多囊卵巢综合征胰岛素抵抗的临床研究

目的:研究多囊卵巢综合征妇女的临床特征与胰岛素抵抗之间的关系。方法:选择76名PCOS女性进行人体测量学指标的检查和测定、性激素水平检测并进行口服葡萄糖耐量试验及胰岛素释放试验。结果:76例PCOS患者中除3例合并糖尿病外,73例PCOS患者中存在胰岛素抵抗者46例,占63%,无胰岛素抵抗者27例,占37%。与无胰岛素抵抗者比较,胰岛素抵抗者体重、BMI、腰围和腰臀比及黑棘皮征明显增高,而两组间性激素6项指标的差异不明显。结论:PCOS妇女中胰岛素抵抗发生率较高;PCOS合并IR患者的体重、BMI、腰围和腰臀比、黑棘皮征明显高于无胰岛素抵抗者;性激素水平与糖代谢异常及胰岛素抵抗无关。     

优思明联合二甲双胍对于多囊卵巢综合征患者内分泌的影响

目的:研究优思明联合二甲双胍对多囊卵巢综合征(PCOS)患者内分泌的影响。方法:选择临床确诊为P-COS患者65例,采用优思明和二甲双胍联合治疗6月,治疗前后分别测定血清黄体生成素(LH)、促卵泡素(FSH)、雌二醇(E2)、睾酮(T)、空腹胰岛素(FIN)、空腹血糖(FBS)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)、总胆固醇(TC)水平。结果:经治疗6个月后,LH、LH/FSH、T的水平均较治疗前明显降低(P<0.05),但FSH、E2下降不明显(P>0.05);治疗后FIN和胰岛素抵抗指数明显改善(P<0.01);TC、TG下降明显(P<0.05),HDL-C升高明显(P<0.05);治疗期间均未出现严重不良反应。结论:优思明联合二甲双胍应用能明显改善PCOS患者性激素水平,降低体内雄激素水平,改善胰岛素抵抗指数,纠正体内异常脂质代谢,降低患者心血管并发症的风险,值得临床推广。     

Evidence-based lifestyle and pharmacological management of infertility in women with polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is the most prevalent endocrine disorder in women of reproductive age and by far the most common cause of anovulatory infertility. Lifestyle change alone, and not in combination with pharmacological ovulation induction such as clomifene citrate or metformin, is generally considered the first-line treatment for the management of infertile anovulatory women with PCOS who are overweight or obese. Clomifene citrate should be considered as a first-line pharmacological therapy to improve fertility outcomes. Second-line medical treatments may include ovulation induction with gonadotropins (in clomifene citrate-resistant or clomifene citrate failure women) or laparoscopic ovarian drilling (in clomifene citrate-resistant women) or possibly with metformin combined with clomifene citrate (in clomifene citrate-resistant women). There is currently insufficient evidence to recommend aromatase inhibitors over that of clomifene citrate in infertile anovulatory women with PCOS in general or specifically in therapy-naive or clomifene citrate-resistant women with PCOS.     

优思明与达英-35治疗多囊卵巢综合征的临床疗效对比

目的:观察屈螺酮炔雌醇(优思明)和炔雌醇环丙孕酮(达英-35)治疗多囊卵巢综合征(PCOS)的临床疗效对比。方法:将62例研究对象随机分成优思明组(30例)和达英-35组(32例),连续治疗3个周期,月经来潮1～5天内复诊,评价治疗前后性激素、脂代谢、体重等临床指标。结果:优思明和达英-35均能降低血清总睾酮(T)、黄体生成素(LH)及改善多毛症状,差异有统计学意义(P<0.05);达英-35组的高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、总胆固醇(T-CHO)治疗后明显增高,差异有统计学意义(P<0.05);优思明组HDL、T-CHO治疗后明显增高,差异有统计学意义(P<0.05);两组治疗前后体重、雄激素、LH水平差值差异没有统计学意义(P>0.05)。结论:优思明和达英-35均能有效改善PCOS高雄激素血症、高LH的内分泌环境及多毛症状,对体重无明显增加。其中优思明对脂代谢的影响小于达英-35,更有利于PCOS患者远期心脑血管疾病的防治。     

