全球精选文摘 - 多囊卵巢综合征患者睾酮生物利用度增加与非酒精性脂肪肝有关

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多囊卵巢综合征患者睾酮生物利用度增加与非酒精性脂肪肝有关

Increased androgen bioavailability is associated with non-alcoholic fatty liver disease in women with polycystic ovary syndrome

Vassilatou E, Lafoyianni S, Vryonidou A 2010/4/21 16:31:00

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Hum Reprod, 2010,

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Background:
Increased prevalence of abnormal aminotransferase levels and/or ultrasonographic evidence of hepatic steatosis (HS) have been found in women with polycystic ovary syndrome (PCOS). However, factors associated with non-alcoholic fatty liver disease (NAFLD) in PCOS are still under investigation. The aim of this case–control study was to investigate the presence of NAFLD and to assess factors associated with this condition in PCOS patients.

Methods:
A prospective study of 57 premenopausal PCOS patients and 60 age-and weight-matched control women, with a history of no or minimal alcohol consumption was conducted. Anthropometric variables, biochemical and hormonal parameters were determined and NAFLD was evaluated by abdominal ultrasonography and biochemical testing, after excluding causes of secondary liver disease. Insulin resistance was assessed by homeostasis model assessment of insulin resistance (HOMA-IR) and free androgen index (FAI) was calculated.

Results:
PCOS patients had an increased prevalence of HS [21/57 patients (36.8%) versus 12/60 controls (20.0%), P<0.05] and abnormal (≥40IU/l) serum aminotransferase levels [13/57 patients (22.8%) versus 2/60 controls (3.3%), P<0.01] than controls. All patients and controls with metabolic syndrome had HS. Factors associated with HS were PCOS diagnosis, older age, increased BMI, waist circumference (WC), HOMA-IR and FAI values and decreased high-density lipid cholesterol and sex hormone binding globulin levels. PCOS patients had an OR of 3.55 (95% CI: 1.02–5.35) for HS versus controls, after adjustment for age, BMI and WC.

Conclusion:
SNAFLD is common in PCOS patients and increased androgen bioavailability may be implicated, in combination with metabolic abnormalities. Liver evaluation is proposed in PCOS patients, especially in those with metabolic syndrome (Table 5).

Multivariate Analysis
Independent Variable	OR	(95%CI)	P-value
HOMA-IR	1.67	(1.09–2.56)	0.017
HDL-cholesterol	0.9	(0.86–0.97)	0.003
SHBG	0.9	(0.85–0.94)	<0.001
FAI	1.31	(1.10–1.57)	0.002
PCOS	3.55	(1.03–12.25)	0.044

Table 5: Multivariate Logistic Regression Results for Hepatic Steatosis as a Dependent Variable (n=117)

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疾病资源中心

高血压	慢性阻塞性肺病
脂肪性肝病	糖尿病
卒中	肺癌
冠心病	子宫内膜异位症
结直肠癌	乳腺癌
心力衰竭	心律失常

病例分析 [栏目介绍]

甲状腺功能亢进合并黄疸

王燕燕王曙

上海交通大学附属瑞金医院内分泌科

患者，女，69岁。2009年1月无明显诱因下出现乏力，当时程度较轻，未予以重视。2009年3月患者乏力症状加重，尿色逐渐加深，大便习惯改变，颜色变淡。4月18日入我院感染科治疗，诉轻度头晕、心慌，体重减轻10kg。无肝区疼痛，无发热，无腹痛、腹泻、腹胀、里急后重，无恶性、呕吐等。入院半月前于外院就诊，查肝功能：ALT 601IU/L，AST 785IU/L，TBIL 97.7umol/L，白蛋白 41g/L，甲状腺功能：游离T3 30.6pmol/L，游离T4 51.9pmol/L，心电图示快速房颤。

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