不同表型多囊卵巢综合征患者活血因子的研究

检测15例典型的多囊卵巢综合征(PCOS)患者、12例无多囊的PCOS患者、11例无高雄的PCOS患者和 8例正常对照女性血清性激素和活血因子.发现典型PCOS组和无多囊PCOS组的黄体生成素、卵泡刺激素、睾酮和雄烯二酮相似,且均明显高于无高雄PCOS组和对照组;3个PCOS组的血管内皮生长因子(VEGF)和血管紧张素-Ⅱ(AT-Ⅱ)值均高于对照组.提示3种类型的PCOS患者VEGF和AT-Ⅱ水平都升高,可能是PCOS易于发生卵巢过度刺激综合征的原因之一.     

多囊卵巢综合征患者糖代谢异常发生率及其特点

目的 探讨多囊卵巢综合征患者糖代谢异常特点及其发生率.方法 回顾性分析2006年6月1日至2009年2月1日广州中山大学孙逸仙纪念医院妇产科收治的初诊多囊卵巢综合征患者654例(青春期101例,成人553例),以120名年龄匹配的健康志愿者为对照组(青春期40名,成人80名).病例和对照组均行口服葡萄糖耐量试验和胰岛素释放试验,比较病例组和对照组、成人多囊卵巢综合征与青春期多囊卵巢综合征、不同体重指数亚组中糖代谢异常的特点及其发生率.结果 多囊卵巢综合征患者糖代谢异常的发生率为24.5%(160/654),显著高于对照组的3.3%(4/120)(χ2=27.11,P<0.0001);成人病例组糖代谢异常的发生率高于青春期病例组(分别为26.6%、12.9%,χ2=8.688,P=0.003),青春期病例组代谢异常的发生率高于青春期对照组(分别为12.9%、0%,χ2=5.671,P=0.02).多囊卵巢综合征患者糖代谢异常主要表现为糖耐量受损(62.5%),其次为空腹血糖受损(43.8%),糖尿病仅占少数(8.1%);糖尿病13例,仅4例(30.8%)空腹血糖>7.0 mmol/L,9例(69.2%)通过口服葡萄糖耐量试验筛查发现.多囊卵巢综合征组糖代谢异常的发生率随体重指数升高而升高(χ2=53.71,P<0.0001).结论 多囊卵巢综合征患者为糖代谢异常的高危人群,其糖代谢异常以糖耐量受损为主,空腹血糖受损次之.多囊卵巢综合征患者(尤其是肥胖者)应行口服葡萄糖耐最试验,以早期发现其糖代谢异常.     

多囊卵巢综合征合并2型糖尿病临床治疗

目的探讨并分析多囊卵巢综合征合并2型糖尿病患者的临床治疗效果。方法选取该院2012年2月—2013年12月期间诊治的多囊卵巢综合征合并2型糖尿病患者42例,将其均分成对照组和观察组两组,采用不同方法对两组分别进行治疗,然后观察并对比两组的相关评价指标。结果观察组在治疗前各相关评价指标与对照组差异无统计学意义(P0.05)。经治疗后,观察组的空腹血糖、排卵前期雌二醇水平、睾酮水平和LH/FSH明显低于对照组,差异有统计学意义(P0.05)。结论对多囊卵巢综合征合并2型糖尿病患者的治疗,应采用综合治疗的方式进行治疗,并能提高患者的治疗效率。     

多囊卵巢综合征合并2型糖尿病临床治疗

目的探讨并分析多囊卵巢综合征合并2型糖尿病患者的临床治疗效果。方法选取该院2012年2月—2013年12月期间诊治的多囊卵巢综合征合并2型糖尿病患者42例,将其均分成对照组和观察组两组,采用不同方法对两组分别进行治疗,然后观察并对比两组的相关评价指标。结果观察组在治疗前各相关评价指标与对照组差异无统计学意义（P〉0.05）。经治疗后,观察组的空腹血糖、排卵前期雌二醇水平、睾酮水平和LH/FSH明显低于对照组,差异有统计学意义（P〈0.05）。结论对多囊卵巢综合征合并2型糖尿病患者的治疗,应采用综合治疗的方式进行治疗,并能提高患者的治疗效率。     

