多囊卵巢综合征诊断及分型的研究与进展

多囊卵巢综合征（polycystic ovary syndrome,PCOS）是青春期及育龄期妇女最常见的一种内分泌紊乱性疾病,以月经稀发或闭经、临床上高雄表现或高雄激素血症和多囊卵巢作为特征,经常伴有胰岛素抵抗（IR）、代偿性高胰岛素血症和肥胖。临床表现有月经紊乱、稀发或闭经、多毛、黑棘皮现象、肥胖、不孕、双侧卵巢多囊样改变（PCO）等,     

高雄激素性月经异常的早卵泡期内分泌表现

月经异常是临床上的常见病多发病,可以有各 种各样的表现。我们选择一组高雄激素性月经稀发、月经量过少、闭经的病人作为受试组,在早卵泡期采 血做六项性激素、硫酸脱氢表雄酮和胰岛素测定,并 与月经周期正常的健康妇女相比较,以期了解这类 月经异常的发病机理。现将结果报告如下。 资料和方法 一、选择血睾酮>60ng/dl的月经稀发、月经量过少、闭经的病人,在临床排除了多囊卵巢综合征后     

多囊卵巢综合征患者的月经改变与血激素水平相关分析

目的探讨多囊卵巢综合征(PCOS)患者月经周期改变与血中睾酮、雄烯二酮和胰岛素水平的关系。方法选择临床诊断为PCOS的患者112例,包括继发闭经组(56例)和月经稀发组(56例),采用放射免疫法测定其血清性激素及空腹胰岛素水平,对比两组患者早卵泡期或闭经状态下各项性激素、空腹胰岛素水平及体重指数。结果继发闭经组患者的睾酮、雄烯二酮、空腹胰岛素水平显著高于月经稀发组(P=0.00,P=0.016,P=0.024)结论(1)继发闭经的PCOS患者体内的血清睾酮、雄烯二酮和空腹胰岛素水平明显高于月经稀发的PCOS患者,提示在育龄期继发闭经的P-COS患者有更严重的内分泌代谢失调。(2)育龄期妇女PCOS月经异常程度与体重无直接相关性,但体重指数与高胰岛素血症/高睾酮直接相关,而高胰岛素/高睾酮水平与月经异常程度相干,提示体重对月经异常可能有间接影响。     

粤籍汉族多囊卵巢综合征遗传流行病学研究

目的分析多囊卵巢综合征（PCOS）的遗传流行病学特征。方法采用调查表的方式对324例PCOS患者及其家系进行调查,同时结合临床检查。应用SPSS13.0软件、Falconer公式对资料进行统计学处理和分析。结果PCOS患者的月经稀发发生率为74.23%,高雄激素血症者占52.71%,卵巢多囊样改变者占93.27%;PCOS组及对照组一级亲属女性月经稀发发生率分别为17.81%和7.70%,男性早秃发生率为别为11.15%和5.33%,先证者家系的月经稀发和男性早秃患病率高于对照者家系;先证者一级亲属遗传度为44.91%。结论遗传因素在PCOS的发病中起着重要作用,但环境因素可能也起着重要的作用。     

多囊卵巢综合征合并甲状腺功能减退的相关性研究

目的 探讨多囊卵巢综合征(PCOS)合并甲状腺功能减退与高雄激素血症和高胰岛素血症及月经紊乱的相关性.方法 270例育龄期多囊卵巢综合征患者作为观察组,225例月经规律的不孕患者(非多囊卵巢综合征患者)作为对照组,比较两组患者的甲状腺激素(TSH、FT3、FT4),根据有无甲状腺功能异常将观察组分为甲减组和非甲减组,比较两组患者多囊卵巢综合征(PCOS)主要症状的发生概率.结果 观察组中17.41％(47/270)的患者伴有甲状腺功能减退,对照组中8.00％(18/225)的患者伴有甲状腺功能减退,TSH与FT3差异有统计学意义,与FT4差异无统计学意义.伴甲减的PCOS患者中伴高雄激素血症、高胰岛素血症、肥胖、月经紊乱的发生比例分别是38.28％、46.81％、31.91％、44.68％,高于对照组,除肥胖外,其余差异均有统计学意义.结论 PCOS患者中有大多数患者伴有甲状腺激素分泌异常,甲状腺功能减退与多囊卵巢综合征之间有密切联系,且高雄激素血症、高胰岛素血症、月经紊乱的发生概率均较高.     

