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中华肥胖与代谢病电子杂志

中华肥胖与代谢病电子杂志 ›› 2021, Vol. 07 ›› Issue (04) : 239 -244. doi: 10.3877/cma.j.issn.2095-9605.2021.04.004

论著

年龄联合腰臀比在肥胖PCOS患者合并SCH筛查的价值分析
江闰犇1, 贾犇黎1, 汪泳1,†()   
  1. 1. 230601　合肥，安徽医科大学第二附属医院减重代谢外科
  • 收稿日期:2021-10-30 出版日期:2021-11-30
  • 通信作者: 汪泳

Analysis of the value of age combined with waist-to-hip ratio in screening obese PCOS patients with SCH.

Runben Jiang1, Benli Jia1, Yong Wang1,†()   

  1. 1. Department of Weight Loss Metabolic Surgery, the Second Hospital of Anhui Medical University, Hefei 230601, China
  • Received:2021-10-30 Published:2021-11-30
  • Corresponding author: Yong Wang
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江闰犇, 贾犇黎, 汪泳. 年龄联合腰臀比在肥胖PCOS患者合并SCH筛查的价值分析[J]. 中华肥胖与代谢病电子杂志, 2021, 07(04): 239-244.

Runben Jiang, Benli Jia, Yong Wang. Analysis of the value of age combined with waist-to-hip ratio in screening obese PCOS patients with SCH.[J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2021, 07(04): 239-244.

目的

研究肥胖伴多囊卵巢综合征（PCOS）患者合并亚临床甲状腺功能减退（SCH）的危险因素，并评估其筛查价值。

方法

回顾性分析2021年1月1日至2021年7月1日在安徽医科大学第二附属医院减重代谢外科就诊的肥胖患者的临床资料，根据PCOS患病情况分为PCOS组和对照组，比较两组SCH患病率差异。进一步将PCOS组患者分为合并SCH组和不合并SCH组，分析患者的一般测量资料、性激素、甲状腺功能、生化等指标。

结果

共纳入患者172例，其中单纯肥胖患者104例，PCOS患者68例，PCOS组中SCH的发生率显著高于对照组（36.76% vs. 17.31%；P=0.004，χ2=8.302）。多因素分析结果显示两个亚组间的年龄、腰臀比（P=0.016，OR=1.144；P=0.044，OR=10.387）具有统计学意义。受试者工作特征曲线（ROC）分析显示联合使用年龄、腰臀比可提高曲线下面积（AUC），诊断SCH的灵敏度和特异度分别为55.8%、88.0%。

结论

肥胖伴PCOS患者并发SCH的风险较高，且年龄、腰臀比是独立危险因素。对于此类患者，年龄联合腰臀比监测具有较好的灵敏度与特异度，可用于肥胖合并PCOS患者并发SCH的筛查。

关键词: 多囊卵巢综合征, 亚临床甲状腺功能减退, 肥胖, 年龄, 腰臀比
Objective

To study the risk factors of obesity and polycystic ovary syndrome (PCOS) patients with subclinical hypothyroidism (SCH), and evaluate its screening value.

Methods

The clinical data of obese patients who attended the Department of Weight Loss and Metabolism in the Second Affiliated Hospital of Anhui Medical University from January 1, 2021 to July 1, 2021 were retrospectively analyzed, according to the prevalence of PCOS, they were divided into PCOS group and control group, the differences in the prevalence of SCH between the two groups were compared. The PCOS group was further divided into combined SCH group and uncombined SCH group, and the general measurement data, sex hormones, thyroid function, biochemical indicators of all patients were analyzed.

Results

A total of 172 patients were enrolled, including 104 patients with simple obesity and 68 obese patients with PCOS. The incidence of SCH in the PCOS group was significantly higher than that in the control group (36.76% vs. 17.31%; P=0.004, χ2=8.302). The results of multivariate analysis showed that age and waist-to-hip ratio (P=0.016, OR=1.144; P=0.044, OR=10.387) were statistically significant between the two subgroups. Receiver operating characteristic curve (ROC) analysis showed that the combined use of age and waist-to-hip ratio could increase the area under the curve (AUC), and the sensitivity and specificity of diagnosing SCHwere 55.8% and 88.0%, respectively.

Conclusions

Obesity combined with PCOS had a higher risk of SCH, and age and waist-to-hip ratio were independent risk factors. For such patients, age combined with waist-to-hip ratio monitoring had good sensitivity and specificity, and could be used to screen obese PCOS patients with SCH.

