Analysis Of The Metabolic Characteristics Of PCOS And Clinical Evaluation After Weight Loss Surgery Or Metformin Treatment

Objective:To observe the basic hormone level and the characteristics of glucose and lipid metabolism in obese patients with PCOS,and the improvement of glucose and lipid metabolism indexes after 3 months of laparoscopic sleeve gastrectomy or oral administration of metformin.Methods:Choose the obese women(BMI≥28 kg/cm~2)with or without PCOS in Hebei medical university second hospital outpatient service of department of gynaecology and Minimally invasive surgery(104 cases),the observation object is divided into obese PCOS group(53 cases)and non-PCOS obese group(51 cases),age and BMI are macthed,compare two groups in the measurement indicators,the difference between sex hormones and glucolipid metabolism index;To observe the improvement of glucose and lipid metabolism indexes in obese PCOS patients 3 months after laparoscopic sleeve gastrectomy(17 cases)or oral metformin(22 cases).Results:1.There was no significant difference between obese PCOS patients in waist circumference(104.3±15.0)cm and WHR(0.9±0.1)and obese non-PCOS patients in waist circumference(109.8±16.1)cm and WHR(0.9±0.1)(P>0.05);For obese PCOS patients,AMH(7.6±3.8)ng/ml,LH/FSH(1.7±0.7),T(1.0±1.0)nmol/L,FAI(18.8±15.2),HOMA-IR(8.7±5.1)ng/ml,TG(2.1±1.3)mmol/L,LDL(3.4±0.7)mmol/L,Apo-B(1.1±0.1)g/L,and uric acid(398.5±80.3)μmol/L were significantly higher than those in the non-PCOS group AMH(4.4±2.4)ng/ml,LH/FSH(1.3±0.8),T(0.6±0.2)nmol/L,FAI(7.9±5.4),HOMA-IR(6.9±5.6)ng/ml,TG(1.6±0.7)mmol/L,LDL(2.8±0.7)mmol/L,Apo-B(1.0±0.2)g/L,and uric acid(365.4±64.0)μmol/L(P>0.05);SHBG(23.3±15.0)nmol/L in obese PCOS patients was significantly lower than SHBG(29.0±13.5)nmol/L in obese non-PCOS patients(P<0.05).2.AMH and INS(r=0.266;P=0.045),apo-b(r=0.414;P=0.002)showed a signifycant positive correlation.LH and FPG(r=0.33;P=0.016),INS(r=0.66;P=0.008),HOMA-IR(r=0.42;P=0.002),HbA1c(r=0.55;P=0.011),TG(r=0.67;P=0.049)significant positive correlation;T was positively correlated with HOMA-IR(r=0.73;P=0.003).3.Body weight(93.7±20.3)kg,BMI(33.7±6.9)kg/cm2,INS(8.3±4.5)mmol/L,HOMA-IR(1.9±1.2),TG(1.3±0.4)mmol/L)3 months after laparoscopic sleeve gastrectomy in obese PCOS patients compared with preoperative body weight(113.3±25.0)kg,BMI(40.7±8.6)kg/cm2,INS(19.8±11.7)mmol/L,HOMA-IR(5.8±3.9),TG(2.1±1.6)mmol/L all decreased significantly(P<0.05).After three months of treatment,HOMA-IR(5.2±2.6)of metformin group was significantly lower than that of preoperative HOMA-IR(8.4±6.9)(P<0.05),and there was no statistically significant difference in the improvement of HOMA-IR between the two groups(P>0.05).Conclusion:1.AMH,LH/FSH,T,SHBG and FAI of obese PCOS patients were significantly higher than that of obese controls,and insulin resistance and lipid metabolism disorders were more serious.2.Body weight and BMI of obese PCOS patients were significantly decreased after weight loss,and IR and blood lipid were significantly improved.IR of metformin group was improved,and there was no difference in the degree of IR improvement between the two groups.