多囊卵巢综合征合并妊娠期糖尿病的临床特点分析

目的研究多囊卵巢综合征合并妊娠期糖尿病的临床特点。方法选择2014年4月—2015年4月该院收治的多囊卵巢综合征合并妊娠期糖尿病患者(A组)、妊娠期糖尿病患者(B组)以及正常妊娠孕产妇(C组)各50例,比较3组的血糖、血脂以及胰岛素抵抗情况。结果 A组与B组血糖、空腹胰岛素、糖化血红蛋白、胰岛素抵抗指数均差异具有统计学意义(P0.05)。从3组血脂情况来看,A组胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白与B、C组差异具有统计学意义(P0.05)。在围产结果方面,3组差异无统计学意义。结论多囊卵巢综合征与妊娠期糖尿病之间存在紧密的关联性,多囊卵巢综合征会增加妊娠期糖尿病、妊娠期高血压疾病的发生,在临床中需要进一步加强多囊卵巢综合征合并妊娠期糖尿病患者的产前检查与治疗,有效干预疾病的进一步发展,由于疾病的复杂性其内在的作用机制还需要通过更加完善、更加全面的研究。     

饮食疗法对多囊卵巢综合征患者人体测量学和胰岛素敏感性的影响

目的 探讨饮食干预对多囊卵巢综合征患者体质量及胰岛素敏感性的影响.方法 2009年6月至2010年2月在复旦大学附属妇产科医院内分泌专科门诊入选31例多囊卵巢综合征患者(年龄19 ～30岁),根据体质指数将其分至肥胖多囊卵巢综合征组(n=17,体质指数≥25 kg/m2)和非肥胖多囊卵巢综合征组(n=14,体质指数＜2...     

甲状腺过氧化均酶抗体与多囊卵巢综合征

正多囊卵巢综合征(PCOS)是1935年stein-leventhal~([1])首次报道一组患者:表现为月经紊乱或闭经、不孕、多毛、肥胖、双侧卵巢增大伴多囊改变,后被称为Stein-leventhal综合征,别名:史坦一列文综合征,Rokitansky瘤,多囊卵巢疾病,双侧性多囊卵巢综合征,硬化性囊性卵巢综合征,高雄激素长期无排卵综合征,慢性雄激素过度形成致排卵停止,Polycystic oveary syndrome,PCOS等的临床较常见的一组     

多囊卵巢综合征合并糖尿病的护理方案以及效果观察

目的观察多囊卵巢综合征合并糖尿病的护理方案以及效果观察。方法选取2017年5月—2018年11月收治的多囊卵巢综合征合并糖尿病患者56例,随机分为参照组(普通护理)和观察组(针对性护理)。比较两者不同护理干预的效果。结果观察组患者生活质量水平比参照组更为优异,护理后患者的血糖水平得到明显控制,且心境状态良好,数据间差异有统计学意义(P0.05)。结论多囊卵巢综合征合并糖尿病患者护理期间应用针对性护理,患者心境平和,血糖水平控制效果显著,生活质量得到保障。     

多囊卵巢综合征并糖尿病患者的综合治疗对妊娠结局的影响

目的探讨多囊卵巢综合征并糖尿病患者的综合治疗对妊娠结局的影响。方法选取92例日照市东港区妇幼保健站妇产科于2015年2月—2016年3月所收治的多囊卵巢综合征并糖尿病患者,依治疗方法不同将其分为对照组和观察组,对照组行常规治疗法,观察组在对照组基础上加施综合治疗,观察并比较两组患者妊娠情况。结果两组患者自然流产率比较差异无统计学意义(P0.05),但观察组自然流产率较对照组有降低趋势,且妊娠期糖尿病及高血压的发生率也明显低于对照组(P0.05)。结论对多囊卵巢综合征并糖尿病患者行综合治疗对妊娠具一定积极作用,同时可减少不良妊娠结局的发生。     