二甲双胍对多囊卵巢综合征患者的治疗作用

多囊卵巢综合征是生育年龄妇女常见的内分泌及糖代谢异常所导致的病理状态。由于高胰岛素血症和胰岛素抵抗在其发病中起重要作用 ,二甲双胍逐渐被应用于治疗多囊卵巢综合征 ,该文回顾总结近年来二甲双胍对多囊卵巢综合征的治疗作用 ,并探讨其作用机制。     

Evidence-based management of infertility in women with polycystic ovary syndrome using surgery or assisted reproductive technology

Polycystic ovary syndrome (PCOS) has been managed surgically since the development of wedge resection in the 1930s. Second-line surgical interventions for anovulation associated with PCOS include laparoscopic ovarian diathermy, which is as effective as medical induction of ovulation with gonadotropins, with a much reduced risk of multiple pregnancy. Bariatric surgery may be considered for morbidly obese patients with PCOS, although further research assessing such surgery specifically in PCOS patients is needed. Assisted reproduction, in the form of IVF with or without intracytoplasmic sperm injection, is usually indicated as third-line medical treatment or in the presence of other infertility factors. There is an ongoing debate concerning the relative merits of IVF and ovulation induction in PCOS, comparing the higher multiple pregnancy rate of ovulation induction with the greater cost and psychological stress of IVF.     

Health-related quality of life in Iranian women with polycystic ovary syndrome: a qualitative study

Background

Polycystic ovary syndrome (PCOS) is associated with a range of challenging symptoms which impact patient’s lives. Iranian women with PCOS are likely to face a number of unique difficulties given particular societal and cultural norms for women. Understanding health-related quality of life (HRQoL) from a patients’perspective is critical to developing the appropriate support interventions. The present study aimed to generate an in-depthunderstanding of HRQoL Iranian women with PCOS.

Methods

Twenty Iranian women were interviewed and data was subjected to thematic analysis.

Results

Women reported substantial effects of PCOS on their quality of life, Themes generated from the data related to sexual - physical problems (An unsexualised self: loss, change and pain; and Being pained and painful); exposure and nvasion: the rejecting and invading social world (Concealing and Avoiding and Public property: public scrutiny), diminished self and diminished life (Infertile as inferior and Exhausted mind andbody) respectively.

Conclusion

PCOS is a physical - sexual, psychological and social syndrome; therefore, it is necessary to taking a more holistic approach to patient care beyond treating physical symptoms.

     

Eating frequency and snacking habits in women with polycystic ovary syndrome

Background: Polycystic ovary syndrome (PCOS) affects up to 10% of women of reproductive age in the UK and obesity is a common feature. Food craving has been anecdotally reported by women with PCOS (Herriot et al., 2008) and some studies suggest that increased eating frequency (EF) and snacking may contribute to increased energy intake (Hampl et al., 2003). This study aimed to describe the EF of women with PCOS and investigate the impact of EF on energy intake and body mass index (BMI). Methods: Seven‐day food diaries were posted to and completed by 131 women diagnosed with PCOS, who were also asked to report their age, weight and height. Eating episodes were categorised as drinks, mixed meals, and savoury or sweet snacks (foods consumed between meals). BMI was estimated using self‐reported weight and height and categorised into <25, 25–29.9 and >30 kg m^?2. Results: All participants completed a food diary, with 122 providing self‐reported height and weight. Mean (SD) age was 32.0 (6.1) years, and mean (SD) BMI was 27.9 (7.9) kg m^?2. Of those who provided details of height and weight, 57% (47%) women had a BMI <25 kg m^?2, 24% (20%) had a BMI 25–29.9 kg m^?2 and 41% (33%) had a BMI of >30 kg m^?2. Mean (SD) energy intake was 8259 (1644) kJ day^?1 [1974 (393) kcal day^?1] and mean carbohydrate intake was 226 (58) g/day. A paired t‐test was used to compare consumption of sweet and savoury snacks. A one‐way analysis of variance was used to analyse differences in energy intake, and to compare stratified BMI groups and EF including drinks. Assumption of homogeneity of variance was violated when analysing differences in stratified BMI and mean total EF excluding drinks; therefore, a robust test of equality of means was used instead. A Pearson product–moment correlation was used to explore correlations between energy or macronutrient intake and EF.

