A Preliminary Study On The Influencing Factors And Cluster Analysis Of Serum Uric Acid In Patients With Polycystic Ovary Syndrome

Background:Hyperuricemia(HUA)is a result of purine metabolism disorder and has long been regarded as uncommon in premenopausal women.However,in recent years,the prevalence of HUA in females is increasing.The experience from gout clinic conducted by Department of General Internal Medicine in Peking Union Medical College Hospital has illustrated that genetic factors as well as metabolic disorders may be associated with HUA in premenopausal women,and after detailed medical history collection and clinical evaluation,some patients are found to have menstrual disorders or suspected polycystic ovary syndrome(PCOS).All factors or diseases mentioned above may play some roles in the development of HUA among premenopausal women.PCOS is a common disease in women of reproductive age,characterized by sex hormone disorders and metabolic disorders.Previous research has payed little attention to serum uric acid(sUA)in PCOS patients.Focusing on sUA and metabolic disorders in PCOS patients may help us learn more about features of and risk factors for HUA of females,and know more about the role of sUA in evaluation of metabolic disorders in PCOS patients so that the management of PCOS may be improved.Objective:The study aims to compare the level of sUA and the prevalence of sUA elevation between PCOS patients and female healthy controls and explore factors affecting sUA as well as the association between sUA and other metabolic components in PCOS patients.Meanwhile,PCOS patients are divided into different groups according to their clinical features.Methods:One hundred and two patients diagnosed with PCOS at gynecological endocrine clinics in Peking Union Medical College Hospital during December,2018 and July,2019 with complete medical records were included in the research.Clinical features were analyzed and compared between PCOS patients and age-matched or BMI-matched premenopausal female healthy control respectively.Linear regression and binary logistic regression were conducted to explore factors affecting sUA level and risk factors for HUA,respectively.Clustering analysis was done to divide PCOS patients into different groups.Results:(1)The mean age of 102 PCOS patients is 27.48 years old(ranging from 15 to 39 years old),the mean BMI and sUA were 24.28kg/m2 and 322.71 ?mol/L,respectively.The proportion of patients with sUA higher than normal was 28.4%.The level of sUA or triglycerides(TG)and the proportion of patients whose sUA or TG was higher than normal were significantly higher in PCOS patients than in age-matched or BMI-matched healthy control(p<0.05).(2)Results have shown that the change of BMI,total cholesterol(TC),TG,fasting blood glucose(FBG),post-prandial blood glucose(PBG),fasting insulin(FINS),HOMA-IR and testosterone(T)level was consistent with the change of sUA in quartile(p<0.05),while the trend of progesterone(P)and follicle-stimulating hormone(FSH)(p<0.05)were inversely associated with the change of sUA in quartile.(3)Multivariate linear regression has shown that sUA was positively correlated with BMI and FINS level(p<0.001,adjusted R2.0.394).The binary logistic regression has shown that BMI?24 kg/m2(OR=9.08,95%CI:1.67-49.31,p=0.011)and FINS abnormality(OR=11.14,95%CI:2.80-44.3'5,p=0.001)may be independent risk factors for sUA abnormality.(4)PCOS patients could be divided into four groups by hierarchical clustering analysis,with growing severity of metabolic disorders from Group One to Group Four.None of the patients in Group One and Two had elevated sUA and they had fewer metabolic disorders than those of Group Three and Four.All patients in Group Four had elevated sUA levels.Conclusion:PCOS patients have a higher risk of HUA.BMI and FINS are important influencing factors for sUA in PCOS patients,which reflects that insulin resistance could be a key factor in development of HUA.The results have also illustrated that sUA elevation may be associated with heavier metabolic problems,so it is important to pay more attention to sUA in PCOS patients in order to facilitate comprehensive management of PCOS.Background:In December,2019,pneumonia of unknown cause cases were reported in Wuhan,Hubei Province,China,and the pathogen was later verified to be a novel coronavirus.The main manifestations of patients with novel coronavirus infected pneumonia included fever,dry cough and dyspnea.Symptoms could progress rapidly and threaten patient's life.To prevent the progression of COVID-19(coronavirus disease 2019)epidemic,on January 23rd,2020,Wuhan city was shut down and government and medical institutions at all levels in different regions of China responded quickly to fight against the epidemic together.General practitioners(GPs)are guardians of public health and contributed a lot to fighting against the COVID-19 epidemic.Their contributions to the control of the epidemic is a reflection of the development of general practice in China.Previous research has rarely paid attention to the influence of epidemics on GPs in career perspectives,meanwhile,research conducted in subjective view of GPs was lacking.Objectives:This study is aimed to explore the influence of COVID-19 epidemic on GPs in career perspectives,paying attention to the subjective feelings of GPs during the epidemic,so that the present conditions of the development of general practice in China could be betters.tudied,and actions could be taken to improve it according to the study.Methods:Telephone semi-structured interviews were conducted from March 14th to March 24th,2020 after getting permits in 12 GPs who were undergoing standardized training for GPs.The main topics of the interview were the impact of COVID-19 epidemic on GPs' wills to continue this job,the changes in attitude to and recognition of general practice.The interviews were recorded and converted to text.Nvivo 11 software was used to code the text and factors influencing GPs' career perspectives were concluded based on the grounded theory and thematic analysis.Results:(1)Eight interviewees were still willing to be a GP after the epidemic and 3 of them had a stronger will to be a GP.Two interviewees hesitated.Two considered to change their job and 1 of them had this thinking due to personal interest instead of this epidemic.(2)Four factors were concluded to have an influence on GPs career perspectives,that is,COVID-19 epidemic outbreak,GPs' responsibility and work in the epidemic,the present conditions of general practice in China and personal factors.Each of them consisted of 4 sub-themes.Conclusions:(1)The influence of COVID-19 epidemic on GPs was various in different aspects and to varying extent.Most of the GPs interviewed chose to continue this job after the epidemic.Most of the interviewees who considered to change their job had already had this thinking before the epidemic and this epidemic has possibly strengthened the idea.(2)The interviewees had a chance to think more about responsibilities of GPs during the epidemic.And they had high expectations that measures could be taken to make general practice develop better in China and make working environment of GPs better.