Clinical Variability in Cardiovascular Disease Risk Factor Screening and Management in Adolescent and Young Adult Women with Polycystic Ovary Syndrome
Clinical Variability in Cardiovascular Disease Risk Factor Screening and Management in Adolescent and Young Adult Women with Polycystic Ovary Syndrome
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DOI：
10.1016/j.jpag.2014.09.010
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发表时间：
2015-10-01
影响因子：
1.8
通讯作者：
DiVasta, Amy D.
中科院分区：
文献类型：
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作者：
Baer, Tamara E.;Milliren, Carly E.;DiVasta, Amy D.
研究目的：回顾2年来多囊卵巢综合征(PCOS)的正常体重(NW)、超重(OW)和肥胖(OB)青春期和青壮年妇女的临床表现、评估和处理。设计：回顾性图表回顾。研究对象：173名青春期和青壮年女性，年龄12-22岁，被诊断为多囊卵巢综合征。干预：人口统计、健康数据和实验室测量从3次临床访问中提取：基线和1年和2年的随访。受试者被分为NW、OW或OB三类。纵向数据采用重复测量变量分析。主要观察指标：体重指数、自我报告的关注和生活方式的改变。结果：大多数患者(73%)是OW或OB。OW(38%)和OB(53%)患者的2型糖尿病家族史高于NW(22%)患者(P=0.002)。黑棘皮病在OW(62%)和OB(21%)患者中被发现，但在NW患者(0%；P<；.001)中没有。尽管筛查率较低，但OB和OW患者的空腹胰岛素(P<；.001)水平高于NW患者(P=.005)，高密度脂蛋白胆固醇水平较低(P=.005)。体重指数Z-分值在OW和OB患者中均随时间的推移而下降(0.07单位/年，P<；.001)。心血管疾病(CVD)筛查存在较大的临床变异性；在筛查的患者中，OW和OB患者具有更大的CVD危险因素。尽管OW和OB患者自我报告对体重和糖尿病风险的担忧，但体重指数百分位数在临床上没有发生显著变化。需要循证干预措施和筛查试验建议，以应对患有多囊卵巢综合征的青少年和年轻人的心血管疾病风险。
Study Objectives: To review the clinical presentation, evaluation, and management of normal-weight (NW), overweight (OW), and obese (OB) adolescent and young adult women with polycystic ovary syndrome (PCOS) during a 2-year follow-up.Design: Retrospective chart review. Participants: One hundred seventy-three adolescent and young adult women, aged 12-22 years, diagnosed with PCOS.Interventions: Demographic, health data, and laboratory measures were abstracted from 3 clinic visits: baseline and 1- and 2-year follow-up. Subjects were classified as NW, OW, or OB. Longitudinal data were analyzed using repeated-measures analysis of variance.Main Outcome Measures: Body mass index, self-reported concerns, and lifestyle changes.Results: Most patients (73%) were OW or OB. Family history of type 2 diabetes was greater in OW (38%) and OB (53%) patients compared with NW (22%) patients (P = .002). Acanthosis nigricans was identified in OW (62%) and OB (21%) patients but not in NW patients (0%; P < .001). OW and OB patients had higher fasting insulin (P < .001) and lower high-density lipoprotein cholesterol (P = .005) levels than NW patients, although screening rates were low. Body mass index Z-scores decreased in both OW and OB patients over time (0.07 unit/yr, P < .001).Conclusions: Most patients with PCOS were OW or OB. Substantial clinical variability existed in cardiovascular disease (CVD) screening; among those screened, OW and OB patients had greater CVD risk factors. Despite self-reported concerns about weight and diabetes risk among OW and OB patients, no clinically significant change in body mass index percentile occurred. Evidence-based interventions and recommendations for screening tests are needed to address CVD risk in adolescents and young adults with PCOS.