目的 探讨生酮饮食对改善合并超重/肥胖的多囊卵巢综合征（PCOS）患者疾病相关症状的安全性和有效性。方 法 2018年 12月至 2019年 5月按照 BMI≥24 kg/m2 和体脂率≥28%标准招募 PCOS患者 18例，进行纯生酮饮食干预，其中 8例患 者试验时间为 1个月，其中 10例患者试验时间为 2个月。对患者进行每日随访监测、每月复查，比较试验前后生酮饮食干预 PCOS患者的安全性、有效性指标。结果 生酮饮食干预1个月的18例患者，体重［（75.03±9.17）kg比（69.64±8.74）kg］、体脂肪 量［（27.10±6.95)kg 比(23.22±7.05）kg］、BMI［（28.01±4.13)kg/m2 比(25.99±3.90）kg/m2 ］、体脂率［（35.68%±5.09%)比(32.84%± 6.11%)］、雄激素［(0.64±0.19)ng/ml比(0.54±0.16)ng/ml］、LH/FSH比值［（1.74±1.03)比(1.19±0.85）］及空腹血糖［(5.36±0.81)mmol/L 比(4.62±0.53)mmol/L］较干预前均显著下降。生酮饮食干预2个月的10例患者，体重［（73.09±6.44)kg比(65.35±5.58）kg］、体脂肪 量［（25.54±4.99)kg 比(20.30±5.17）kg］、BMI［（27.21±2.95)kg/m2 比(24.33±2.55) kg/m2 ］、体脂率［（34.76%±4.64%)比(30.77%± 6.04%)］及空腹血糖［(5.40±0.92)mmol/L 比(4.61±0.55)mmol/L］较干预前均显著下降，月经周期中位数由 60 d缩短为 44 d，差异 有统计学意义。生酮饮食治疗期间Ⅰ级不良反应发生率为22.2%, 主要为便秘、疲劳及高尿酸血症，经休息及饮食调整后均明 显改善。结论 生酮饮食干预可能是PCOS患者安全有效的体重管理方式之一，并可以使PCOS患者的月经周期趋于正常。

Objective To assess the safety and effectiveness of ketogenic diet on improving polycystic ovary syndrome (PCOS) ⁃related symptoms in patients with overweight or obesity. Methods According to the inclusion and exclusion criteria, 18 PCOS patients were recruited in our study from December 2018 to May 2019, and were all carried out ketogenic diet intervention alone. The duration was one month for 8 patients and two months for the other 10 patients. All recruiters were followed up every day and rechecked monthly while the safety and effectiveness indexes were observed in the course. Results Of the eighteen patients who were treated with a ketogenic diet for one month, the body weight［（75.03±9.17）kg vs（69.64±8.74）kg］, fat mass ［（27.10±6.95)kg vs (23.22±7.05）kg］, BMI［（28.01±4.13)kg/m2 vs (25.99±3.90）kg/m2］, body fat rate［(35.68%±5.09%）vs （32.84%±6.11%)］, testosterone［(0.64±0.19)ng/ml vs (0.54±0.16)ng/ml］, LH/FSH［(1.74±1.03） vs （1.19±0.85)］ and fasting glucose［(5.36±0.81)mmol/L vs (4.62±0.53)mmol/L］were decreased dramatically. Of the ten patients who were treated with a ketogenic diet for two month, the body weight［（73.09±6.44)kg vs (65.35±5.58）kg］, fat mass［（25.54±4.99)kg vs（20.30±5.17）kg］, BMI［（27.21±2.95)kg/m2 vs (24.33±2.55) kg/m2］, body fat rate［(34.76%±4.64%) vs (30.77%±6.04%)］, and fasting glucose ［(5.40±0.92)mmol/L vs (4.61±0.55)mmol/L］were decreased dramatically. The median menstrual cycle decreased from 60 days to 44 days among the ten patients, which was statistically significant. The incidence of grade I adverse reactions during ketogenic diet treatment was 22.2%, mainly constipation, fatigue and hyperuricemia, which were significantly improved after rest and diet modification. Conclusion This Preliminary studies suggested that ketogenic diet intervention may be one of the safe and effective ways of body quality management for PCOS patients, and can normalize the menstrual cycle of PCOS patients.