The Study On The Relationship Between Serum Fructose And Uric Acid In Women With Polycystic Ovary Syndrome

Objective:Polycystic ovary syndrome（PCOS）is closely linked to metabolic disorders.Uric acid is a downstream product of fructose,while the fructose and uric acid are associated with metabolic disorders characterized by PCOS such as obesity and insulin resistance.However,the relationship between serum uric acid and fructose levels in patients with PCOS remains unclear.The experiment aims to clarify the serum uric acid level in patients with polycystic ovary syndrome,and to explore the relationship between the serum uric acid and fructose level in PCOS and PCOS-related metabolic disorders.Methods:A total of 774 Chinese Han women were recruited,including 292 patients with PCOS and 482 control subjects who presented with tubal or male factor infertility.PCOS was diagnosed based on the the Rotterdam criteria.The study population was further subdivided according to PCOS-related metabolic alterations,including obesity,insulin resistance,dyslipidemia,metabolic syndrome.For all subjects,background information including age and body mass index（BMI）was collected.Serum samples were obtained from subjects after 12 hours of fasting on days 3-5 of spontaneous menstrual bleeding or progesterone withdrawal bleeding.One specimen was measured in the clinical laboratory of our hospital to measure the estradiol（E2）,progestin（P）,total testosterone（TT）,luteinizing hormone（LH）,follicle-stimulating hormone（FSH）,prolactin（PRL）,anti-Müllerian hormone（AMH）,fasting plasma glucose（FPG）,lipid profiles,fasting insulin（FSI）,total cholesterol（TC）,triglycerides（TG）,low-density lipoprotein cholesterol（LDL-C）,high-density lipoprotein cholesterol（HDL-C）and thyroid-stimulating hormone（TSH）.Fructose,free testosterone（FT）and dehydroepiandrosterone sulfate（DHEAS）serum concentrations were measured using commercial enzyme-linked immunosorbent assay kits.Serum uric acid levels were determined using an enzymatic assay performed.The distribution of continuous variables was evaluated for normality using the Kolmogorov-Smirnov test.Differences between the PCOS and control groups were examined using an independent sample t-test（normally distributed variables）or the Mann-Whitney U test（non-normally distributed variables）.Restricted cubic splines（RCS）were conducted to assess the relationship between serum uric acid and fructose levels in PCOS.Logistic regression analysis was used to determine the odds ratios（OR）with 95%confidence intervals（CI）for various characteristics associated with hyperuricemia in PCOS.Results:（1）Both serum fructose and uric acid levels were significantly increased in women with PCOS than those in the control women（P<0.001）.（2）RCS indicated that serum uric acid levels linearly and positively correlated with serum fructose levels in women with PCOS(P_overall<0.001,P_non-linear=0.30),whereas no correlation was found between serum uric acid and fructose levels in control women(P_overall=0.712,P_non-linear=0.43).（3）Serum uric acid levels were different in PCOS women at different levels of fructose.（4）There was a correlation between serum uric acid and fructose levels in PCOS women over 25 years of age.（5）Among the metabolic indexes,the serum uric acid level of PCOS women was linearly correlated with FPG,FSI,HOMA-IR,TSH and TG,while non-linear with TC,LDL-C and HDL-C.（6）Among endocrine indexes,the serum uric acid level of PCOS women had a linear relationship with FT and PRL,but a non-linear relationship with LH and E2.（7）In the obese subgroups,there was a non-linear correlation between serum uric acid and fructose levels in PCOS(P_overall<0.001,P_non-linear=0.02).（8）Serum uric acid levels were linearly and positively associated with serum fructose levels in PCOS patients with insulin resistance,dyslipidemia,and metabolic syndrome.（9）After adjusting for confounding factors,elevated serum fructose levels were an independent risk factor for hyperuricemia in patients with PCOS（P=0.001;OR,1.380;95%confidence interval,1.207–1.577）.Conclusion:The serum fructose and uric acid were significantly higher in PCOS women than in control women.There was a significantly positive association of elevated uric acid levels with serum fructose levels in PCOS.Elevated serum fructose level is an independent risk factor for hyperuricemia in PCOS patients.suggesting elevated serum uric acid levels in PCOS may reflect an underlying disorder of fructose metabolism.