摘要目的 探讨基于患者体成分特征,通过互联网线上生活方式干预对多囊卵巢综合征(PCOS)患者的治疗作用.方法 纳入2017年5月-2018年3月期间在爱丁互联网连锁门诊上海、杭州、深圳门诊及国内8家妇产科医院自愿参与互联网线上生活方式干预治疗的103例PCOS患者,根据体质量指数(BMI)分为超重和肥胖组(BMI≥24 kg/m2)和非肥胖组(BMI＜24 kg/m2);基于患者体成分测定结果,制定个体化的饮食和运动干预方案并进行微信群组管理.12周后比较干预前后患者的体成分变化与生殖激素、胰岛素抵抗(IR)改善情况和自发排卵恢复情况;并分析这些指标变化与患者排卵恢复的相关性.结果 经12周的生活方式干预后:①超重和肥胖组和非肥胖组体脂率均明显降低(P＜0.01);非肥胖组的骨骼肌占比明显升高(P＜0.01);②超重和肥胖组和非肥胖组胰岛素抵抗指数(HOMA-IR)和胰岛素释放试验曲线下面积均明显降低(均P＜0.01),其中有4例糖尿病患者(超重和肥胖组与非肥胖组各2例)糖耐量均较前改善;③超重和肥胖组脂肪率下降与HOMA-IR降低呈正相关(r=0.368,P=0.021),非肥胖组患者骨骼肌占比升高与HOMA-IR值变化呈明显负相关(r=-0.512,P=0.001);④超重和肥胖组的自发排卵恢复率为60.9％(28/46),非肥胖组为72.1％(31/43),均较治疗前明显升高(P.＜0.001);且超重和肥胖组自发排卵恢复与体脂率下降呈正相关(r=0.343,P=0.003),非肥胖组自发排卵恢复则与骨骼肌占比升高呈正相关(r=0.506,P=0.001).结论 根据患者体成分特征制定个体化的减脂或/及增肌生活方式干预使超重和肥胖PCOS患者脂肪率降低,非肥胖PCOS患者骨骼肌占比升高,可提高患者胰岛素敏感性,进而促进患者排卵功能的恢复;基于体成分的生活方式干预才是精准、科学的生活方式干预.

abstractsObjective To evaluate the effect of an online intervention program based on the analysis of human body composition on reproductive and metabolic abnormalities in polycystic ovary syndrome (PCOS) women.Methods A total of 103 patients with PCOS were recruited from May 2017 to March 2018 in Eden Outpatient and other 8 hospitals,and divided into 2 groups:overweight and obese group [body mass index (BMI) ≥ 24 kg/m2] and non-obese group (BMI＜24 kg/m2).The individualized diet and exercise program was formulated for these PCOS patients.Over the 12 weeks intervention,diet and exercise of the patients was recorded using WeChat Mini Programs.After intervention,changes in body composition,insulin resistance (IR) and ovulation were monitored and their correlations were analyzed.Results After 12 weeks of treatment,1) body fat percentage of both groups significantly decreased (P＜0.01),while only skeletal muscle mass percentage increased in non-obese group (P＜0.01);2) homeostasis model assessment-insulin resistance index (HOMA-IR) and insulin area under curve in both groups significantly decreased (P＜0.01),and intervention improved glucose tolerance in 4 diabetic patients (2 cases in overweight and obese group,2 cases in non-obese group);3) the decrease of HOMA-IR in overweight and obese group was positively correlated with the decrease of body fat percentage in overweight and obese group (r=0.368,P=0.021);while,negatively correlated with the increase of skeletal muscle mass percentage in non-obese group (r=-0.512,P=0.001);4) the recoveries of spontaneous ovulation in overweight and obese group and non-obese group were 60.9％ (28/46) and 72.1％ (31/43),respectively.The recovery of ovulation was positively correlated with the decrease of body fat percentage in the overweight and obese group (r=0.343,P=0.003);while,positively correlated with the increase of skeletal muscle mass percent in non-obese group (r=0.506,P=0.001).Conclusion According to the body composition,an individualized lifestyle intervention reduces body fat percentage of obese PCOS patients and increases skeletal muscle body mass in non-obese PCOS patients,then improves IR and recover spontaneous ovulation.The intervention of lifestyle based on body composition is precise and scientific intervention of lifestyle