抗心磷脂抗体阳性孕妇的血液动力学特点

目的　探讨抗心磷脂抗体(aCL)阳性孕妇的血液动力学特点。方法　选择aCL阳性孕妇272例,其中有不良孕产史(含1次及以上自然流产、死胎史)91例(A组)、无不良孕产史者181例(B组),aCL阴性且无不良孕产史孕妇186例(C组),采用金标免疫斑点法检测3组孕妇血清aCL,无创性妊娠高血压综合征(妊高征)血液动力学监测仪监测3组孕妇血液动力学参数变化。结果血液黏度A组为(4 .7±0 .5)mPa·s、B组(4. 6±0 .7)mPa·s、C组(4 .4±0 .4)mPa·s,B、C两组比较,差异有统计学意义(t=-2 157,P<0 .05);波形系数A组为0 .41±0. 04、B组为0 39±0. 05、C组为0. 39±0 .04,A、B两组比较,差异有统计学意义(P<0 .05);外周阻力A组为( 1 .3±0 .4 )mmHg·s·ml-1、B组为(1 .2±0 .4)mmHg·s·ml-1、C组为(1. 2±0. 4)mmHg·s·ml-1,A、B两组比较,差异有统计学意义(P<0 .05);心脏排血指数A组为( 43±15 )ml/(s·m2 )、B组为( 48±16 )ml/(s·m2 )、C组为(48±14)ml/(s·m2 ),A、B两组比较,差异也有统计学意义(P<0 .05)。结论　aCL阳性有不良孕产史孕妇的血液黏度、波形系数、外周阻力异常增高,心脏排血指数下降,aCL可能与自然流产、死胎等不良妊娠结局相关。     

多囊卵巢综合征患者血清脂联素水平与胰岛素抵抗关系的研究

目的探讨多囊卵巢综合征(PCOS)患者血清脂联素(APN)水平与胰岛素抵抗的关系。方法采用酶联免疫吸附法(ELISA)测定40例PCOS患者[PCOS组,根据体重指数(BMI)分为肥胖者(BMI≥25kg/m2)19例,非肥胖者(BMI<25kg/m2)21例]及15例健康志愿者和10例非PCOS不孕患者(对照组,其中肥胖者9例,非肥胖者16例)的APN水平,化学发光法、葡萄糖氧化酶法、放射免疫法分别测定空腹胰岛素、空腹血糖、肿瘤坏死因子α(TNF-α)水平。计算两组患者胰岛素敏感指数(ISI),评价胰岛素抵抗程度。结果(1)PCOS组肥胖者APN水平为(1·6±0·5)mg/L,PCOS组非肥胖者为(3·0±0·6)mg/L,对照组肥胖者为(3·2±0·3)mg/L,非肥胖者为(4·9±0·5)mg/L,两组分别比较,差异均有统计学意义(P<0·05)。(2)PCOS组肥胖者胰岛素水平为(17±6)mU/L,非肥胖者为(14±6)mU/L,对照组肥胖者为(10±3)mU/L,非肥胖者为(7±3)mU/L,两组分别比较,差异有统计学意义(P<0·05)。(3)PCOS组肥胖者空腹血糖为(5·2±0·7)mmol/L,非肥胖者为(5·1±0·6)mmol/L,对照组肥胖者为(5·4±0·5)mmol/L,非肥胖者为(4·8±0·6)mmol/L,两组分别比较,差异无统计学意义(P>0·05)。(4)PCOS组肥胖者TNF-α水平为(1·32±0·14)μg/L,非肥胖者为(1·02±0·12)μg/L,对照组肥胖者为(0·93±0·15)μg/L,非肥胖者为(0·63±0·18)μg/L,两组分别比较,差异有统计学意义(P<0·05)。(5)PCOS组肥胖者ISI为-4·5±0·3,非肥胖者为-4·1±0·4,对照组肥胖者为-3·6±0·3,非肥胖者为-3·1±0·4,两组分别比较,差异也有统计学意义(P<0·05)。PCOS组患者APN水平与BMI呈显著负相关关系(r=-0·56,P<0·05),与ISI呈显著正相关关系(r=0·49,P<0·05)。结论PCOS患者APN水平降低,并以PCOS肥胖者降低更明显;PCOS患者APN水平下降与胰岛素敏感性及胰岛素抵抗相关。     

