Dose-effect analysis of treatment by modified Zhibaidihuang decoction on polycystic ovary syndrome hyperandrogenism

OBJECTIVE

To observe the efficacy and safety of different dosages of modified Zhibaidihuang decoction (MZBDD) on polycystic ovary syndrome (PCOS) hyperandrogenism (HA) patients.

多囊卵巢综合征患者的超声特征及其与内分泌指标间相关性分析

目的：比较多囊卵巢综合征（polycystic ovary syndrome,PCOS）伴与不伴高雄激素血症的患者超声特征及内分泌指标差异,并分析其间的相关性。方法：以睾酮≥1.08 ng/mL或游离睾酮≥3.18 pg/mL为标准,将126例PCOS患者分为PCOS伴高雄激素血症（hyperandrogenism,HA）（PCOS/HA组,34例）与PCOS不伴高雄激素（PCOS/NHA组,92例）。采用腔内超声检查测量并比较2组患者卵巢、子宫的灰阶及彩色多普勒二维超声参数;同时检测并比较2组患者的内分泌代谢指标,分析各超声参数与各内分泌代谢指标间的相关性。结果：PCOS/HA组患者的年龄明显小于PCOS/NHA组（P〈0.05）,而其卵巢体积、卵巢卵泡数、卵巢间质面积、卵巢间质面积与总面积之比、子宫动脉阻力指数均较PCOS/NHA组明显增高（P均〈0.05）,其卵巢间质动脉阻力指数则较PCOS/NHA组显著降低（P〈0.01）。内分泌指标中,PCOS/HA组患者的睾酮、游离睾酮、硫酸脱氢表雄酮、雄烯二酮、三酰甘油、空腹血浆胰岛素均显著高于PCOS/NHA组（P均〈0.05）。且PCOS/HA患者的卵巢卵泡数与其游离睾酮、糖化血红蛋白水平呈正相关（r分别为0.62、0.78,P均〈0.01）;其卵巢体积、子宫动脉阻力指数与其体质量指数呈正相关（r分别为0.64、0.57,P分别〈0.01、〈0.05）;其卵巢间质动脉阻力指数则与体质量指数、性激素结合球蛋白、胰岛素抵抗指数、空腹血浆胰岛素水平相关（r分别为-0.46、0.55、-0.55、-0.57,P均〈0.05）。结论：PCOS/HA组与PCOS/NHA组患者间的超声特征及内分泌指标有一定差异,且PCOS/HA组中这两者间有一定相关性。     

微小RNA在多囊卵巢综合征病因学研究中的新进展

多囊卵巢综合征（PCOS）是一种常见的生殖内分泌疾病，其主要特征是高雄激素血症、稀发排卵或无排卵、卵巢多囊样改变及胰岛素抵抗。微小RNA（miRNA）是一类小分子非编码RNA，在转录后水平对靶基因进行调控。miRNA可以通过调节卵巢颗粒细胞增殖和凋亡影响卵泡发育、排卵与闭锁；通过影响雄激素的合成和释放，导致内分泌紊乱；通过调节糖代谢及胰岛素敏感性，诱导胰岛素抵抗的产生，从而参与PCOS的发病过程。现就miRNA在PCOS病因学研究中的进展进行综述。     

Concomitant dysregulation of androgen secretion and dysfunction of adipose tissue induced insulin resistance

Hyperandrogenism and hyperinsulinemia have resulted from dysfunction of the theca cell of the ovary and adipose tissue and each one potentiates the other in patients with androgen excess disorders e.g., polycystic ovary disease and idiopathic hirsutism. Possible external and/or internal triggers can produce such cellular dysfunction. There is evidence that sodium valproate acts as a trigger of cellular dysfunction and produces both hyperinsulinemia and hyperandrogenism. Therefore, the elimination of these triggers can help the patients to recover from hyperinsulinemia, insulin resistance and hyperandrogenism.     

Characteristics of Adolescents with Differing Polycystic Ovary Syndrome Phenotypes

Study ObjectiveTo analyze clinical, metabolic, hormonal, and ultrasound characteristics of adolescents with polycystic ovary syndrome phenotypes.DesignWe performed a retrospective analysis of quality improvement data. We divided patients according to phenotype on the basis of clinical or biochemical diagnosis of hyperandrogenism (HA), irregular menstruation (IM), and presence or absence of polycystic ovarian morphology (PCOM) on pelvic ultrasound (PUS) images, if obtained. The 5 resulting groups were: (1) HA/IM/normal PUS, n = 28; (2) HA/PCOM, n = 10; (3) IM/PCOM, n = 18; (4) HA/IM/PCOM, n = 40; and (5) HA/IM/no PUS obtained, n = 80. We compared parameters between groups using the nonparametric Wilcoxon rank sum test.SettingBoston Children's Hospital, 2012-2016.ParticipantsOne hundred seventy-six girls and young women aged 11-25 years.InterventionsNone.Main Outcome Measures(1) Clinical, metabolic, and hormonal characteristics; and (2) PUS measurements.ResultsGroups with HA had significantly higher acne scores, Ferriman-Gallwey scores, and total and free testosterone concentrations than groups without HA. Significant differences in hemoglobin A1c were found between the IM/PCOM and HA/IM/PCOM groups (5.1% vs 5.3%; P = .01) and the IM/PCOM and HA/IM/no PUS groups (5.1% vs 5.3%; P < .01). In patients who had ultrasound performed, 49/94 (52.1%) met PCOM criteria on the basis of ovarian size, 37/94 (39.4%) on the basis of follicle number, and 27/94 (28.7%) on both; 10/94 (10.5)% had incidental findings on ultrasound, with 2 patients requiring further management.ConclusionLimited differences in clinical, metabolic, and hormonal characteristics exist between adolescents with different phenotypes of polycystic ovary syndrome, and are mostly related to the presence or absence of HA. Of patients with ultrasound examinations, only 2 had clinically actionable incidental findings.     

The adrenal and polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders characterized by androgen excess, oligo-ovulation and polycystic ovaries. Although ovaries are the main source of increased androgens in the syndrome, between 20 and 30% of patients with PCOS have adrenal androgen (AA) excess, detectable primarily by elevated dehydroepiandrosterone sulfate (DHEAS) levels. Patients with PCOS demonstrate a generalized hypersecretion of adrenocortical products, basally and in response to ACTH stimulation. The mechanisms of these abnormalities are unclear although AA excess in PCOS is likely a complex trait, modulated by both intrinsic and acquired factors. To date, no specific genetic defects have been identified. The production of AAs in response to ACTH appears to be closely related to altered factors regulating glucose-mediated glucose disposal, increased peripheral metabolism of cortisol, and to a less extent to the effects of extra-adrenal androgens, insulin resistance, hyperinsulinemia or obesity. Finally, DHEAS levels and the response of AAs to ACTH are relatively constant over time and are closely correlated between PCOS patients and their siblings suggesting that this abnormality is an inherited trait in PCOS.     

青春期多囊卵巢综合征的诊治

青春期多囊卵巢综合征(PCOS)发病率高,病因不明,临床表现和生化特征复杂多样,不易与正常青春期表现进行区分,故青春期PCOS的诊治经常受到忽视,而对青春期PCOS患者进行早期诊断和治疗,不仅能改善患者的临床症状、减少青少年精神心理疾病的发生,而且也许能阻止日后发生的代谢和心血管方面的并发症。故青春期PCOS的诊治十分重要。