An association between non-alcoholic fatty liver disease and polycystic ovarian syndrome
An association between non-alcoholic fatty liver disease and polycystic ovarian syndrome
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DOI：
10.1111/j.1440-1746.2008.05740.x
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发表时间：
2009-02-01
影响因子：
4.1
通讯作者：
Weltman, Martin D.
中科院分区：
文献类型：
--
作者：
Brzozowska, Malgorzata M.;Ostapowicz, George;Weltman, Martin D.
本研究的目的是确定非酒精性脂肪肝（NAFLD）和多囊卵巢综合征（PCOS）之间是否存在关联。使用2003年鹿特丹共识会议标准，对14名连续的育龄期女性患者（20 - 45岁）进行PCOS筛查，这些患者要么具有肝活检证实的NAFLD（50%），要么具有腹部超声（US）证实的脂肪变性以及升高的ALT水平（50%）。排除了雄激素过多症的其他原因。所有受试者均接受相关问卷调查和临床检查以及激素测定、盆腔（1例）或经阴道超声（13例），并筛选代谢综合征的证据。14名妇女中有10名符合2003年鹿特丹共识的PCOS诊断标准（71%）。8名妇女患有寡/闭经，9名妇女表现出高雄激素血症的存在，6名有不孕症的历史。7名妇女有生化高雄激素血症的证据，低SHBG，提高游离睾酮和血清LH浓度升高。7名女性符合美国PCOS标准。10例PCOS患者中有3例同时患有2型糖尿病。PCOS合并NAFLD组的甘油三酯和胆固醇水平高于非PCOS组，而HDL水平低于非PCOS组。5例NAFLD合并PCOS患者在肝活检中发现纤维化，提示更晚期的肝脏疾病。尽管由于样本量的限制，我们发现大多数NAFLD患者存在PCOS的证据。NAFLD妇女应定期筛查PCOS、糖尿病和心血管疾病的代谢危险因素。同样，患有PCOS的女性应该筛查NAFLD。对于一些PCOS女性，特别是那些有代谢综合征证据的女性，应该在更早的年龄考虑肝脏疾病的评估。
The aim of this study was to determine if there is an association between non-alcoholic fatty liver disease (NAFLD) and polycystic ovarian syndrome (PCOS). NAFLD and PCOS are both known to be associated with metabolic syndrome/insulin resistance.Fourteen consecutive female patients of reproductive age (20-45) either with liver biopsy proven NAFLD (50%) or abdominal ultrasound (US) consistent with steatosis together with elevated ALT levels (50%) were screened for PCOS using 2003 Rotterdam consensus meeting criteria. Other causes of hyperandrogenism were excluded. All subjects underwent relevant questionnaire and clinical exam together with hormonal assays, pelvic (1) or transvaginal US (13) and were screened for evidence of the metabolic syndrome.Ten out of fourteen women matched 2003 Rotterdam consensus meeting diagnostic criteria for PCOS (71%). Eight women suffered from oligo/amenorrhoea, nine women manifested presence of hyperandrogenism and six had history of infertility. Seven women had evidence of biochemical hyperandrogenism with low SHBG, raised free testosterone and elevation of serum LH concentration. Seven women fulfilled US criteria for PCOS. Three of ten patients with PCOS also had type 2 diabetes mellitus. Women with PCOS and NAFLD had higher triglyceride and cholesterol and lower HDL level than group without PCOS. Five patients with NAFLD and PCOS had documented fibrosis on liver biopsy, indicative of more advanced liver disease.Despite limitations of the study due to the sample size, we found evidence of PCOS in the majority of subjects with NAFLD. Women with NAFLD should be routinely screened for presence of PCOS, diabetes mellitus and metabolic risk factors for cardiovascular disease. Equally, women with PCOS should be screened for NAFLD. Evaluation for liver disease should be considered at an earlier age in some women with PCOS particularly those with an evidence of metabolic syndrome.