汉族育龄多囊卵巢综合征患者的临床特征及分析

目的探讨汉族育龄妇女患多囊卵巢综合征(PCOS)的临床特征。方法根据欧洲人类生殖协会(ESHRE)和美国生殖医学协会(ASRM)提出的,将符合稀发排卵、高雄激素征象及卵巢多囊样表现3项中的2项即可诊断PCOS的标准(即ESHRE/ASRM诊断标准),采用分层整群随机抽样的方法,以问卷方式调查了山东省济南市某地区1027名育龄妇女,对检出的PCOS患者的临床表现、糖代谢特征进行分析;并与同期94名月经正常、已正常生育、无痤疮、无男性毛发分布及无卵巢多囊表现等的妇女(对照组)进行比较。结果(1)1027份调查问卷,收回有效问卷828份(即828名调查对象),问卷反馈率为80·62%。共检出PCOS患者85例,其中≤35岁患者为97·65%(83/85)。(2)同年龄段PCOS患者的月经周期较对照组长,反映临床高雄激素征象及程度的多毛F-G分数、睾酮、游离雄激素指数较对照组高,平均小卵泡数均较对照组多,血清性激素结合球蛋白较对照组降低,以上两者分别比较,差异均有统计学意义(P<0·01)。85例PCOS者的月经稀发程度、F-G分数、痤疮的发生情况、平均小卵泡数,随年龄增长呈现逐渐缩短或降低的趋势。(3)PCOS有不孕史患者的胰岛素抵抗指数为1·49±0·73,无不孕史患者为1·31±0·66,两者比较,差异有统计学意义(t=2·058;P<0·05)。PCOS肥胖患者的空腹胰岛素为(8·50±3·46)mU/L、空腹血糖为(5·70±2·27)mmol/L、胰岛素敏感指数为0·025±0·015;非肥胖患者空腹胰岛素为(5·45±0·54)mU/L、空腹血糖为(4·88±0·45)mmol/L,胰岛素敏感指数为0·044±0·026,以上两者比较,差异均有统计学意义(P<0·01,P<0·05)。结论按照ESHRE/ASRM诊断标准,35岁以下的育龄妇女是PCOS患者的主要群体;PCOS患者的稀发排卵、高雄激素征象、卵巢多囊表现等临床特征随年龄增长而变化;育龄期PCOS合并不孕、肥胖患者存在糖代谢改变,应重视其胰岛素抵抗现象。     

多囊卵巢综合征患者胰岛素受体基因外显子17的多态性研究

目的　探讨胰岛素受体基因外显子17与多囊卵巢综合征(PCOS)发病的关系。方法对33例PCOS患者(PCOS组)和28例因单纯输卵管原因或男性不育的不孕妇女(对照组)的胰岛素受体基因外显子17进行PCR扩增、单链构型多态性电泳分析,及等位基因分布频率比较。同时对各基因型患者进行内分泌检测。结果　两组胰岛素受体基因外显子17的1008bp处,均有T基因型向C基因型(T→C)的突变,均发现了3种基因型,即T/T、C/T、C/C基因型。PCOS组C/C基因型为39%,对照组为11%,两组比较,差异有统计学意义(P<0 .05 );PCOS组C/C基因型肥胖患者为47%,非肥胖患者为33%,两者比较,差异无统计学意义(P>0 .05)。PCOS组合并胰岛素抵抗患者为50%,无合并胰岛素抵抗患者为36%,两者比较,差异无统计学意义(P>0 .05)。PCOS组患者胰岛素敏感指数,T/T基因型患者为0 .038±0 .016,C/C基因型患者为0 .024±0 .010,C/T基因型患者为0 .028±0 .014,C/T基因型及C/C基因型与T/T基因型患者比较,差异有统计学意义(P<0 .05);T/T基因型与C/C基因型患者比较,差异无统计学意义(P>0 .05)。胰岛素受体β亚基表达及血清黄体生成素、睾酮水平, 3种基因型患者比较,差异均无统计学意义(P>0 .05)。结论　PCOS患者胰岛素受体基因外显子17多态性在1008bp发生T→C的突变频率高于     

