The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지

The clinical characteristics of Korean women with polycystic ovary syndrome

한국인 다낭난소증후군 환자의 임상특징

Park, Hwi-Ra;Oh, Jee-Young;Hong, Young-Sun;Sung, Yeon-Ah;Lee, Hye-Jin;Cheong, Hye-Won
박휘라;오지영;홍영선;성연아;이혜진;정혜원

  • Published : 20070800
⟨ Previous Next ⟩

Abstract

Background : Polycystic ovary syndrome (PCOS) is characterized by chronic anovulation and hyperandrogenism and this malady arises in 5~10% of reproductive women. There may be significant ethnic and racial variations in the clinical presentation of PCOS. The current study is aimed to define the clinical characteristics, including the metabolic features, of Korean women with PCOS. Methods : We recruited 156 patients with PCOS and 252 healthy regular cycling women as controls between March 2003 and May 2006. The diagnosis of PCOS was made according to the criteria of the European Society of Human Reproduction and Embryology in 2003. The anthropometric measurements including weight, height, waist circumference, and physical examination for the modified Ferriman-Gallwey hirsutism scoring scale were performed. Reproductive hormones, blood lipids and standard 75g oral glucose tolerance tests were done to assess glucose tolerance and insulin sensitivity. Results : Twenty six percent of the women with PCOS were obese and 6.4% of them had hirsutism. One of the 156 women (0.6%) with PCOS was newly diagnosed with diabetes mellitus and 25 of them (16.0%) had impaired glucose tolerance. The triglyceride levels and plasma glucose levels at 0, 30, 60, 90 and 120 minute and the plasma insulin levels at 30, 60, 90 and 120 minutes after initiating the oral glucose tolerance test in women with PCOS were significantly higher compared to those values for the controls. The HOMA-IR was significantly higher in the women with PCOS compared to the controls, even after adjusting for age and the body mass index. Conclusions : Obesity and clinical hyperandrogenism were not frequent in Korean women with PCOS, but this population did display distinct insulin resistance.

목적 : 다낭난소증후군(polycystic ovary syndrome, PCOS)은 만성 무배란과 안드로겐 과다를 특징으로 하는 가임 여성의 5~10%에서 발생하는 흔한 내분비질환이다. PCOS는 인슐린 저항성을 포함한 여러 가지 기전 에 의한 증후군으로 그 임상양상 또한 인종에 따라 다양하게 보고되어 있다. 본 연구는 한국인 PCOS 환자의 대사 양상을 포함한 임상 특징을 규명하고자 시행되었다. 방법 : 2003년 3월부터 2006년 5월까지 European Society of Human Reproduction and Embryology(ESHRE) 기준으로 진단된 156명의 PCOS 환자와 대조군 252명을 대상으로 하였다. 대조군은 월경주기가 정상이고 직계가족 중 당뇨병, 고혈압, 불임의 병력이 없는 여성으로 하였다. 신체계측과 FG score를 산출하였고, 생식호르몬 농도, 혈청 지질농도, 내당능 상태와 인슐린 감수성 평가를 위한 75 g 경구 당부하검사를 시행하였다. 결과 : PCOS 환자 26.9%에서 비만이 6.4%에서 조모 증이 있었다. 경구 당부하 검사를 시행한 결과 PCOS 환자 156명 중 1명 (0.6%)이 당뇨병이었고, 25명 (16.0%)이 내당능 장애였다. PCOS 환자의 트리글리세리드 농도, 경구 당부하검사의 0분, 30분, 60분, 90분, 120분 혈당과 30분, 60분, 90분, 120분 인슐린이 대조군에 비해 의미 있게 높았다 (p<0.05). PCOS 환자에서 대조군에 비해 인슐린 저항성 지표인 HOMA-IR이 의미 있게 높았다 (p<0.05). 결론 : 한국인 PCOS 환자는 조모증과 비만의 빈도는 다른 인종에 비해 낮았으며 인슐린 저항성은 현저하였다.

