Síndrome metabólica em mulheres com síndrome dos ovários policísticos e sua correlação com doença hepática gordurosa não-alcoólica avaliada por elastografia

Abstract

Introduction: Polycystic Ovary Syndrome (PCOS) is one of the most common endocrine disorders in women of reproductive age. Metabolic Syndrome (MetS) occurs in about 43% of patients with PCOS, as obesity and insulin resistance develop a major role in its progress, and Non-Alcoholic Fatty Liver Disease (NAFLD) being the hepatic expression of MetS. Goals: to evaluate the prevalence of MetS and NAFLD, comparing women with and without PCOS; to measure the hepatic stiffness and analyze the hepatic echotexture for NAFLD evaluation through imaging techniques in women with and without PCOS. Methods: Cross-sectional study, where 100 volunteers with overweight and/or obesity class 1, 50 with PCOS, 50 without. All of the volunteers were subject of anthropometric and laboratorial evaluation and transvaginal ultrasound for PCOS diagnosis or exclusion, followed by an evaluation of criteria for the presence of MetS. The Rotterdam Criteria were used for the PCOS diagnosis and the National Cholesterol Education Program/Adult Treatment Panel III (NCEP/ATPIII) for MetS diagnosis. Afterwards, elastography and hepatic ultrasound were carried out, in order to evaluate hepatic stiffness and echotexture, respectively. Differences of p < 0,05 were considered statistically relevant. Results: Women with PCOS have a four times higher risk of having MetS, Odds Ratio (Reliability 95%) = 4,14, than patients without PCOS. Women with PCOS had greater abdominal circumference (100,9 ± 9,08 cm vs 94,96 ± 6,99 cm), higher triglycerides (162 ± 54,63 mg/dL vs 137,54 ± 36,91 mg/dL), and lower average for Colestherol-HDL (45,66 ± 6,88 mg/dL vs 49,78 ± 7,05), with relevant statistical difference. Through transvaginal ultrasound, more hepatic steatosis was found in the cases (slight: 26% vs 13%; moderate: 10% vs 6%; severe: 4% vs 0, with p 0,184). Average speed of ARFI in women with MetS from the PCOS group was 1,12m/s vs 1,12 m/s from the non-PCOS group, p 0,664, thus, not pointing to NAFLD alteration. Conclusions: There was a fourfold higher frequency of MetS in women with PCOS. Abdominal obesity, Dyslipidemia and insulin resistance were the factors more related to risk of MetS. Women with PCOS had more hepatic steatosis, although without statistical relevance.