medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2025-7-28-35medalphabet-4231Research ArticleСтатьиЦиркадные ритмы у женщин с синдромом поликистозных яичников и их роль в определении метаболических нарушенийCircadian rhythms in women with polycystic ovarian syndromeand their role in determining metabolic dysfunctionhttps://orcid.org/0000-0002-4183-1252ВедзижеваЭ. Р.VedzizhevaE. R.

Ведзижева Элина Руслановна - к.м.н., врач акушер-гинеколог.

Москва

Elina R. Vedzizheva - PhD Med, obstetrician-gynaecologist.

Moscow

elina_vedzizheva@mail.ruКузнецоваИ. В.KuznetsovaI. V.

Кузнецова Ирина Всеволодовна - д.м.н., проф., президент Международной ассоциации гинекологов, эндокринологов, терапевтов (МАГЭТ), зам. генерального директора по научно-исследовательской работе.

Москва

Irina V. Kuznetsova - DM Sci (habil.), professor, president of the International Association of Gynaecologists, Endocrinologists, Therapists (IAGET), deputy general director for Research.

Moscow

ms.smith.ivk@gmail.comГБУЗ «Городская клиническая больница имени Ф.И. Иноземцева ДЗМ»РоссияF.I. Inozemtsev City Clinical HospitalRussian FederationООО «Витбиомед+»РоссияVitbiomed+ LLCRussian Federation20252303202507Современная гинекология (1)2835Copyright © Ведзижева Э.Р., Кузнецова И.В., 20252025Ведзижева Э.Р., Кузнецова И.В.Vedzizheva E.R., Kuznetsova I.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-alphabet.com/jour/article/view/4231

Синдром поликистозных яичников (СПКЯ) – наиболее распространенное эндокринное заболевание у женщин репродуктивного возраста, для которых подход к образу жизни является неотъемлемой частью лечения. Несмотря на современные методы терапии данного синдрома, значительное число женщин с этим заболеванием не достигают цели лечения, что позволяет предположить наличие других особенностей этого синдрома, которые не принимаются во внимание при оценке и, следовательно, при выборе терапевтического подхода. Известно, что хронотип играет роль в определении предпочтений в питании и риска развития эндокринно-метаболических заболеваний, в том числе и при СПКЯ.

Цель

Цель: изучить различия в циркадном ритме у женщин с СПКЯ, а также оценить их роль в определении метаболических аспектов заболевания.

Материалы и методы

Материалы и методы. В исследование были включены 109 женщин в возрасте от 18 до 36 лет (средний возраст 26,3±4,3 года) с установленным диагнозом СПКЯ, которые в зависимости от хронотипа были разделены на 3 группы: 1-я группа (вечерний хронотип) – 19 человек (17,4%), 2-я группа (промежуточный хронотип) – 38 человек (34,9%) и 3-я группа (утренний хронотип) – 52 человека (47,7%). Всем пациенткам проводились стандартные клинико-лабораторно-инструментальные обследования для определения статуса СПКЯ, а также сбор анамнеза и физический осмотр с оценкой антропометрических показателей.

Результаты

Результаты. У пациенток с вечерним хронотипом физическая активность была ниже, а частота курения и артериальной гипертензии выше по сравнению с пациентками с другими типами циркадных ритмов. Вечерний хронотип ассоциировался с более высокими показателями индекса массы тела (ИМТ; p=0,001), окружности талии и бедер (ОТ и ОБ; p=0,004 и p=0,003 соответственно), соотношения ОТ/ОБ (p=0,017), окружности шеи (p=0,013) и процента жировой массы Deurenberg (p=0,001), а также с более низкими уровнями пролактина и 25(OH)D (p=0,046 и p=0,037 соответственно) по сравнению с промежуточным фенотипом. А по сравнению с утренним фенотипом у женщин с СПКЯ и вечерним фенотипом были значимо выше ИМТ (p<0,001), ОТ (p<0,001), ОБ (p<0,001), ОТ/ОБ (p=0,009), ОШ (p<0,001), процент жировой массы Deurenberg (p<0,001), а также уровни липопротеинов очень низкой плотности (p=0,042), ApoA1 (p=0,042), инсулина (p=0,020), индекса HOMA-IR (p=0,035), и ниже уровень 25(OH)D (p=0,004). При утреннем варианте циркадного ритма чаще наблюдалась липопротеинемия низкой плотности по сравнению с группой СПКЯ с вечерним хронотипом (p=0,042), а также реже изолированные нарушения липидного обмена по сравнению с промежуточным вариантом циркадного ритма (p=0,028).

Выводы

Выводы. Больные СПКЯ с вечерним хронотипом имеют худшие антропометрические показатели, более тяжелую степень ИР и в целом реже ведут здоровый образ жизни, чаще страдают АГ по сравнению с женщинами с СПКЯ и с другими типами хронотипов. Дальнейшее изучение нарушений циркадных ритмов при СПКЯ имеет значительный потенциал и может помочь в разработке эффективных стратегий лечения данного заболевания.

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age for which a lifestyle approach is an integral part of treatment. Despite modern therapies for this syndrome, a significant number of women with this condition do not achieve treatment goals, suggesting that there are other features of this syndrome that are not taken into account in the assessment and therefore choice of therapeutic approach. Chronotype is known to play a role in determining dietary preferences and the risk of developing endocrine-metabolic diseases, including those of PCOS.

Aim

Aim: to study differences in circadian rhythms in women with PCOS and to evaluate their role in determining metabolic aspects of the disease.

Materials and methods

Materials and methods: 109 women aged 18–36 years (mean age 26.3±4.3 years) with a confirmed diagnosis of PCOS were included in the study and divided into 3 groups according to chronotype: Group 1 (evening chronotype) – 19 (17.4 %) subjects, Group 2 (intermediate chronotype) – 38 (34.9%) subjects and Group 3 (morning chronotype) – 52 (47.7%) subjects. All patients underwent standard clinical, laboratory and instrumental examinations to determine the status of PCOS, as well as a medical history and physical examination with assessment of anthropometric parameters.

Results

Results: patients with the evening chronotype exercised less regularly and were significantly less physically active, and had higher rates of smoking and arterial hypertension than patients with other types of circadian rhythm. The evening chronotype was associated with higher body mass index (BMI; p=0.001), waist and hip circumference (WC and HC; p=0.004 and p=0.003, respectively), WC/HC ratio (p=0.017), neck circumference (NC; p=0.013), and Deurenberg fat mass percentage (p=0.001), as well as lower prolactin and 25(OH)D levels (p=0.046 and p=0.037, respectively) compared to the mid-phase phenotype. And compared to the morning phenotype, women with the PCOS and evening phenotypes had significantly higher BMI (p<0.001), WC (p<0.001), HC (p<0.001), OB (p<0.001), WC/HC (p=0.009), NC (p<0.001), Deurenberg fat mass percentage (p<0.001) and levels of very low density lipoproteins (p=0.042), ApoA1 (p=0.042), insulin (p=0.020), HOMA-IR index (p=0.035) and lower 25(OH)D (p=0.004). Low-density lipoproteinemia was more common in the morning circadian variant compared to the evening PCOS group (p=0.042), and isolated lipid abnormalities were less common compared to the intermediate chronotype (p=0.028).

Conclusions

Conclusions: women with PCOS and evening chronotype have worse anthropometric indices, more severe degree of IR and in general are less likely to lead a healthy lifestyle, suffer more often from arterial hypertension compared to women with PCOS and other types of chronotypes. Further study of circadian rhythm abnormalities in PCOS has significant potential and may help to develop effective treatment strategies for this disease.

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The authors declare that there are no conflicts of interest present.