Key words: Polycystic ovary syndrome, Subclinical hypothyroidism, Obesity, Age, Waist-to-hip Ratio
表1 对照组与PCOS组临床资料比较
  对照组 PCOS组 P值 t值
年龄（岁） 32.39±6.28 28.71±5.89 <0.001* -3.891
BMI（kg/m2） 35.73±4.31 37.27±5.73 0.062 1.887
FSH（mIU/mL） 5.27±2.69 4.62±1.36 0.039* -2.083
LH（ mIU/mL） 6.09±2.10 8.31±3.40 0.023* 2.288
睾酮（ng/dL） 29.99±10.46 63.92±19.46 <0.001* 4.659
TT4（nmol/L） 106.09±15.01 109.58±20.91 0.209 1.261
FT4（pmol/L） 14.89±1.63 15.37±1.73 0.071 1.817
TSH（mIU/L） 3.08±1.44 4.29±3.16 0.004* 2.962
胰岛素（pmol/L） 165.83±47.06 257.99±91.30 0.001* 3.412
FPG（mmol/L） 5.49±0.70 6.91±1.36 <0.001* 7.953
TG（mmol/L） 1.74±0.96 1.96±1.35 0.245 1.169
HDL-C（mmol/L） 1.11±0.22 1.08±0.16 0.247 -1.161
TC（mmol/L） 4.68±0.99 4.38±1.08 0.078 -1.772
LDL-C（mmol/L） 3.07±0.63 2.87±0.70 0.052 -1.957
腰围（cm） 113.08±12.05 115.01±13.98 0.335 0.967
臀围（cm） 119.40±10.83 121.40±11.67 0.254 1.144
腰臀比 0.95±0.07 0.95±0.07 0.879 -0.153
超声多囊（例） 0 26（38.24%） <0.001* —
表2 PCOS合并SCH组与PCOS不合并SCH组临床资料比较
  不合并SCH组（n=43） 合并SCH组（n=25） P值 t/χ2值
年龄（岁） 30.28±6.24 25.76±4.53 0.002* -3.163
BMI（kg/m2） 36.92±5.43 37.88±6.28 0.510 0.662
FSH（mIU/mL） 4.56±1.33 4.74±1.45 0.612 0.510
LH（mIU/mL） 6.99±3.24 10.58±4.36 0.074 1.855
睾酮（ng/dL） 57.23±16.62 75.42±19.15 0.227 1.221
TT4（nmol/L） 109.18±22.66 110.18±17.93 0.850 0.190
FT4（pmol/L） 15.51±1.84 15.13±1.55 0.389 -0.868
TSH（mIU/L） 2.71±0.84 7.02±3.79 <0.001* 5.611
胰岛素（pmol/L） 228.76±69.77 308.24±60.35 0.221 0.002
FPG（mmol/L） 6.77±1.08 6.62±0.98 0.008* 2.753
TG（mmol/L） 1.83±1.01 2.17±1.81 0.329 0.984
HDL-C（mmol/L） 1.08±1.16 1.07±0.18 0.769 -0.294
TC（mmol/L） 4.40±1.07 4.36±1.13 0.879 -0.153
LDL-C（mmol/L） 2.92±0.58 2.79±0.88 0.452 -0.756
腰围（cm） 116.16±14.18 113.04±13.67 0.378 -0.887
臀围（cm） 120.79±12.20 122.44±10.86 0.578 0.559
腰臀比 0.96±0.07 0.92±0.07 0.020* -2.394
超声多囊（例） 17（39.53%） 9（36.00%） 0.772 0.084
表3 PCOS患者并发SCH的危险因素分析
影响因素 β Wald值 P值 OR值 95% CI
年龄 0.135 5.760 0.016 1.144 1.025 ~1.277
FPG -1.000 2.120 0.145 0.368 0.096~1.414
腰臀比 2.341 4.062 0.044 10.387 1.067~101.158
图1 ROC曲线图
表4 各项指标的诊断效果评价
检验变量 AUC P值 95% CI 诊断点取值 灵敏度 特异度 最大约登指数
年龄 0.725 0.002 0.603~0.846 29.5 0.558 0.840 0.398
腰臀比 0.660 0.028 0.522~0.798 0.945 0.605 0.680 0.285
年龄+腰臀比 0.771 0.000 0.657~0.884 0.731 0.558 0.880 0.438
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