Glucose And Lipid Metabolism In Different Types Of Patients With PCOS

Objective:To compare the state of metabolism such as plasma glucose and serum lipid in women with different types of polycystic ovary syndrome (PCOS) and to investigate the clinical and metabolic features of them; To observe the expression of the glucose transporter factor (GLUT4) and insulin receptor (INSR) in the endometrial of PCOS with IR.Methods:From Jan 2012 to Jun 2013, a total of 129 women with PCOS in the section for outpatients of First Affiliated Hospital of Shanxi Medical University were enrolled in this study. Divided the patients into 3 types according to the 2003 ESHRE/ASRM Rotterdam consensus on diagnostic criteria:there are 58 patients in type A-(hyperandrogenism+anovulation +polycystic ovary); there are 26 patients in type B(hyperandrogenism+ anovulation); there are 45 patients in type C(anovulation +polycystic ovary). (1) observation index:general statue:age, menarche age, the times of pregnancy, abortion and dilivery; physical examination: height, weight, waist circumference, hip circumference, blood pressure; laboratory detection:sex hormone, serum lipid, OGTT and insulin releasing test; pelvic cavity of ultrasound examination; calculating:BMI, WHR, HOMA-IR. (2) Observing the expression of GLUT4 and INSR in endometrium by immunohistochemical technique, observation group(n=7) was PCOS with IR and simple hyperplasia endometrium; there were two control groups, one(n=7) was proliferative endometrium, the other(n=8) was simple hyperplasia endometrium.Result:(1) the Clinical and metabolic features of PCOS patients:the proportion of A, B and C are 45.0%,20.2% and 34.8%,respectively; the average age and menarche age are 25 and 13 years old; there are 38 unmarried and 91 married women in PCOS; all the 129 patients were oligomenorrhea or anovulation, ther are 103 polycystic ovary and 84 hyperandrogenism in 129 PCOS pateints; the average level of BMI is 28.02kg/m2 and WHR is 0.91, the ratio of IR、IFG、IGT、 DM and MS are 82.6%(112/129),26.4%(34/129),35.7%(46/129),5.43%(7/129) and 30.2%(35/129), respectively; the total abnormal rate of blood lipid is 52.4%(55/105), the abnormal rate of TC、TG、LDL-C and HDL-C respectivly are 3.8%(4/105)、16.2%(17/105)、3.8%(4/105) and 40%(42/105);(2)the differences of following indexes compared among A,B,and C types were statistically significance:①BMI, WHR, in three types were respectively:(26.50±8.70, 29.90±7.61,28.90±5.22), (0.90±0.12,0.95±0.11,0.93±0.11), in type A were less than type B and C; ② 2-hour serum insulin(113.59±106.13,196.87±153.70, 157.47±127.15),3-hour serum insulin (41.46±92.65,82.51±160.11, 71.47±108.70)mIU/L, in type A were less than type B and C; Fasting plasma glucose(FPG)(5.67±0.95,6.23±1.40,5.69±1.22), A and C type were lower than that of type B; HOMA-IR in three types were (4.45±2.70,6.43±5.29,5.31±4.13), type A was lower than in B;③ total cholesterol, LDL-C in three types were respectively:(4.44±0.73,4.91±0.85,4.46±0.73), (2.59±0.61,3.30±0.56, 2.59±0.75), A and C type were lower than that of type B; triglyceride in three types were (1.01±1.06,1.07±0.60,1.77±1.28) in type A was lower than that in type C; HDL-C in three types were (1.27±0.49, 1.11±0.36,1.01±0.37), in type A is higher than in type C; ④ luteinizing hormone(LH) were respectively (12.95±7.20,7.10±8.00,9.85±7.10), in type A is higher than that in type B; testosterone(T) were respectively (1.30±0.50,1.35±0.53,0.62±0.21), in types A and B were higher than type C;⑤omparison of the abnormal rate about metabolism:abnormal rates of obesity in three types were (34/58,22/26,35/45) respectively, A type of less than B, C types; ⑥ comparing obesity patients of three types were statistically significance:TC and LDL-C were (4.39±1.08,4.84± 1.45,4.19±0.79) and (2.79±0.68,3.26±0.94,2.49±0.66), in type A and C is lower than in type B; TG(0.88±0.51,1.26±1.70,1.86±2.07), in type A is lower than B; HDL-C(1.18±0.34,1.24±0.52,0.92±0.37), in type B is lower than C; T(1.40±0.55,1.40±0.50,0.70±0.20), in type A and B are higher than C. (3) the correlation analysis of metabolic abnormalities:to analyze IR, MS, obesity and abdominal obesity in pairs, the correlation all reached statistical difference except IR&MS(P<0.05); (4)the gray value of GLUT4 and INSR expressed differences in the endometrium was statistically significant (P<0.05), and the observation group is greater than the hyperplasia control group than the proliferative control group.Conclusion:(1) Patients with PCOS are all reproductive age women, irregular menstruation and infertility in the clinical setting and attendance, because the sign of hyperandrogenism is not obviously, so plasma androgen is always used to dignose hyperandrogenism; The incidence of obesity (abdominal obesity), IR and the metabolic abnormalitiesis of blood lipid are higher than previous reports, Severe cases are already IGT even DM. The proportion of IR is much higher than the metabolic syndrome. (2) PCOS with hyperandrogenism and long term anovulation have the most seriously metabolic abnormalities abnormal, PCOS with hyperandrogenism, long term anovulationand and polycystic ovary are least serious; according to comparing the obesity women of the three types, the clinical and metabolic features of PCOS are no bussiness with the type of PCOS but obesity, PCOS women with obesity have higher risk of the abnormal in IR, blood glucose and lipid. (3)There are positive correlation relationship among obesity, IR and MS in PCOS patients. (4) The expression which is associated with IR happened in endometrium of GLUT4 and INSR is a decreasing trend in the normal proliferative endometrium, simple hyperplasia endometrium(non-IR), simple hyperplasia endometrium(PCOS with IR).