Table 1. Energy intake and eating frequency in women with PCOS

卵泡穿刺治疗PCOS所致不孕症

目的针对PCOS促排卵中出现的多卵泡发育及排卵障碍,采用穿刺卵泡技术治疗不孕症。方法使用HMG/HCG促排卵共31个周期,阴道B超监测卵泡发育,给予多卵泡发育患者采用刺破卵泡4~8个,吸出多余卵泡,同时行AIH或指导前一天晚上同房。结果31个周期中,当月临床妊娠5例,妊娠率16.12%。术后半年内再次促排卵自然妊娠3例,总妊娠率25.80%。结论对于PCOS患者在促排卵过程中出现多卵泡发育和排卵障碍,采用卵泡穿刺技术是一个有效且安全的方法。     

多囊卵巢综合征的胰岛素抵抗研究进展

胰岛素抵抗在多囊卵巢综合征的发生及病理生理中起着重要作用 ,认识多囊卵巢综合征与胰岛素抵抗的形成机制及其病理生理 ,有助于我们选择恰当的治疗方法。该文综述了近年来多囊卵巢综合征与胰岛素抵抗的关系及治疗进展 ,旨在为PCOS患者合理化用药提供理论依据     

来曲唑用于多囊卵巢综合征促排卵疗效观察

目的:探讨来曲唑用于多囊卵巢综合征引起无排卵性不孕妇女的促排卵效果及其对生殖激素的影响。方法:选择2006年1月1日~2007年1月31日于该院就诊的氯米芬抵抗的PCOS患者41例,随机分为2组,来曲唑组(实验组)在月经周期第3~7天口服来曲唑(LE)2·5mg/d,尿促性素组(对照组)在月经周期第3天开始采用低剂量递增法肌注尿促性素(hMG),超声监测卵泡发育,当最大卵泡平均直径≥18mm时,肌注绒毛膜促性腺激素(hCG)10000 IU诱发排卵,于hCG日取肘静脉血测定黄体生成素(LH)、雌二醇(E2)、睾酮(T),并观察排卵率、妊娠率、子宫内膜厚度及生殖激素的变化。结果:来曲唑组的排卵率和周期妊娠率与尿促性素组相似(P>0·05),来曲唑组单个优势卵泡的发生率明显高于hMG组,其成熟卵泡数显著低于尿促性素组(P<0·05),来曲唑组在hCG日子宫内膜的厚度与尿促性素组相似,来曲唑组在hCG日血清E2、T水平与尿促性素组无明显差异。结论:来曲唑用于氯米芬抵抗引起的无排卵性不孕妇女具有良好的排卵率和妊娠率,且单卵泡排卵率高于尿促性素。     