多囊卵巢综合征合并妊娠期糖尿病的风险性分析与针对性干预研究

目的研究伴有多囊卵巢综合征(PCOS)孕妇合并妊娠期糖尿病(GDM)的风险性及针对性干预效果。方法该院2015年5月—2017年7月共撷取伴有多囊卵巢综合征孕妇78例。按照伴有多囊卵巢综合征孕妇门诊就诊尾号奇偶数,分奇数为观察组、偶数为对照组,每组各39例。观察组实施针对性护理,对照组实施常规护理,对比两组护理效果。结果观察组和对照组的妊娠期糖尿病发生率数据对比为:20.51%、43.59%,差异有统计学的意义(P0.05)。观察组的护理满意度为94.87%,对照组的护理满意度为76.92%,前者明显优于后者(P0.05)。结论伴有多囊卵巢综合征孕妇,接受针对性护理干预,能降低妊娠期糖尿病的风险性,提高其护理满意度,具有重要的临床应用及推广价值。     

Persistence of hyperinsulinemia in polycystic ovary syndrome after ovarian suppression by gonadotropin-releasing hormone agonist.

To investigate the effect of long-term androgen suppression on insulin sensitivity, obese and non-obese women with the polycystic ovary syndrome and obese and non-obese ovulatory women were given an oral glucose tolerance test before and after treatment with a gonadotropin-releasing hormone agonist. The women with polycystic ovary syndrome showed higher basal luteinizing hormone and androgen levels than the ovulatory women. All women with the polycystic ovary syndrome responded non-diabetically to the glucose tolerance test. However, compared with controls, the obese women with the polycystic ovary syndrome showed a hyperinsulinemic response to the glucose tolerance test, indicating insulin resistance. During the 3-h glucose tolerance test there was no concomitant change in androgen levels in the hyperinsulinemic women with the polycystic ovary syndrome. The insulin response to an oral glucose tolerance test remained unchanged in all women, although a hypogonadotropic hypogonadal state was maintained for several weeks. This study therefore suggests that endogenous androgens do not play a role in sustaining insulin resistance in women with the polycystic ovary syndrome.     

非酒精性脂肪性肝病与多囊卵巢综合征相关性研究

目的探讨非酒精性脂肪肝(NAFLD)与多囊卵巢综合征(PCOS)的相关性。方法选择PCOS患者47例和非PCOS患者47例,比较两组患者NAFLD、胰岛素抵抗(IR)、丙氨酸氨基转移酶(ALT)升高发生情况及一般临床参数。结果 PCOS组NAFLD、IR、ALT升高的发生率分别为42.6%、68.1%、34.0%,与对照组(分别为17.0%、10.6%、8.5%)比较显著增高,差异有统计学意义(P0.01);PCOS组伴NAFLD患者与不伴NALFD患者比较,ALT、睾酮(TESTO)显著增高,差异有统计学意义(P0.01)。体重指数(BMI)、促卵泡成熟激素(FSH),人促黄体生成激素(LH2)、睾酮(TESTO)两两相比较,差异有统计学意义(P0.05);PCOS伴NAFLD患者年龄小于不伴NAFLD的PCOS患者(P0.01);多因素Logisitc回归分析提示ALT的异常及胰岛素抵抗状态是PCOS伴发NAFLD的主要风险因素(ALTOR=1.12,P=0.01;HOMA-IROR=1.58,P=0.01)。结论 NAFLD在PCOS患者中患病率高,提示两种疾病有临床相关性,对年轻的PCOS患者有必要尽早进行肝脏疾病的相关检查。     

Surgical treatment of polycystic ovary syndrome

Laparoscopic ovarian surgery for the induction of ovulation in women with polycystic ovary syndrome provides a single-treatment option with a good rate of unifollicular ovulation, thereby minimizing the need for extensive ultrasound monitoring because of a low risk of multiple pregnancy. The cumulative conception rates after 6 months are lower than those with gonadotropin therapy, but after 12 months the pregnancy rates are similar. The risks, albeit low, are those of laparoscopic surgery, general anaesthesia and ovarian damage.     

The reproductive phenotype in polycystic ovary syndrome

The symptoms of women with polycystic ovary syndrome (PCOS) include hirsutism and irregular menstrual bleeding due to ovarian androgen excess and chronic anovulation. Typically, these features emerge late in puberty or shortly thereafter. The proposed mechanism(s) responsible for increased ovarian androgen production include heightened theca cell responsiveness to gonadotropin stimulation, increased pituitary secretion of luteinizing hormone, and hyperinsulinemia. The cause of ovulatory dysfunction is not well understood, but is linked to abnormal follicle growth and development within the ovary. As a result, infertility is common among women with PCOS and, in many instances, is the initial presenting complaint. Insulin resistance and obesity are frequently associated with PCOS and probably contribute to the severity of symptoms. The polycystic ovary that accompanies the syndrome has recently been defined as having 12 or more follicles per ovary or an ovarian volume greater than 10 ml as determined by ultrasonography. In addition, there is an increased number of growing follicles in the polycystic ovary. Despite this distinctive appearance, the cause and development of the polycystic ovary are completely unknown.     