宫腔镜下不同手术方式治疗子宫内膜息肉的临床疗效观察

目的探讨宫腔镜下不同手术方式治疗子宫内膜息肉的疗效。方法对不同年龄和不同生育要求的子宫内膜息肉患者327例,分别行子宫内膜息肉切除+子宫内膜汽化电切术(A组,53例);子宫内膜息肉切除+子宫内膜电切术(B组,175例);子宫内膜息肉切除+息肉旁浅层内膜切除术(C组,54例,要求保留生育功能者);子宫内膜息肉切除+子宫内膜电凝术(D组,45例,绝经后患者)。结果手术时间:A组(15·1±0·8)s,B组(19·7±0·7)s,C组(20·9±0·7)s,D组(22·1±0·8)s,A组平均手术时间与其他3组比较,差异有统计学意义(P<0·01);术后子宫内膜息肉复发率:A、D组为0,B组为1·7%(3/175),C组为7·4%(4/54),C组术后复发率与其他3组分别比较,差异均有统计学意义(P<0·05);C组术后无闭经者,但术后息肉复发率高于其他3组,C组中有14例术后5~23个月妊娠。结论宫腔镜下不同手术方式治疗子宫内膜息肉的临床疗效无明显差异,但子宫内膜息肉切除+息肉旁浅层内膜切除术后复发率高;应根据患者年龄、生育要求等选择适宜的宫腔镜下手术方式。     

多囊卵巢综合征合并胰岛素抵抗患者脂肪组织中磷脂酰肌醇3激酶的检测及其意义

目的检测多囊卵巢综合征(PCOS)合并胰岛素抵抗(IR)患者脂肪组织中磷脂酰肌醇3激酶(PI-3K)的表达,探讨PCOS患者发生IR的机制。方法检测PCOS发生IR 19例患者(PCOS IR组)、PCOS未发生IR 10例患者(PCOS非IR组)及因单纯子宫肌瘤施行手术的15例患者(对照组)的空腹血清胰岛素(FIN)及空腹血糖(FPG)的水平。采用稳态模型(HOMA)法评价及计算IR指数(HOMA-IR);采用蛋白印迹法检测脂肪组织中PI-3K蛋白的表达;采用RT-PCR技术检测PI-3K mRNA的表达;采用免疫沉淀技术、薄层层析及γ液体闪烁计数仪检测PI-3K的活性,设对照组平均PI-3K活性为100%。结果(1)PCOS IR组患者血清FIN为(25．2±3．8)mU/L,HOMA-IR为1．6±0．3;PCOS非IR组分别为(13．4±3．8)mU/L及0．9±0．3;对照组分别为(9．5±2．6)mU/L及0．5±0．3,3组分别比较,差异均有统计学意义(P＜0．05)。(2)PCOS IR组PI-3K蛋白及mRNA相对表达水平分别为0．65±0．10及0．92±0．12;PCOS非IR组分别为0．72±0．10及1．01±0．10;对照组分别为0．73±0．14及1．00±0．12,3组分别比较,差异均无统计学意义(P＞0．05)。(3)PCOS IR组PI- 3K活性下降为81%,PCOS非IR组下降为89%,PCOS IR组及PCOS非IR组分别与对照组比较,差异均有统计学意义(P＜0．01,P＜0．05)。PCOS IR组和PCOS非IR组PI-3K活性与HOMA-IR均呈显著负相关关系(r=-0．69,P＜0．01;r=-0．62,P＜0．05)。结论PCOS IR患者的PI-3K蛋白及mRNA的表达无明显改变,但PCOS患者PI-3K活性降低,可能是PCOS患者发生IR的机理之一。     

多囊卵巢综合征无排卵患者子宫内膜超声形态学及组织学变化

目的探讨多囊卵巢综合征(PCOS)无排卵患者子宫内膜超声形态学的变化特点,及组织学变化与激素水平的关系。方法采用B超观察76例PCOS无排卵患者(PCOS组)及32例排卵正常的不孕患者(对照组)的子宫内膜;按照Gonen等的分型方法,将子宫内膜分为A型(即低回声三线型)、B型(即均质中等回声)、C型(即强回声)3型;采用免疫组化技术,检测子宫内膜腺上皮细胞增殖相关核抗原Ki67及降钙素的表达;采用透射电镜观察子宫内膜超微结构;采用酶联免疫发光法,检测血清中黄体生成激素及孕酮等的水平。结果PCOS组子宫内膜为A型者23例,B型者34例、C型者17例,另2例患者因内膜厚度<5mm,未进行分型。A型患者的内膜间质发育异常比率为9%(2/23),B型和C型为43%(22/51)两者比较,差异有统计学意义(P<0·05)。PCOS组分泌期内膜腺上皮细胞Ki67表达为(14±6)%,对照组为(9±7)%,两组比较,差异有统计学意义(P<0·05)。PCOS组增生期子宫内膜腺上皮细胞中细胞器增多;分泌期显示分泌反应不良。结论PCOS无排卵患者子宫内膜呈现增生和分泌表现异常,其内膜超声形态学的强回声表现,可能与局灶性内膜间质发生异常组织学改变有关。     