80例多囊卵巢综合征疗效观察

多囊卵巢综合征(polycystic ovary syndrome,PCOS)是最常见的妇科内分泌疾病之一,育龄期妇女PCOS的发病率约为4%~12%。PCOS不但造成女性内分泌失调和不孕,而且还对患者的心血管系统、糖代谢和子宫内膜等有长远的影响[1]。本文对80例高雄激素、高胰岛素血症和无排卵的不孕患者进行临床治疗和观察。1资料与方法1.1临床资料选择2003年1月至2005年1月在我院内分泌门诊就诊的PCOS患者80例,随机分为A、B两组。选择标准:①临床表现为月经稀发、多毛、痤疮、肥胖、闭经及不孕。②阴道B超检查示双侧卵巢对称性增大,卵巢内均有2~3 mm大小的卵…     

多囊卵巢综合征与生殖道及肠道微生物组的相互作用

多囊卵巢综合征(Polycystic Ovary Syndrome,PCOS)是育龄女性最常见的内分泌代谢疾病之一,以高雄激素血症、多囊卵巢、稀发排卵或无排卵为主要临床特征。PCOS发病率高、表型复杂,病因及病理生理学机制尚不明确。近年来,有不少研究聚焦于人体微生物组在PCOS病理生理学机制中的作用。因此,本综述以多囊卵巢综合征与生殖道、肠道微生物组的相互作用为主题,总结探讨了PCOS患者的微生物组特征、PCOS如何影响人体微生物组以及人体微生物组在PCOS发生发展中的作用。     

雄激素及其受体与多囊卵巢综合征

多囊卵巢综合征(PCOS)是育龄期妇女常见的一种内分泌代谢性疾病,发病率为5%~10%,其发病机制尚未完全阐明。高雄激素血症是PCOS的突出特点,尤其是卵巢局部的高雄激素环境是导致PCOS的关键原因,因此对高雄激素形成这一特征性改变的研究成为阐明PCOS病因的重点所在。雄激素主要通过激活雄激素受体(AR)来发挥作用,故AR的作用不容忽视,我们着重就雄激素和AR在PCOS发病中的作用作一综述。     

多囊卵巢综合征的研究进展

多囊卵巢综合征（PCOS）是由女性生殖内分泌和代谢功能异常导致的排卵障碍性疾病,在生育年龄妇女中发病率为5％-10％,在无排卵的不孕症患者中约占70％。临床表现呈多态性,包括月经稀发、闭经、不孕、肥胖、多毛、痤疮等。近几年研究发现,PCOS不仅影响患者生殖功能,还存在多方面的代谢障碍,PCOS的概念超出妇科内分泌的领域,成为一组累及多系统的慢性内分泌代谢疾病。     

多囊卵巢综合征患者达英-35治疗前后内分泌激素水平的变化

多囊卵巢综合征(PCOS)是青春期和育龄妇女最为常见的内分泌紊乱疾病,发病率占育龄妇女的5%~10%,其临床表现复杂多样,以闭经、不排卵、肥胖以及多毛、痤疮等高雄激素症状为主要特征,并常伴有高胰岛素血症、胰岛素抵抗(IR)等代谢异常,严重影响妇女的健康和生活质量。本文观察了35     

Herbal medicine for the management of polycystic ovary syndrome (PCOS) and associated oligo/amenorrhoea and hyperandrogenism; a review of the laboratory evidence for effects with corroborative clinical findings

Background

Polycystic ovary syndrome (PCOS) is a prevalent, complex endocrine disorder characterised by polycystic ovaries, chronic anovulation and hyperandrogenism leading to symptoms of irregular menstrual cycles, hirsutism, acne and infertility. Evidence based medical management emphasises a multidisciplinary approach for PCOS, as conventional pharmaceutical treatment addresses single symptoms, may be contra-indicated, is often associated with side effects and not effective in some cases. In addition women with PCOS have expressed a strong desire for alternative treatments. This review examines the reproductive endocrine effects in PCOS for an alternative treatment, herbal medicine. The aim of this review was to identify consistent evidence from both pre-clinical and clinical research, to add to the evidence base for herbal medicine in PCOS (and associated oligo/amenorrhoea and hyperandrogenism) and to inform herbal selection in the provision clinical care for these common conditions.

