and LH/FSH ratio (P>0.05) . Multivariate Logistic regression showed that increased testosterone was an independent risk factor for elevated transaminase in obese PCOS patients〔OR=6.339, 95%CI (1.834, 21.906) , P=0.004〕.

Conclusion

Elevated transaminase may be associated with lipid metabolism disorder, insulin resistance and hyperandrogenism, and increased testosterone was an independent risk factor for elevated transaminase in obese PCOS patients.

Key words: Polycystic ovary syndrome, Obesity, Transaminase, Testosterone, Insulin resistance, Lipid metabolism

中图分类号:

R711.75

王东旭,石文婧,徐樱溪,等. 肥胖多囊卵巢综合征患者转氨酶升高的影响因素研究[J]. 中国全科医学, 2022, 25(03): 320-324. DOI: 10.12114/j.issn.1007-9572.2021.02.054.

图/表 4

参考文献 23

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组别	例数	年龄（岁）	BMI（kg/m²）	腰围（cm）	WHR	体脂百分比（%）	VFA（cm²）	ALT〔M（QR），U/L〕	AST〔M（QR），U/L〕	FBG（mmol/L）
单纯肥胖组	39	25.6±5.7	31.8±5.1	98.10±7.86	0.94±0.06	40.51±5.92	158.70±46.13	22.00（2.00）	18.00（9.00）	5.38±0.45
肥胖PCOS组	77	26.1±4.4	31.2±4.4	99.68±8.35	0.95±0.05	40.94±5.57	162.14±45.92	44.00（53.50）	27.00（30.50）	5.57±0.59
t（Z）值		0.346	0.694	0.978	1.559	0.309	0.307	-3.949^a	-4.038^a	1.942
P值		0.730	0.489	0.330	0.122	0.758	0.762	<0.001	<0.001	0.055

组别	例数	年龄（岁）	BMI（kg/m²）	腰围（cm）	WHR	体脂百分比（%）	VFA（cm²）	ALT〔M（QR），U/L〕	AST〔M（QR），U/L〕	FBG（mmol/L）
单纯肥胖组	39	25.6±5.7	31.8±5.1	98.10±7.86	0.94±0.06	40.51±5.92	158.70±46.13	22.00（2.00）	18.00（9.00）	5.38±0.45
肥胖PCOS组	77	26.1±4.4	31.2±4.4	99.68±8.35	0.95±0.05	40.94±5.57	162.14±45.92	44.00（53.50）	27.00（30.50）	5.57±0.59
t（Z）值		0.346	0.694	0.978	1.559	0.309	0.307	-3.949^a	-4.038^a	1.942
P值		0.730	0.489	0.330	0.122	0.758	0.762	<0.001	<0.001	0.055

项目		TG	TC	HDL	LDL	ApoB	LH	T	SHBG	FIns	HOMA-IR	FAI	LH/SH
ALT
	r_s值	0.359	0.387	-0.295	0.473	0.327	0.179	0.477	-0.157	0.369	0.357	0.464	0.152
	P值	<0.001	<0.001	0.001	<0.001	<0.001	0.054	<0.001	0.099	<0.001	<0.001	<0.001	0.103
AST
	r_s值	0.411	0.368	-0.264	0.421	0.351	0.140	0.416	-0.159	0.387	0.365	0.405	0.086
	P值	<0.001	<0.001	0.004	<0.001	<0.001	0.133	<0.001	0.094	<0.001	<0.001	<0.001	0.356

项目		TG	TC	HDL	LDL	ApoB	LH	T	SHBG	FIns	HOMA-IR	FAI	LH/SH
ALT
	r_s值	0.359	0.387	-0.295	0.473	0.327	0.179	0.477	-0.157	0.369	0.357	0.464	0.152
	P值	<0.001	<0.001	0.001	<0.001	<0.001	0.054	<0.001	0.099	<0.001	<0.001	<0.001	0.103
AST
	r_s值	0.411	0.368	-0.264	0.421	0.351	0.140	0.416	-0.159	0.387	0.365	0.405	0.086
	P值	<0.001	<0.001	0.004	<0.001	<0.001	0.133	<0.001	0.094	<0.001	<0.001	<0.001	0.356

变量	赋值
转氨酶	ALT>40 U/L和/或AST>35 U/L=1，ALT≤40 U/L且AST≤35 U/L=0
TG	≥1.40 mmol/L=1，<1.40 mmol/L=0
TC	≥4.79 mmol/L=1，<4.79 mmol/L=0
HDL	≥1.23 mmol/L=1，<1.23 mmol/L=0
LDL	≥2.91 mmol/L=1，<2.91 mmol/L=0
ApoB	≥0.94 g/L=1，<0.94 g/L=0
T	≥2.18 nmol/L=1，T<2.18 nmol/L=0
FIns	≥19.70 mU/L=1，<19.70 mU/L=0
HOMA-IR	≥4.70=1，<4.70=0
FAI	≥11.78%=1，<11.78%=0