多囊性卵巢症候群影響因子之探討
本研究目的在探討多囊性卵巢症候群 (Polycystic ovary syndrome; PCOS) 患者之危險因 子，如：雄性肥胖、胰島素抗性、同半胱胺酸及各類脂質濃度等。採病例對照研究法，
從台安醫院生殖醫學中心選取病例組及對照組，收集其血液檢體並利用結構式問卷調查 研究對象的生活習慣、月經週期史、過去病史及家族疾病史等人口學資料，另外也分析 兩組間微量元素硒、鉻及 ( 抗 ) 氧化壓力的差異。研究結果顯示，多囊性卵巢症候群患 者體內胰島素抗性指標較對照組高 ( 空腹胰島素濃度中位值： 9.0 vs. 4.22 μU/ml, p=0.00 02 ；空腹血糖 / 胰島素比值之中位值： 10.48 vs. 22.62, p=0.0003 ； Homeostasis model a ssessment, HOMA ： 2.09 VS. 0.98, p<0.0001 ； Quantitative sensitivity check index , QUIC KI ： 0.34 vs. 0.39, p<0.0001) ，另外，同半胱胺酸濃度及脂質障礙情形皆較對照組高，
並且達統計上顯著意義， ( 同半胱胺酸中位值 : 8.34 vs. 6.94 μmol/l, p=0.02 ；三酸甘油 脂中位數： 82.0 vs. 62.5 mg/dl, p=0.004 ；膽固醇中位數： 177.0 vs.155.0 mg/dl, p=0.000 9) ；而微量元素鉻 (Chromium) 、硒 (Selenium) 、代表抗氧化壓力的 Glutathione(GSH) 及代表氧化壓力的脂質過氧化物質 (Malondialdehyde;MDA) ，在本研究中並沒有特別的 發現。在模式分析中發現年齡、總膽固醇 / 高密度脂蛋白比值 (Total cholesterol/HDL rati o) 、飯後血糖 (PC sugar) 、胰島素抗性指標 HOMA 是最能解釋罹患 PCOS 的變項，解 釋力達 43% 。本研究結果發現 PCOS 病患同時具備較高的胰島素抗性、高同半胱胺酸 血症及脂質障礙等特性，而這些特性同時也是心血管疾病的危險因子，因此，預防 PC OS 的發生或惡化應該與預防心血管疾病類似，即低油飲食、規律運動、控制體重等生 活習慣的培養是很重要的，而 PCOS 患者未來是否容易發生心血管疾病並不清楚，真正 的關係仍有待釐清。
A study on risk factors of Polycystic Ovary Syndrome
In order to explore the risk factors, such as android obesity, insulin resistance, homocysteine, l ipid profile of Polycystic Ovary Syndrome (PCOS) in women. A case-control study was perfo rmed. Two groups with and without PCOS women were included at the center for reproductiv e medicine and infertility in Taiwan Adventist Hospital. The demographic characteristics were collected by structural questionnaire that included the life habits, history of menstration, past h istory and family history etc. The blood samples were also collected for biochemical examinat ion. Moreover, the concentration of blood trace element (selenium, chromium) in PCOS and n on-PCOS women were also measured.
Our results showed that insulin resistance (median of AC insulin: 9.0 vs. 4.22 μU/ml, p=0.000 2; AC G/I ratio: 10.48 vs. 22.62, p=0.0003; HOMA: 2.09 VS. 0.98, p<0.0001; QUICKI: 0.34 vs. 0.39, p<0.0001), concentration of plasma homocysteine (median: 8.34 vs. 6.94 μmol/l, p=0 .02) and dyslipidemia (median: triglyceride:82.0 vs. 62.5 mg/dl, p=0.004; cholesterol: 177.0 v s.155.0 mg/dl, p=0.0009) in the PCOS patients was significantly higher than in the non-PCOS patients. Waist circumference was high and concentrations of chromium, glutathione were low in PCOS women than non-PCOS women, but not significantly. Selenium and MDA were no fi nding. In multiple logistic regression analysis, Age, Total cholesterol/HDL ratio, pc sugar and HOMA (Homeostasis model assessment) had the best explanatory power for PCOS with coeff iciency of determination 0.43. Because the risk factors of PCOS is identical to cardiovascular r isk factors, therefore, low oil diet, exercise regularly, control the body weight that maybe the most important lifestyles for prevention. Several risk factor clusters together in PCOS women and its contribution to the development of cardiovascular disease need more evidence to confir m in the future.
