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題 名 | 多囊性卵巢症候群肥胖患者經生活型態改變減重治療後病情改善--病例報告=Case Report: The Improvement of Obese Polycystic Ovary Syndrome after Weight Reduction by Therapeutic Lifestyle Change |
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作 者 | 張敬仁; 張文道; 張文瀚; 郎惠芬; 蔡森蔚; 陳麗琴; | 書刊名 | 臺灣家庭醫學雜誌 |
卷 期 | 12:2 2002.06[民91.06] |
頁 次 | 頁87-96 |
分類號 | 417.12 |
關鍵詞 | 多囊性卵巢症候群; 肥胖患者; 減重治療; Polycystic ovary syndrome; Obesity; Lifestyle modification; Metabolic syndrome; |
語 文 | 中文(Chinese) |
中文摘要 | 多囊性卵巢症候群(polycystic ovary syndrome,簡稱PCOS)是婦女相當常見的內分泌異常疾病之一。雖然臨床表徵差異性很大,但主要包括三種臨床表徵:(1)慢性不排卵(chronic anovulation)造成的月經異常〔月經次數變少(oligomenorrhea)或無月經(amenorrhea)〕;(2)高雄性素特徵(hyperandrogenism),如多毛症(hirsutism)、青春痘(acne)、高雄性素血症〔黃體化內泌素(LH)上升、睪固酮(testosterone)上升〕;(3)胰島素抗拒性(insulin resistance)相關的代謝異常,如高血壓、高血糖、血脂肪異常、高尿酸血症等。 這位肥胖的多囊性卵巢症候群患者自17歲起即有月經不規則。19歲於本院婦產部求診時,抽血資料顯示:LH/FSH比值上升(3.29)、男性荷爾蒙(睪固酮88 ng/dL)輕度上升,經腹部婦科超音波無異常發現。病人於民國九十年十一月,第一次至本院家庭醫學科健康減重門診求診,當時年齡28歲,身高164.7公分,體重88公斤,身體質量指數(BMI)33.4,腰圍91.5公分、腰臀比0.86,血壓122/92毫米水銀柱,脈搏82次/分,兩側下肢有輕微多毛的現象,實驗室資料顯示總膽固醇輕度偏高(205 mg/dL)、高密度脂蛋白膽固醇偏低(35 mg/dL)、三酸甘油酯明顯升高(427 mg/dL)、輕度空腹血糖昇高(110mg/dL),身體組成分析體脂肪比為38.7%。就診前,有近一年的時間沒有月經來潮。經過生活型態改變的減重治療三週後,體重降至83.2公斤,月經即開始來潮。後來隨著體重繼續下降,月經來潮的間隔、時間及經血量也漸趨正常。至民國九十一年六月二十日,體重已減至64.4公斤(BMI=24.0),腰圍72.8公分、腰臀圍比值0.83,血壓126/79毫米水銀柱,體脂肪比下降至24.5%。實驗室資料顯示LH/FSH比值下降(0.82)、總膽固醇下降(118 mg/dL)、高密度脂蛋白膽固醇上升(44 mg/dL)、三酸甘油酯明顯下降(56 mg/dL)、空腹血糖下降(85mg/dL)。整個治療過程並未使用減重藥物或刺激排卵藥物。 本個案顯示,單獨藉由生活形態改變的減重治療,對於肥胖的多囊性卵巢症候群患者,可以降低其胰島素抗拒性及高雄性素狀態,改善其不排卵及月經週期不規則的現象,且能改善其代謝異常。 |
英文摘要 | Polycystic ovary syndrome (PCOS) is one of the common endocrine diseases in women. Although the symptoms and signs are various, it is mainly comprised of 3 clinical characteristics: (1) menstrual dysfunction, ranging from oligomenorrhea to amenorrhea and resulting from chronic anovulation; (2) clinical signs of hyperandrogenism, such as hirsutism, acne, elevated luteinizing hormone and testosterone; (3) metabolic disorders related to insulin resistance, such as hypertension, hyperglycemia, dyslipidemia and hyperuricemia. We encountered an obese PCOS patient with menstrual irregularity since the age of 17. She first visited our Gynecological OPD when she was 19 and the blood tests revealed elevated LH/FSH ratio (3.29) and high serum testosterone (88 ng/dL). There was no abnormal finding in transabdominal gynecological sonography. She had suffered amenorrhea for 1 year before her first visit to our Healthful Weight-Reduction OPD at the Department of Family Medicine in Nov. 2001 when she was 28 years old. Physical examination showed body height to be 164 cm, body weight 88 kg, body mass index (BMI) 33.4, waist circumference 91.5 cm, waist-to-hip ratio 0.86, blood pressure 122/92 mmHg, pulse rate 82/min, and mild hirsutism over both lower limbs. Laboratory data revealed higher serum total cholesterol (205 mg/dL), triglyceride (427 mg/dL), fasting blood glucose (110 mg/dL), and lower HDL-C (35 mg/dL). Bioelectrical impedance body composition analysis showed a high body fat percentage (38.7%). Therapeutic lifestyle change therapy for weight reduction was administered to her. Three weeks later, her body weight was reduced to 83.2 kg and she began to menstruate. As her body weight continued to decline, the interval, duration and amount of menstruation gradually became normal. On June 20, 2002, her body weight was 64.4 kg (BMI=24.0), waist circumference 72.8 cm, waist-to-hip ratio 0.83, and blood pressure 126/79 mmHg. Her body fat percentage declined to 24.5%. There was improvement in LH/FSH ratio (0.82), serum total cholesterol (118 mg/dL), HDL-C (44 mg/dL), triglyceride (56 mg/dL) and fasting blood glucose (85 mg/dL). In the course of clinical therapy, no medication was prescribed to reduce weight or to stimulate ovulation. This clinical experience shows that weight reduction by therapeutic lifestyle change alone is effective to reduce insulin resistance and hyperandrogenism and it helps bring about improvement on anovulation, menstrual irregularity, and metabolic disorders in obese PCOS patients. |
本系統中英文摘要資訊取自各篇刊載內容。