Keywords

References

  1. Diamanki-Kandarakis E, Kouli CR, Bergiele AT, Filandra FA, Tsianateli TC, Spina GG, Zapanti ED, Bartzis MI. A survey of the polycystic ovary syndrome in the Greek island of Lesbos: hormonal and metabolic profile. J Clin Endocrinol Metab 84:4006-4011, 1999 https://doi.org/10.1210/jc.84.11.4006
  2. Asuncion M, Calvo RM, San Millan JL, Sancho J, Avila S, Escobar-Morreale HF. A prospective study of the prevalence of the polycystic ovary syndrome in unselected Caucasian women from Spain. J Clin Endocrinol Metab 85:2434-2438, 2000 https://doi.org/10.1210/jc.85.7.2434
  3. Michelmore KF, Balen AH, Dunger DB, Vessey MP. Polycystic ovaries and associated clinical and biochemical features in young women. Clin Endocrinol 51:779-786, 1999 https://doi.org/10.1046/j.1365-2265.1999.00886.x
  4. Knochenhauer ES, Key TJ, Kahsar-Miller M, Waggoner W, Boots LR, Azziz R. Prevalence of the polycystic ovary syndrome in unselected black and white women of the southeastern United Sates: a prospective study. J Clin Endocrinol Metab 83:3078- 3082, 1998 https://doi.org/10.1210/jc.83.9.3078
  5. Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO. The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab 89:2745-2749, 2004 https://doi.org/10.1210/jc.2003-032046
  6. Carmina E, Lobo RA. Polycystic ovary syndrome (PCOS): arguably the most common endocrinopathy is associated with significant morbidity in women. J Clin Endocrinol Metab 84:1897-1899, 1999 https://doi.org/10.1210/jc.84.6.1897
  7. Dunaif A, Givens JR, Haseltine FP, Merriam GR. Current issues in endocrinology and metabolism: polycystic ovary syndrome. Boston, Blackwell, 1992
  8. Carmina E, Koyama T, Chang L, Stanczyk FZ, Lobo RA. Does ethnicity influence the prevalence of adrenal hyperandrogenism and insulin resistance in polycystic ovary syndrome? Am J Obstet Gynecol 167:1807-1812, 1992 https://doi.org/10.1016/0002-9378(92)91779-A
  9. Wijeyaratne CN, Balen AH, Barth JH, Belchetz PE. Clinical manifestations and insulin resistance (IR) in polycystic ovary syndrome (PCOS) among South Asians and Caucasians: is there a difference? Clin Endocrinol 57:343-350, 2002 https://doi.org/10.1046/j.1365-2265.2002.01603.x
  10. Dunaif A, Sorbara L, Delson R, Green G. Ethnicity and polycystic ovary syndrome are associated with independent and additive decrease in insulin action in Caribbean Hispanic women. Diabetes 42:1462-1468, 1993 https://doi.org/10.2337/diabetes.42.10.1462
  11. The Rotterdam ESHRE/ASRM-sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long health risks related to polycystic ovary syndrome. Hum Reprod 19:41-47, 2004 https://doi.org/10.1093/humrep/deh098
  12. Vermeulen A, Verdonck L, Kaufman JM. A critical evaluation of simple methods for the estimation of free testosterone in serum. J Clin Endocrinol Metab 84:3666-3672, 1999 https://doi.org/10.1210/jc.84.10.3666
  13. The Asia-Pacific perspecitve. Redefining obesity and its treatment [article online]. 2000. Available from http://www.diabetes.com.au/downloads/obesity-report.pdf
  14. World Health Organization. Definition, diagnosis and classification of diabetes mellitus and its complication: report of a WHO consultation: part 1. diagnosis and classification of diabetes mellitus. Geneva, World Health Organization, 1999
  15. Wareham NJ, Phillips DI, Byrne CD, Hales CN. The 30 minute insulin incremental response in an oral glucose tolerance test as a measure of insulin secretion. Diabet Med 12:931, 1995
  16. Oh JY, Hong YS, Sung YA, Barrett-Connor E. Prevalence and factor analysis of metabolic syndrome in an urban Korean population. Diabetes Care 27:2027-2032, 2004 https://doi.org/10.2337/diacare.27.8.2027
  17. 변은경, 김효정, 오지영, 홍영선, 성연아. 서울지역 여자 대학생에서 다낭성난소증후군의 유병율. 대한내분비학회지 20:120-126, 2005
  18. Chang WY, Knochenhauser ES, Bartolucci AA, Azziz R. Phenotypic spectrum of polycystic ovary syndrome: clinical and biochemical characterization of the three major clinical subgroups. Fertil Steril 83:1717-1723, 2005 https://doi.org/10.1016/j.fertnstert.2005.01.096
  19. Sam S, Dunaif A. Polycystic ovary syndrome: syndrome XX? Trends Endocrinol Metab 14:365- 370, 2003 https://doi.org/10.1016/j.tem.2003.08.002
  20. Ehrmann DA, Barnes RB, Rosenfield RL, Cavaghan MK, Imperal J. Prevalence of impaired glucose tolerance and diabetes in women with polycystic ovary syndrome. Diabetes Care 22:141-146, 1999 https://doi.org/10.2337/diacare.22.1.141
  21. Lergo RS, Kunselman AR, Dodson WC, Dunaif A. Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospective, controlled study in 254 affected women. J Clin Endocrinol Metab 84:165-169, 1999
  22. Solomon CG, Hu FB, Dunaif A, Edward JR, Willett WC, Hunter DJ, Colditz GA, Speizer FE, Manson JE. Long or highly irregular menstrual cycles as a marker for risk of type2 diabetes mellitus. JAMA 286:2421-2426, 2001 https://doi.org/10.1001/jama.286.19.2421