不同肥胖标准PCOS患者血清sICAM-1水平对比观察及意义

目的比较不同肥胖标准的多囊卵巢综合征(PCOS)患者血清可溶性细胞间黏附分子-1(sICAM-1)水平,并探讨其意义。方法选取PCOS患者54例,将体质量指数(BMI)≥24 kg/m~218例归为肥胖A组,<24 kg/m~2者36例归为非肥胖A组;腰臀比(WHR)≥0.8者29例归为肥胖B组,<0.8者25例归为非肥胖B组;WHR≥0.8且BMI≥24 kg/m~2的患者14例归为肥胖C组,BMI<24 kg/m~2且WHR<0.8的患者15例归为非肥胖C组。采用ELISA方法检测各组患者血清sICAM-1水平。结果肥胖A、B、C组血清sICAM-1水平分别高于非肥胖A、B、C组(P均<0.05);肥胖A、B、C组血清sICAM-1水平比较P均>0.05;非肥胖A组血清sICAM-1水平高于非肥胖B、C组(P均<0.05),非肥胖B、C组血清sICAM-1水平相比,P>0.05。患者血清sICAM-1水平与BMI、WHR均呈正相关(r=0.204,0.360,P均<0.05),sICAM-1与WHR的相关性高于sICAM-1与BMI的相关性(P<0.05)。结论 PCOS患者血清sICAM-1水平与BMI...     

Serum FSH bioactivity and response to acute gonadotrophin releasing hormone (GnRH) agonist stimulation in patients with polycystic ovary syndrome (PCOS) as compared to control groups

OBJECTIVE We evaluated the biological activity of FSH in the serum of women with polycystic ovary syndrome before and after acute administration of a GnRH agonist as compared to control groups. DESIGN FSH, oestradiol and androstenedione response to buserelin (100 μg s.c.) comparing seven polycystic ovary patients, six idiopathic hirsute women, 11 normal women in the follicular phase and nine normal men. MEASUREMENTS Rat granulosa cell aromatase bioassay in the presence or absence of polyethyleneglycol (PEG) pretreated 2% serum. Serum biological FSH (B-FSH), immunological FSH (I-FSH) and B/I ratio at times 0,1, 2, 3, 4, 8, 12 and 24 hours. Serum androstenedione and oestradiol at times 0 and 24 hours. RESULTS Human gonadotrophin-free (oral contraceptive user and after FSH immunoabsorption) and PEG-pre-treated serum increases the aromatase activity in response to increasing doses of purified FSH. The maximum enzymatic activity is however higher with 2% serum than with 4% serum. The amplitude of the B-FSH response to the GnRH agonist is markedly decreased in the polycystic group as compared to the group of normal women. There is also a small decrease in the l-FSH response in the polycystic women. When compared to that of normal women, the area under the curve in the polycystic ovary patients is reduced by 71% for B-FSH (P<001) and by 23% for l-FSH (P<0.05). The B-FSH and I-FSH responses in men are very small. After an initial decrease the B/I ratio returns to baseline level in normal women but remains low in the other groups. At time 24 hours, there is no significant change in the serum concentration of androstenedione but serum oestradiol, the baseline of which is significantly higher in the polycystic patients than in normal women, is also significantly higher at 24 hours (P< 0.05) in response to the pharmacological release of FSH. CONCLUSION The gonadotrophin-free and PEG-pre-treated human serum has an inherent stimulatory effect on the rat granulosa aromatase bioassay with a higher activity at 2% serum. Acute GnRH agonist stimulation reveals a deficiency in the FSH response in polycystic ovary patients. The greater deficit in B-FSH than in l-FSH would indicate a possible modification in the FSH isoforms in this syndrome. The meaning of this observation for the understanding of the physiopathology of the polycystic ovary syndrome remains to be evaluated.     