Methods

We undertook two searches of the scientific literature. The first search sought pre-clinical studies which explained the reproductive endocrine effects of whole herbal extracts in oligo/amenorrhoea, hyperandrogenism and PCOS. Herbal medicines from the first search informed key words for the second search. The second search sought clinical studies, which corroborated laboratory findings. Subjects included women with PCOS, menstrual irregularities and hyperandrogenism.

Results

A total of 33 studies were included in this review. Eighteen pre-clinical studies reported mechanisms of effect and fifteen clinical studies corroborated pre-clinical findings, including eight randomised controlled trials, and 762 women with menstrual irregularities, hyperandrogenism and/or PCOS. Interventions included herbal extracts of Vitex agnus-castus, Cimicifuga racemosa, Tribulus terrestris, Glycyrrhiza spp., Paeonia lactiflora and Cinnamomum cassia. Endocrine outcomes included reduced luteinising hormone (LH), prolactin, fasting insulin and testosterone. There was evidence for the regulation of ovulation, improved metabolic hormone profile and improved fertility outcomes in PCOS. There was evidence for an equivalent effect of two herbal medicines and the pharmaceutical agents bromocriptine (and Vitex agnus-castus) and clomiphene citrate (and Cimicifuga racemosa). There was less robust evidence for the complementary combination of spirinolactone and Glycyrrhiza spp. for hyperandrogenism.

Conclusions

Preclinical and clinical studies provide evidence that six herbal medicines may have beneficial effects for women with oligo/amenorrhea, hyperandrogenism and PCOS. However the quantity of pre-clinical data was limited, and the quality of clinical evidence was variable. Further pre-clinical studies are needed to explain the effects of herbal medicines not included in this review with current clinical evidence but an absence of pre-clinical data.

     

Longitudinal evaluation of reproductive function in women treated for bipolar disorder

BACKGROUND: We assessed reproductive endocrine and metabolic markers in women treated for bipolar disorder over a 2-year time period, controlling for valproate use. METHODS: Twenty-five women ages 18-45 with bipolar disorder underwent longitudinal evaluations. Subjects completed a reproductive health questionnaire and endocrinological exam at baseline. Total and free testosterone, progesterone, LH, FSH, fasting insulin and glucose, and other hormones were measured across the menstrual cycle at baseline and at 2-year follow-up. RESULTS: Ten subjects were currently receiving valproate as a mood stabilizing agent; of the remaining subjects, six received lithium and five received atypical antipsychotics. Of all subjects, 41.7% reported current oligomenorrhea, while 40% reported oligomenorrhea before starting medication. Rates of oligomenorrhea and clinical hyperandrogenism did not differ by medication use. Eighty percent of women had a high homeostatic model assessment of insulin resistance (HOMA-IR) at baseline; all other measures were normal. Over time, all subjects exhibited a significant decrease in luteal phase progesterone and increase in free testosterone concentrations. Valproate use was associated with an increase over time in total testosterone. Baseline values and changes in BMI were similar across groups. LIMITATIONS: Limitations include small sample size and the absence of a control group. CONCLUSION: We confirm our previous observations of high rates of menstrual abnormalities, hyperandrogenemia and insulin resistance in women with bipolar disorder. These results tentatively support the role of valproate in hyperandrogenemia; however, rates of oligomenorrhea and clinical hyperandrogenism did not differ between medication groups.     

