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다낭성난소증후군에서 성선자극호르몬 분비 이상과 임상적, 호르몬, 대사적 특성과의 연관성

INAPPROPRIATE GONADOTROPIN SECRETION IN POLYCYSTIC OVARY SYNDROME: THE RELATIONSHIP WITH CLINICAL, HORMONAL AND METABOLIC CHARACTERISTICS

임경진|최영미|전영은|조시현|최영식|서석교|이병석|심아라|황유임
대한산부인과학회 (Korean Soceity of Obstetrics and Gynecology)|2011.11|Obstetrics & Gynecology Science|제54권 제11호|pp. 659-665

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키워드

다낭성난소증후군Polycystic ovary syndrome황체형성호르몬Luteinizing hormone (LH)난포자극호르몬황체형성호르몬/난포자극호르몬 비Follicle stimulating hormone (FSH)LH/FSH ratio
주제분류산부인과학

초록

목적다낭성난소증후군 환자에서 황체형성호르몬(luteinizing hormone, LH) 과 난포자극호르몬(follicle-stimulating hormone, FSH)의 비에 따른 임상적, 호르몬, 대사적 특성과의 연관성에 대하여 알아보고자 하였다. 연구방법총 225명의 다낭성난소증후군 환자가 연구에 포함이 되었고 혈중 LH/FSH 비에 따라 A군(LH/FSH ＜ 2,160명) 및 B군(LH/FSH > 2, 65명)으로 나누었다. 양 군 간에 초경 연령, 체질량지수, 혈압, 난소 부피, 혈중 안드로겐 농도, 공복 시 당/인슐린 비, homeostatic model assessment of insulin resistance (HOMA-IR), 지질 농도를 포함하여 임상적, 호르몬, 대사적 특성을 비교하였다. 또한, LH/FSH 비와 각 변수들간의 상관관계를 평가하기 위하여 피어슨 상관계수 분석이 시행되었다. 결과초경 연령은 B군에서 유의하게 늦었다. 체질량지수, 허리-엉덩이 둘레비, 혈압은 A군과 비교하여 B군에서 유의하게 낮았다. 난소의 부피,혈중 황체형성호르몬, 에스트라디올, 총 테스토스테론, 성호르몬결합글로불린, 17-수산화 프로게스테론(hydroxyprogesterone, OHP), 저밀도지단백 농도는 B군에서 유의하게 높았다. 75 g 경구 당부하 2시간 후 혈당 및 인슐린 농도, HOMA-IR은 A군에서 유의하게 높았다. 체질량지수를 보정한 후 LH/FSH 비는 초경연령, 총 난소 부피, 총 테스토스테론 농도 및 17-OHP 농도는 통계적으로 유의한 양의 상관관계를보였다. 결론다낭성난소증후군 환자에서 부적절한 성선자극호르몬 분비는 체질량지수와 음의 상관관계를 보이며 체질량지수와 상관없이 늦은 초경나이 및 난소 안드로겐 합성의 증가와 밀접한 관련이 있으나 대사적 특성과는 직접적인 연관성이 없을 것으로 생각된다.

Abstract

Objective To evaluate the clinical, hormonal and metabolic characteristics according to luteinizing hormone (LH)/follicle stimulating hormone (FSH)ratio in women with polycystic ovary syndrome (PCOS). Methods A total of 225 women with PCOS were included in this study. They were divided into two groups according to LH/FSH ratio; group A (LH/FSH < 2,n=160) and group B (LH/FSH > 2, n=65). We compared clinical, hormonal and metabolic characteristics including age at menarche, body mass index (BMI), blood pressures, ovarian volume, and serum androgen levels between the two groups. Serum glucose and insulin levels, fasting glucose/insulin ratio, homeostatic model assessment of insulin resistance (HOMA-IR), and lipid profi les were also compared between the two groups. Pearson correlation coeffi cients were used to evaluate correlation between the LH/FSH ratio and various parameters. Results Age of menarche in the group B was signifi cantly later than that in the group A. BMI, waist-hip ratio and blood pressures were signifi cantly lower in the group B compared to those of the group A. Ovarian volume and serum levels of LH, estradiol, total testosterone, sex-hormone binding globulin, 17-hydroxyprogesterone (OHP), and high density lipoprotein were signifi cantly higher in the group B. Postprandial 2 hours glucose, insulin and HOMA-IR were signifi cantly higher in the group A. After adjustment of BMI, the LH/FSH ratio was signifi cantly positively correlated with age at menarche, ovarian volume, total testosterone levels, and 17-OHP levels. Conclusion The inappropriate gonadotropin secretion may be negatively correlated with BMI, and positively with age of menarche and increased ovarian androgen production irrespective of BMI in women with PCOS. However, it may not be associated with metabolic characteristics.

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