Clinical features in women with polycystic ovaries: relationships to insulin sensitivity, insulin gene VNTR and birth weight

OBJECTIVE: Polycystic ovaries are a common ultrasound finding, yet few of these women have many clinical features of polycystic ovary syndrome. Clinical presentation may relate to degree of insulin resistance, common polymorphism at the insulin gene VNTR, and birth weight. We therefore examined the relationship between insulin sensitivity, insulin gene VNTR genotype, birth weight and presence of polycystic ovaries/features of polycystic ovary syndrome in a normal population study. DESIGN AND PATIENTS: In 224 young women recruited as normal volunteers, ovarian morphology was determined by transabdominal ultrasound and features of polycystic ovary syndrome were identified on clinical and biochemical examination. Insulin sensitivity was estimated from fasting glucose and insulin levels using the homeostasis model. Insulin gene VNTR genotypes were determined in women and their parents. MEASUREMENTS AND RESULTS: Thirty-three per cent (74/224) had polycystic ovaries on ultrasound. These women had higher birth weights (P = 0.004), higher insulin sensitivity (P = 0.02) and higher leptin levels for body mass index (P = 0.04) than women with normal ovaries. However among women with polycystic ovaries, increasing severity of clinical phenotype (based on number of features of: menstrual irregularity, acne, hirsutism, serum testosterone > 3 mmol/l and LH > 10 IU/l) was associated with decreasing insulin sensitivity (P < 0.0001) and related to paternally transmitted insulin gene VNTR class III alleles (P = 0.03). CONCLUSION: Women with polycystic ovaries on ultrasound have increased insulin sensitivity and possible leptin resistance, which could predispose to future weight gain. However, in these women the appearance of clinical features of polycystic ovary syndrome is related to insulin resistance and insulin gene VNTR class III alleles.     

Prevalence and predictors of dyslipidemia in women with polycystic ovary syndrome.

PURPOSE: Women with polycystic ovary syndrome are hyperandrogenemic and insulin resistant, which are associated with alterations in circulating lipid and lipoprotein levels. We sought to determine the prevalence of, and risk factors for, lipid abnormalities in these women. SUBJECTS AND METHODS: Non-Hispanic white women with polycystic ovary syndrome (n = 195) and ethnically matched control women (n = 62) had fasting blood obtained for hormone and lipid levels. Subjects were categorized by body mass index (nonobese <27 kg/m(2), obese > or =27 kg/m(2)), and analyses were adjusted for age. RESULTS: Total cholesterol and low-density lipoprotein cholesterol (LDL-C) levels increased significantly in obese women with polycystic ovary syndrome (n = 153) compared with obese control women (n = 35; mean difference in total cholesterol level = 29 mg/dL; 95% confidence interval [CI]: 14 to 45 mg/dL; P <0.001; mean difference in LDL-C level = 16 mg/dL; 95% CI: 4 to 30 mg/dL; P = 0.006). Similarly, total cholesterol and LDL-C levels increased significantly in nonobese women with polycystic ovary syndrome (n = 42) compared with nonobese control women (n = 27; mean difference in total cholesterol = 32 mg/dL; 95% CI: 13 to 52 mg/dL; P <0.001; mean difference in LDL-C level = 32 mg/dL; 95% CI: 15 to 52 mg/dL; P <0.001). In obese women, high-density lipoprotein cholesterol (HDL-C) and triglyceride levels increased significantly in women with polycystic ovary syndrome compared with control women (mean difference in HDL-C level = 6 mg/dL; 95% CI: 2 to 12 mg/dL; P = 0.002; mean difference in triglyceride level = 34 mg/dL; 95% CI: 1 to 77 mg/dL; P = 0.04). Differences in LDL-C and HDL-C levels, but not triglyceride levels, remained significant after adjusting for alcohol intake, smoking, and exercise. Although age, body mass index, and polycystic ovary syndrome status were significant predictors of lipid levels, these factors accounted for no more than 25% of the variance. CONCLUSIONS: In this large study of non-Hispanic white women, elevations in LDL-C levels were the predominant lipid abnormality in women with polycystic ovary syndrome, independent of obesity. The characteristic dyslipidemia of insulin resistance was absent. Indeed, obese women with polycystic ovary syndrome had relatively elevated HDL-C levels, which may confer some protection against cardiovascular disease.     