肿瘤坏死因子α启动子基因多态性与妊娠期糖尿病的相关性研究

目的探讨肿瘤坏死因子α(TNF-α)启动子基因多态性及其血浆水平与妊娠期糖尿病(GDM)发病的关系。方法采用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)检测35例GDM孕妇(GDM组)及35例正常孕妇(对照组)TNF-α启动子-308基因型。采用放射免疫法测定两组孕妇血浆中TNF-α水平及计算胰岛素抵抗指数。结果(1)GDM组A等位基因频率(61·4%)显著高于对照组(30·0%),GA+AA型基因频率(71·4%)也显著高于对照组(37·1%),两组比较,差异有统计学意义(P<0·01)。(2)GDM组孕妇血浆TNF-α水平为(52±13)fmol/L,对照组为(14±4)fmol/L,两组比较,差异有统计学意义(P<0·05)。(3)GDM组胰岛素抵抗指数为13·6±6·5,对照组为1·9±0·2,两组比较,差异有统计学意义(P<0·05)。结论TNF-α-308G/A基因多态性与GDM发病有关,其机制可能是通过升高GDM孕妇血浆TNF-α水平,产生胰岛素抵抗而导致GDM的发生。     

环氧合酶2及前列腺素15-羟基脱氢酶在早产患者胎盘及胎膜组织中的表达

目的探讨环氧合酶2(COX-2)、前列腺素15-羟基脱氢酶(15-PGDH)在胎盘和胎膜组织中的表达变化及其与早产发生的关系。方法采用免疫组化二步法,测定14例早产产妇(早产组)、18例足月临产产妇(足月临产组)、17例足月未临产产妇(对照组)的胎盘和胎膜组织中COX-2与15-PGDH的定位与表达水平(以阳性百分数计分和细胞染色计分相加表示)。结果(1)COX-2在3组产妇的羊膜上皮细胞、绒毛膜细胞和蜕膜细胞的胞质中均有表达。COX-2在早产组胎膜和胎盘组织羊膜上皮细胞中的表达水平分别为(4·6±1·2)、(4·7±0·9)分,在足月临产组分别为(3·2±1·0)、(3·6±1·0)分,在对照组分别为(2·2±0·6)、(2·5±0·9)分。早产组及足月临产组明显高于对照组,两两比较,差异均有统计学意义(P<0·01);早产组与足月临产组比较,差异也有统计学意义(P<0·01)。3组间胎膜羊膜上皮细胞与胎盘羊膜上皮细胞中的COX-2表达水平相互比较,差异均无统计学意义(P>0·05)。(2)COX-2在早产组胎盘绒毛膜细胞中的表达水平为(4·9±1·0)分,在足月临产组为(3·9±1·2)分,在对照组为(2·3±0·7)分,早产组及足月临产组明显高于对照组,两两比较,差异均有统计学意义(P<0·01);早产组与足月临产组比较,差异也有统计学意义(P<0·01)。而3组胎膜绒毛膜组织中COX-2表达水平比较,差异无统计学意义(P>0·05);在3组胎盘蜕膜细胞中的表达水平比较,差异也无统计学意义(P>0·05)。(3)15-PGDH在3组产妇羊膜上皮细胞、绒毛膜细胞和蜕膜细胞的胞质中均有表达,3组胎膜及胎盘组织的羊膜上皮细胞中15-PGDH表达水平比较,差异无统计学意义(P>0·05);而在胎膜及胎盘组织的绒毛膜细胞中表达水平,早产组分别为(1·5±0·6)、(2·3±0·8)分,足月临产组分别为(2·6±0·8)、(3·0±0·7)分,对照组分别为(4·4±1·1)、(4·1±1·2)分,早产组及足月临产组明显低于对照组,两者比较,差异有统计学意义(P<0·01);早产组与足月临产组比较,差异也有统计学意义(P<0·05)。在胎盘组织蜕膜细胞中的表达水平,早产组为(2·1±0·7)分,足月临产组为(2·8±0·8)分,对照组为(4·5±1·0)分,早产组及足月临产组明显低于对照组,两者比较,差异有统计学意义(P<0·01);早产组与足月临产组比较,差异也有统计学意义(P<0·05)。结论COX-2在羊膜上皮细胞中的高表达和15-PGDH在绒毛膜、蜕膜细胞中的低表达,与早产的分娩发动有关。二者在早产的发生中起一定作用。     