多囊卵巢综合征患者血浆内脂素水平的变化及意义

目的:探讨多囊卵巢综合征(PCOS)患者血浆内脂素水平的变化及意义。方法:采用酶联免疫吸附法测定50例PCOS患者和45例健康体检者血浆内脂素水平,采用化学发光法测定空腹胰岛素(FINS)和血清性激素水平,采用葡萄糖氧化酶法测定空腹血糖(FPG)水平,并分析血浆内脂素水平与体重指数(BMI)、腰臀比(WHR)、空腹血糖、空腹胰岛素、胰岛素抵抗指数(HOMA-IR)和血清性激素的关系。结果:①PCOS组血浆内脂素水平为(21.18±4.31)ng/ml,对照组为(12.47±3.38)ng/ml,两组相比有统计学差异(P<0.01);肥胖PCOS组血浆内脂素水平为(22.10±5.20)ng/ml,非肥胖P-COS组为(20.39±3.27)ng/ml,分别高于肥胖对照组(14.68±3.02)ng/ml及非肥胖对照组(10.71±2.53)ng/mL(P<0.01)。②相关性分析显示,PCOS组血浆内脂素水平与WHR(r=0.43,P<0.01)、HOMA-IR(r=0.55,P<0.01)呈正相关。结论:PCOS患者血浆内脂素水平升高;血浆内脂素水平与胰岛素抵抗、肥胖呈正相关。     

二甲双胍对多囊卵巢综合征不孕症患者的治疗及临床观察

目的 观察二甲双胍治疗多囊卵巢综合症不孕症患者的疗效,探讨其临床价值.方法 选择陕西省咸阳市中心医院于2014年1月至2015年6月收治的多囊卵巢综合征不孕症患者100例作为研究对象,按照配对分组法分为对照组和观察组,每组50例,对照组给予口服达英-35治疗,观察组于对照组基础上联合应用二甲双胍治疗,两组均连续服药3个月,比较两组疗效.结果 两组患者治疗前体质量指数、黄体生成素、睾酮水平比较均无统计学差异(t值分别为0.869、1.534、1.153,均P>0.05);治疗后观察组体质量指数、黄体生成素、睾酮水平均低于对照组,且两组治疗后水平均低于治疗前(t=7.889~25.876,均P<0.05).两组患者治疗前、治疗后空腹血糖及2h血糖水平比较均无显著统计学差异(t值分别为0.665、0.905、0.766、0.665,均P>0.05);观察组治疗后空腹胰岛素及2h胰岛素水平均显著低于对照组,且均低于术前(t值分别为37.915,18.404,均P<0.05).观察组治疗后排卵率及妊娠率分别为72.0%(36例)、42.0%(21例),均显著高于对照组52.0%(26例)、20.0%(10例),差异有统计学意义(χ2值分别为4.244、5.657,均P<0.05).观察组治疗期间不良反应发生率34.0%(17例),与对照组32.0%(16例)比较,无显著统计学差异(χ2=0.045,P>0.05).结论 二甲双胍用于多囊卵巢综合征不孕症患者治疗可取得较佳疗效,胰岛素水平显著降低,有助于排卵,且不良反应发生率低,具有重要临床价值.     

盐酸吡格列酮治疗肥胖型多囊卵巢综合征临床分析

目的:探讨盐酸吡格列酮对肥胖型多囊卵巢综合征(PCOS)患者内分泌、糖脂代谢的影响。方法:29例肥胖型PCOS患者口服盐酸吡格列酮共3个月,观察治疗前后F-G评分、卵泡总数及卵巢体积的改变以及性激素、IR程度、血清脂联素(APN)、血脂水平的变化。结果:治疗前APN与HomaIR、甘油三脂(TG)、低密度脂蛋白胆固醇(LDL-C)呈显著负相关(P<0.05),与高密度脂蛋白胆固醇(HDL-C)呈显著正相关(P<0.05);治疗后PCOS患者F-G评分显著降低(P<0.05),卵泡总数及卵巢体积亦显著降低(P<0.01);血清黄体生成素(LH)、黄体生成素与促卵泡生成素比值(LH/FSH)、雄烯二酮(A2)水平均显著下降(P<0.05);各胰岛素抵抗指标均明显降低(P<0.01);TG、LDL-C显著下降(P<0.01),总胆固醇(TC)亦明显下降(P<0.05),HDL、APN显著升高(P<0.05)。结论:应用盐酸吡格列酮治疗肥胖型PCOS患者,在纠正IR和高雄激素的同时,改善了糖脂代谢,具有较好的治疗效果。     