No association between the -308 polymorphism in the tumour necrosis factor alpha (TNFalpha) promoter region and polycystic ovaries

The tumour necrosis factor (TNF)2 allele appears to be linked with increased insulin resistance and obesity, conditions often found in overweight patients with polycystic ovary syndrome (PCOS). The significance of TNFalpha polymorphism in relation to the clinical and biochemical parameters associated with PCOS was investigated in 122 well-characterized patients with polycystic ovaries (PCO). Of these, 84 had an abnormal menstrual cycle and were classified as having PCOS, while the remaining 38 had a normal menstrual cycle and were classified as having PCO. There were a further 28 individuals without PCO (non-PCO) and 108 individuals whose PCO status was undetermined (reference population). The promoter region of the TNFalpha gene was amplified by polymerase chain reaction (PCR), and the presence or absence of the polymorphism at -308 was determined by single-strand conformational polymorphism (SSCP) analysis. The less common TNF allele (TNF2) was found as TNF1/2 or TNF2/2 in 11/38 (29%) of PCO subjects, 25/84 (30%) of PCOS subjects, 7/28 (25%) of non-PCO subjects, and 45/108 (42%) of the reference population. There was no significant difference in the incidence of the TNF2 allele between the groups. The relationship of TNF genotype to clinical and biochemical parameters was examined. In both the PCO group and the PCOS group, the presence of the TNF2 allele was significantly associated with lower glucose values obtained from the glucose tolerance testing (P<0.05). The TNF genotype was not significantly associated with any clinical or biochemical parameter measured in the PCO, PCOS or non-PCOS groups. Thus, the TNFalpha -308 polymorphism does not appear to strongly influence genetic susceptibility to polycystic ovaries.     

The Polycystic Ovary Syndrome Does Not Predict Further Miscarriage in Japanese Couples Experiencing Recurrent Miscarriages

Problem  It has been a matter of controversy whether the polycystic ovary syndrome (PCOS) is actually a causal factor of miscarriages because of the absence of internationally established criteria. We, therefore, in this study investigated whether PCOS and a polycystic ovary (PCO) morphology have predictive value for subsequent miscarriages using new International and Japanese criteria.
Method of study  A total of 195 patients with a history of two consecutive first trimester miscarriages and without abnormal chromosomes in either partner, antiphospholipid antibodies or uterine anomalies, were examined. The prospective pregnancy outcome was compared between patients with and without PCOS, PCO morphology, elevated luteinizing hormone (LH), hyperandrogenism and obesity.
Results  Of a total of 195 patients, 56 (28.7%) miscarried subsequently. Three (1.5%) and 12 (6.2%) were diagnosed as suffering from PCOS by Japanese and International criteria respectively. There was no relation between a diagnosis of PCOS, PCO morphology, elevated LH, free testosterone or obesity and the subsequent miscarriage rate.
Conclusion  A routine test for diagnosis of PCOS is not necessary in patients experiencing recurrent miscarriages because none of the related parameters examined in this study predicted subsequent miscarriage.     

A molecular mechanism underlying ovarian dysfunction of polycystic ovary syndrome: hyperandrogenism induces epigenetic alterations in the granulosa cells

The objective of this study was to explore whether hyperandrogenism induces epigenetic alterations of peroxisome proliferator-activated receptor gamma 1 (PPARG1), nuclear corepressor 1 (NCOR1), and histone deacetylase 3 (HDAC3) genes in granulosa cells (GCs) of polycystic ovary syndrome (PCOS) women and whether these alterations are involved in the ovarian dysfunction induced by hyperandrogenism. Thirty-two infertile PCOS women and 147 infertile women with tubal blockage were recruited. PCOS women were divided into the hyperandrogenism (HA) PCOS group (n?=?13) and nonhyperandrogenism (N-HA) PCOS group (n?=?19). Sixty female Sprague-Dawley rats were used for PCOS model establishment. In GCs of HA PCOS women, PPARG1 mRNA expression was lower, whereas NCOR1 and HDAC3 mRNA expression were higher than N-HA PCOS women and controls (P?相似文献   

Endocrinology: Subjects with polycystic ovaries without hyperandrogenaemia exhibit similar disturbances in insulin and lipid profiles as those with polycystic ovary syndrome

