The Clinical Features And Serum Metabolomics Studies On Polycystic Ovary Syndrome Patients With Metabolic Syndrome

Ojective:Polycystic ovary syndrome(PCOS)is the common endocrine disease with a cluster of metabolic abnormalities.Women with PCOS have an increased risk of developing type 2 diabetes mellitus and cardiovascular disease.The aim of this tudy was to investigate the prevalence of metabolic syndrome(MS)and the relationship between phlegm-dampness constitution and metabolic abnormalities in PCOS women.Furthermore,we analyzed clinical features and conducted a plasma metabolic analysis to investigate the metabolic changes undrelying PCOS with MS and controls in order to explore potential biomarkers reflecting features of metabolic syndrome in PCOS women,as well as for the early preventinon and treatment of metabolic disturbance.Methods:According to 2003 Rotterdam PCOS criteria and 2005 NCEP-ATP?MS critera,307 PCOS women were recruited to investigate the prevalence of MS and the relationship between phlegm-dampness constitution and metabolic abnormalities in PCOS women.Then,the second study consisted of five groups:44 PCOS with MS as group A,34 PCOS with 0 risk factors of MS as group B,29 MS controls as group C,32 cases with Orisk factors of MS as group D,and 31 obeses women as group E.Clinical and anthropometrical variables were measured in all subjects.Plasma samples of subjects were tested for hormonal,metabolic profiles.Futhermore,we conducted a plasma metabolic analysis to investigate the metabolic changes using ultra high performance liquid chromatography-mass spectrometry.Results:(1)Cilincal results:Of 307 PCOS subjects,there were 97 subjects diagnosed with MS and the prevalence of MS in PCOS women was 31.6%(97/307).The proportion of PCOS patients with phlegm-dampness constitution was 23.78%(73/307),but the propotion of phlegm-dampness constitution subjects was 44.33%(43/97)in PCOS with MS.Age,BMI,FPG,TG,TC,LDL-C,apoB,and apoB/A1 were significant higher in PCOS with phlegm-dampness constitution group when compared with PCOS subjects with no-phlegm-dampness constitution.In the prospective study,there were no significant differerce in age among five groups.Three obese groups of A,C and E were of similar BMI and WHR,and two thin groups of B and D were of similar BMI and WHR.However,WHR was significantly higher in obese groups compared with thin groups.Group B had the highest levels of LH and LH-to-FSH ratio,which were significantly higher than C,D,and E group.Group A had higher T,FAI and HOMA-IR levels compared other control groups.There was significantly higher serum T level in B group compared with D and E groups.While SHBG were significantly higher in A,C and E obese groups compared with B and D groups.Furthermore,the AND level was significantly higher in women with PCOS than subjects without PCOS.However,there were no differences among five groups.A,B,and C groups had a higher serum LDL-C level compared with D and E groups.And apoB,apoB/A1 and AI were higher in subjects with MS than those without MS.(2)Metabonomics results:The results showed that the fat acid,phospholipid,amino acid,and purine metabolism pathways were influenced in PCOS women with MS.Group A had higher levels of plasma free fat acid(including FFA14:0,FFA16:0,FFA18:1,FFA18:2,FFA18:3,FFA20:0,FFA20:4,and FFA22:6),lysophosphatidylcholine(including LPC14:0,LPC16:0,LPC16:1,LPC18:0,LPC18:2,LPC20:4,LPC20:5,and LPC22:5),uric acid,branched-chain and aromatic amino acids as compared with group B and E.Moreover,group A had higher levels of free fat acid(including FFA14:0,FFA18:1,FFA20:0,FFA20:4,and FFA22:6),lysophosphatidylcho-line(including LPC18:2,LPC20:4,LPC20:5,and LPC22:5),amino acids(including glutamic acid,N?-Acetyl-L-Iysine,Y-Glu-Leu and phe-phen)and uric acid than group C.Conclusion:(1)The prevalence of MS in PCOS women shows a marked variation between different regions.phlegm-dampness constitution are associated with etabolic abnormalities in PCOS women.And,phlegm-dampness constitution is the major constitution in PCOS women with MS.(2)The reproductive axis dysfunction is the most common feature in non-obese PCOS with normal metabolism,while hyperinsulinemia and insulin resistance is the characteristic in PCOS subjects with MS.PCOS is an independent cardiovascular risk so that recommend a complete lipid pattern assessment for prevention of cardiovascular disease in all women with PCOS.(3)More marked change in the plasma metabolites in PCOS women with MS is detected compared with MS women.Elevated levels of plasma long-chain free fat acid,lysophosphatidylcholine,uric acid,branched-chain and aromatic amino acids contribute to developing MS in PCOS women.