한국인 다낭난소증후군 환자의 임상특징
The clinical characteristics of Korean women with polycystic ovary syndrome
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목적 : 다낭난소증후군(polycystic ovary syndrome, PCOS)은 만성 무배란과 안드로겐 과다를 특징으로 하는 가임 여성의 5～10%에서 발생하는 흔한 내분비질환이다. PCOS는 인슐린 저항성을 포함한 여러 가지 기전에 의한 증후군으로 그 임상양상 또한 인종에 따라 다양하게 보고되어 있다. 본 연구는 한국인 PCOS 환자의 대사 양상을 포함한 임상 특징을 규명하고자 시행되었다. 방법 : 2003년 3월부터 2006년 5월까지 European Society of Human Reproduction and Embryology (ESHRE) 기준으로 진단된 156명의 PCOS 환자와 대조군 252명을 대상으로 하였다. 대조군은 월경주기가 정상이고 직계가족 중 당뇨병, 고혈압, 불임의 병력이 없는 여성으로 하였다. 신체계측과 FG score를 산출하였고, 생식호르몬 농도, 혈청 지질농도, 내당능 상태와 인슐린 감수성 평가를 위한 75 g 경구 당부하검사를 시행하였다. 결과 : PCOS 환자 26.9%에서 비만이 6.4%에서 조모증이 있었다. 경구 당부하 검사를 시행한 결과 PCOS 환자 156명 중 1명 (0.6%)이 당뇨병이었고, 25명 (16.0%)이 내당능 장애였다. PCOS 환자의 트리글리세리드 농도, 경구 당부하검사의 0분, 30분, 60분, 90분, 120분 혈당과 30분, 60분, 90분, 120분 인슐린이 대조군에 비해 의미 있게 높았다 (p<0.05). PCOS 환자에서 대조군에 비해 인슐린 저항성 지표인 HOMA-IR이 의미 있게 높았다 (p<0.05). 결론 : 한국인 PCOS 환자는 조모증과 비만의 빈도는 다른 인종에 비해 낮았으며 인슐린 저항성은 현저하였다.
Abstract
Background : Polycystic ovary syndrome (PCOS) is characterized by chronic anovulation and hyperandrogenism and this malady arises in 5～10% of reproductive women. There may be significant ethnic and racial variations in the clinical presentation of PCOS. The current study is aimed to define the clinical characteristics, including the metabolic features, of Korean women with PCOS. Methods : We recruited 156 patients with PCOS and 252 healthy regular cycling women as controls between March 2003 and May 2006. The diagnosis of PCOS was made according to the criteria of the European Society of Human Reproduction and Embryology in 2003. The anthropometric measurements including weight, height, waist circumference, and physical examination for the modified Ferriman-Gallwey hirsutism scoring scale were performed. Reproductive hormones, blood lipids and standard 75g oral glucose tolerance tests were done to assess glucose tolerance and insulin sensitivity. Results : Twenty six percent of the women with PCOS were obese and 6.4% of them had hirsutism. One of the 156 women (0.6%) with PCOS was newly diagnosed with diabetes mellitus and 25 of them (16.0%) had impaired glucose tolerance. The triglyceride levels and plasma glucose levels at 0, 30, 60, 90 and 120 minute and the plasma insulin levels at 30, 60, 90 and 120 minutes after initiating the oral glucose tolerance test in women with PCOS were significantly higher compared to those values for the controls. The HOMA-IR was significantly higher in the women with PCOS compared to the controls, even after adjusting for age and the body mass index. Conclusions : Obesity and clinical hyperandrogenism were not frequent in Korean women with PCOS, but this population did display distinct insulin resistance.(Korean J Med 73:169-175, 2007)
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