曲普瑞林治疗多囊卵巢综合征不孕的疗效观察

目的观察曲普瑞林对多囊卵巢综合征不孕患者促排卵的效果。方法多囊卵巢综合征患者内分泌紊乱纠正后,实验组给予曲普瑞林+HCG治疗,对照组给予氯米芬+HCG治疗,比较两组给药后排卵时间、周期排卵率、临床妊娠率、流产率等。结果实验组用药72h内排卵率(χ2=4.39)、周期排卵率(χ2=4.71)、妊娠率(χ2=3.89)明显高于对照组(P﹤0.05),还能减少OHSS(χ2=4.32)、LUFS发生率(χ2=4.69),两组流产率相似(χ2=0.09),差异无统计学意义(P﹥0.05)。结论曲普瑞林具有较好的促排卵效果,与HCG合用更能提高排卵妊娠率。     

61例多囊卵巢综合征妇女行供精人工授精结局分析

目的探讨多囊卵巢综合征(polycystic ovary syndrome,PCOS)妇女采用不同治疗方案后行供精人工授精(artificial insemination by donor,AID)助孕的临床治疗效果。方法回顾性分析广东省计划生育专科医院61例妇女自然周期或是不同方案促排卵后行AID助孕122个周期,比较不同方案的临床妊娠率的差异。结果周期妊娠率20.83%,累积妊娠率40.98%,不同方案比较,妊娠率差异有统计学意义(P<0.05)。以克罗米芬(clomifene citrate,CC)/人绝经期促性腺激素(human menopausal gonadotropin,HMG)/人绒毛膜促性腺激素(human chorionic gonadotrophin,HCG)促排卵的妊娠率最高,卵泡刺激素(follicle stimulating hormone,FSH)/HCG组妊娠率与他莫昔芬(tamoxifen,TMX)/HMG/HCG组及CC/HMG/HCG组比较,差异有统计学意义(P<0.05)。结论 PCOS妇女调整周期自然排卵可以获得较高的妊娠率,CC/TMX与促性腺激素(gonadotropin,Gn)结合可以增加排卵率和临床妊娠率,减少Gn的应用时间,减少卵巢过度刺激综合征(Ovarian hyperstimulation syndrome,OHSS)的发生。     

氧化应激与非肥胖多囊卵巢综合征关系

目的探讨氧化应激与非肥胖多囊卵巢综合征(PCOS)的关系。方法问卷调查湖北省武汉地区42例非肥胖PCOS患者和46名对照妇女的基本特征,检测其血清丙二醛(MDA)和8-羟基脱氧鸟苷(8-OHdG)等水平,并对MDA和8-OHdG与其他指标的相关性进行Spearman相关分析。结果非肥胖PCOS组患者血清中胆固醇(CHO)、总睾酮(TESTO)、促黄体激素(LH)、空腹胰岛素(FI)、胰岛素抵抗指数(HOMA-IR)、MDA和8-OHdG水平均高于对照组(均P<0.05);卵泡刺激素(FSH)水平低于对照组(Z=-2.942,P<0.01);相关分析结果显示,MDA和8-OHdG水平均与HOMA-IR(r=0.434,P<0.01;r=0.304,P<0.01)、 TESTO(r=0.339,P<0.01;r=0.378,P<0.01)、 LH(r=0.217,P=0.023;r=0.326,P<0.01)呈正相关,提示血清MDA和8-OHdG水平与PCOS的高胰岛素抵抗、高雄血症以及卵巢功能紊乱有关。结论非肥胖PCOS患者血清氧化应激水平高于健康对照组,且这种高氧化应激状态与非肥胖PCOS患者的高胰岛素抵抗和高雄血症密切相关。