肥胖合并多囊卵巢综合征患者超声指标与代谢指标的相关性分析

目的探讨肥胖合并多囊卵巢综合征患者超声指标与代谢指标的相关性。 方法选择惠州市中心人民医院2020年1月至2021年6月收治的42例肥胖型多囊卵巢综合征患者,作为观察组;同时选取我院接受治疗的42例基础体温双相不孕患者,作为对照组。监测卵泡数（FN）、卵巢间质面积（OSA）、卵巢总面积（OTA）、子宫动脉阻力指数（UARI）、卵巢间质动脉阻力指数（OARI）等超声指标,以及促卵泡素（FSH）、促黄体生成素（LH）、睾酮（T）、空腹血糖（FPG）、空腹胰岛素（FINS）、总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）等代谢指标,通过Person相关性分析研究超声指标与代谢指标的相关性。 结果观察组超声指标如FN、OSA、OTA、UARI均高于对照组,而OARI小于对照组（P<0.05）;内分泌及代谢指标FSH、LH、T水平及FPG、FINS、TC、TG、LDL-C水平均高于对照组（P<0.05）;肥胖合并多囊卵巢综合征患者FN、OSA均与T水平呈正相关关系,而OARI与FPG、FINS呈负相关关系（P<0.05）。 结论肥胖多囊卵巢综合征患者FN、OSA、OTA、UARI等超声指标明显增加,且FN、OSA与代谢指标T呈正相关关系,OARI与FPG、FINS呈负相关关系。     

Postprandial thermogenesis is reduced in polycystic ovary syndrome and is associated with increased insulin resistance

OBJECTIVE: In order to investigate the possible causes and effects of obesity in polycystic ovary syndrome resting energy expenditure, postprandial thermogenesis and insulin resistance were measured in 14 polycystic ovary syndrome subjects and in 14 controls. DESIGN: A cross-sectional study of a selected group of patients was performed. PATIENTS: Seven of the PCOS subjects were obese and seven lean. Controls were individually matched for age, race, weight, body mass index (BMI) lean body mass and percentage fat. The obese, but not lean, polycystic ovary syndrome subjects had a greater waist:hip ratio than controls (median (range) obese PCOS 0.865 (0.823-0.960) vs obese control 0.804 (0.823-0.940), P less than 0.025). MEASUREMENTS: Metabolic rate was measured by continuous indirect calorimetry and insulin sensitivity was assessed by a short insulin tolerance test. RESULTS: The resting energy expenditure (REE) was similar in PCOS subjects and controls (median (range), 6796 (5489-7774) vs 6833 (4893-8492) kJ/day). REE correlated with LBM in the PCOS group (r = 0.83, P less than 0.00) and the control group (r = 0.82, P less than 0.001). Postprandial thermogenesis was reduced in polycystic ovary syndrome (obese: median 45.4 (range 33.6-100.0) vs 86.5 (67.2-109.2) kJ (P less than 0.05); lean: 79.4 (73.5-108.4) vs 89.9 (76.0-109.2) kJ (P less than 0.05). Fasting insulin (9.7 +/- 3.6 vs 4.4 +/- 0.8 mU/l, P less than 0.05) and postprandial incremental insulin rise (163 +/- 31 vs 116 +/- 15 mU/l, P less than 0.025) were higher in polycystic ovary syndrome. Insulin sensitivity was reduced in polycystic ovary syndrome (obese: median 136 (range 92-169) vs 173 (109-225) mumol/l/min (P less than 0.05); lean: 161 (138-225) vs 194 (161-253) mumol/l/min (P less than 0.05)). The reduction in insulin sensitivity correlated with the reduced postprandial thermogenesis in the polycystic ovary syndrome group (r = 0.75, P less than 0.01). CONCLUSION: These results confirm previous reports of hyperinsulinaemia and insulin resistance in polycystic ovary syndrome. Furthermore, polycystic ovary syndrome subjects have a reduced postprandial thermogenesis which is related statistically to the reduced insulin sensitivity. The decreased postprandial thermogenesis may predispose women with polycystic ovary syndrome to weight gain.