Polycystic ovaries (PCO) are detected using ultrasonographyin a proportion of women who do not have clinical symptoms ofthe polycystic ovary syndrome (PCOS). The aim of this studywas to compare the metabolic and endocrine differences betweenwomen with such ultrasound-detected PCO and women with PCOS,and to relate these changes to clinical presentation with particularreference to cycle irregularity. A group of 118 women showingPCO on vaginal ultrasound scan was divided into those who hadno hyperandrogenaemia (n = 21) and those who had increased androgensand a clinical presentation normally associated with PCOS (n= 97). These were compared with a reference group of 26 normalsubjects. Glucose tolerance, lipid concentrations and endocrineprofiles were compared between groups. Apart from higher concentrationsof androgens in the PCOS group, there were no significant differencesbetween the PCO and PCOS groups in either fasting and stimulatedinsulin and glucose or in concentrations of sex hormone-bindingglobulin, gonadotrophins and blood lipids or in ovarian volume.Both PCO and PCOS subjects with cycle irregularity had significantlyhigher concentrations of serum fasting and stimulated insulinindependent of androgens and body mass index than those withnormal cycles. It was concluded that: (i) PCO and PCOS patientshave equivalent disturbances in relation to insulin and glucosemetabolism as well as lipid and lipoprotein disturbances comparedto reference subjects; (ii) higher serum insulin values areassociated with menstrual irregularity in both groups; (iii)ultrasound evidence for PCO predicts similar metabolic sequelaeto PCOS and can therefore be used for studies of the geneticsand long term risks for this condition.     

卵泡发育与多囊卵巢综合征相关因素的研究进展

多囊卵巢综合征（PCOS）是育龄期女性最常见的生殖内分泌紊乱疾病,可表现为高雄激素血症,高胰岛素血症,胰岛素抵抗（IR）,并可引起生殖功能的障碍,该病与卵泡发育异常密切相关。人类卵泡的发育过程包括原始卵泡的募集、生长、发育、最终只有一个优势卵泡发育成熟并排卵。在这个过程中,生殖激素、内分泌、旁分泌,肽类细胞生长因子对卵泡生长发育进行规律而有序的调节,在PCOS患者中这些机制出现异常。本文就卵泡发育异常,及其与PCOS之间相关因素做一简要综述。     

Detection of functional ovarian hyperandrogenism in women with androgen excess.

BACKGROUND. Distinguishing between ovarian and adrenal causes of androgen excess may be difficult. We have found that women with the polycystic ovary syndrome have supranormal plasma 17-hydroxyprogesterone responses to the gonadotropin-releasing hormone agonist nafarelin. We determined the usefulness of testing with nafarelin to distinguish ovarian causes of hyperandrogenism in women. METHODS. We studied 40 consecutive women with hyperandrogenism who had oligomenorrhea, hirsutism, or acne. All 40 underwent testing with nafarelin, dexamethasone, and corticotropin with measurement of circulating concentrations of gonadotropins and steroid hormones, and 19 underwent ovarian ultrasonography. RESULTS. The plasma 17-hydroxyprogesterone response to nafarelin was supranormal in 23 of the 40 women (58 percent), and the plasma androgen response to corticotropin was elevated in 23; 13 women had both abnormalities. Only one woman had conclusive evidence of a steroidogenic block; she had nonclassic adrenal 21-hydroxylase deficiency. Of the 23 women with abnormal responses to nafarelin, only 11 (48 percent) had elevated base-line serum luteinizing hormone concentrations. Of the 13 women with abnormal responses to nafarelin who underwent ultrasonography, 7 (54 percent) had polycystic ovaries. Peak plasma 17-hydroxyprogesterone concentrations after nafarelin administration correlated closely with plasma free testosterone concentrations after dexamethasone administration (r = 0.75, P less than 0.001). CONCLUSIONS. Approximately half of women with oligomenorrhea, hirsutism, or acne have an abnormal response to the gonadotropin-releasing hormone agonist nafarelin, suggesting an ovarian cause of their androgen excess.