摘要目的 分析初诊的不同表型多囊卵巢综合征(PCOS)患者血清脂质谱的变化,探究高胰岛素血症与高雄激素血症在其中所起的不同作用.方法 收集初诊PCOS患者32例,同时选择年龄和体质指数(BMI)匹配的正常育龄妇女34例作为对照,采集病史、体检和血标本,测常规生化和激素水平,利用液相和气相色谱联用质谱(LC-MS和GC-MS)测定血清脂质谱和多不饱和脂肪酸代谢产物的水平.结果 (1)肥胖的PCOS患者存在磷脂酰胆碱(PC)/溶血磷脂酰胆碱(LPC)代谢异常:PC(16∶0,18∶0,18∶1,18∶2,20∶4)升高,LPC(16∶0,18∶0,18∶1)下降(均P<0.05);(2)多不饱和脂肪酸(PUFA)显著下降,长链饱和脂肪酸升高;(3)通过测定PUFA代谢及其代谢产物水平,发现胰岛素促进PUFAs的代谢,而雄激素则起抑制作用.结论 PCOS患者存在磷脂、游离脂肪酸及多不饱和脂肪酸代谢的异常;胰岛素可能参与促进PUFAs的代谢,雄激素可能在其中发挥抑制作用.

abstractsObjective To investigate serum lipid profiles in newly diagnosed patients with polycystic ovary syndrome (PCOS) using lipidomics and correlate these features with hyperinsulinemia and hyperandrogenism associated with PCOS and obesity. Methods 32 newly-diagnosed PCOS women and 34 controls were enrolled and divided into obese and lean subgroups according to the body mass index (BMI). Anthropometric, biochemical, and hormonal parameters were collected. Serum lipid profiles including phospholipids, free fatty acids (FFAs), and bioactive lipids were analyzed using GC-MS and LC-MS. Results PCOS patients, in particular, the obese ones with fatty liver, have abnormal phosphatidylcholine (PC)/lysophospholipid (LPC) metabolism. PC was increased (16∶0, 18∶0, 18∶1, 18∶2, and 20∶4), while LPC was decreased (16∶0, 18∶0, and 18∶1; all P<0.05). Serum polyunsaturated fatty acids (PUFAs), were decreased significantly, and the long chain saturated fatty acid was increased. We also found that insulin stimulated the metabolism of PUFAs, but the androgen inhibits the metabolism of PUFAs by measuring their metabolites. Conclusion PCOS patients have metabolic disorders of phospholipids and PUFAs. Insulin stimulated while androgen inhibited PUFAs metabolism.