早发型重度先兆子痫的临床界定及保守治疗探讨

目的　探讨早发型重度先兆子痫的临床界定及保守治疗的临床意义。方法　回顾分析1988年9月至2004年4月,北京大学第三医院收治的255例无严重并发症及合并症的重度先兆子痫患者的临床资料,按重度先兆子痫发病孕周分为4组:A组<28周, 24例; B组28~31周, 50例;C组32~33周, 34例;D组≥34周, 147例。主要分析指标包括:发病孕周、终止妊娠孕周、孕周延长时间、严重并发症发生情况、胎儿及新生儿死亡率和小于孕龄儿发生率。结果　(1)A组保守治疗时间平均为(9 ±8)d,B组为(11±8)d,C组为(8±6)d,D组为(5±4)d,D组保守治疗时间与前3组比较, 差异有统计学意义(P<0 .01 )。而A、B、C各组间的保守治疗时间比较,差异无统计学意义(P>0. 05)。A、B、C各组孕妇并发症发生率比较,差异也无统计学意义(P>0 .05 ),但与D组比较,差异有统计学意义(P<0 .01);A、B组胎儿及新生儿死亡率、胎死宫内发生率与C、D组比较,差异均有统计学意义(P<0 .01),而C、D两组间比较,差异无统计学意义(P>0 .05)。(2)多因素logistic回归分析显示,重度先兆子痫发病孕周,是影响孕妇并发症发生率的重要因素,而与保守治疗时间无相关性。终止妊娠孕周是影响胎儿及新生儿死亡率的主要因素,其次为发病孕周。(3)以32孕周为界值进行多因素分析显示,终止妊娠孕周     

各项雄激素指标用于诊断多囊卵巢综合征的临床意义

目的:探讨各雄激素指标用于多囊卵巢综合征(PCOS)患者的诊断价值及临床意义。方法:分析294例PCOS患者及116例对照女性的临床表现和各生化雄激素指标,将PCOS组分为有高雄症状组和无高雄症状组,肥胖组和非肥胖组,检测总睾酮(TT)、性激素结合球蛋白(SHBG)、硫酸脱氢表雄酮(DHEA-S)、雄烯二酮(A4),并计算游离雄激素指数(FAI),绘制ROC曲线,计算曲线下面积,探讨各指标对于PCOS及其诊断价值。结果:PCOS患者BMI、m FG评分、痤疮评分、TT、DHEA-S、A4和FAI均较正常对照组高(P0.05),SHBG较正常对照组低(P0.05)。PCOS组及对照组各指标的曲线下面积(AUC)比较:DHEA-S(0.643)SHBG(0.746)TT(0.778)A4(0.849)FAI(0.915),DHEA-S、A4、FAI与TT相比有显著差异(P0.05),TT与SHBG无明显差异(P0.05)。有无高雄激素临床表现组间各指标AUC:DHEA-S(0.638)TT(0.685)A4(0.702)SHBG(0.847)FAI(0.938),FAI与TT比较差异有统计学意义(P0.05);肥胖组:DHEA-S(0.687)TT(0.711)A4(0.739)SHBG(0.768)FAI(0.860),SHBG、FAI与TT比较差异有统计学意义(P0.05)。结论:A4及FAI对于PCOS的诊断价值高于TT,且FAI在对高雄激素临床表现及肥胖的敏感性较高,更适合临床推广应用。     

Relationship between hyperandrogenism,obesity, inflammation and polycystic ovary syndrome

This prospective study aimed to determine the status of circulating levels of C-reactive protein (CRP), tumor necrosis factor α (TNF-α), IL-27, IL-35, IL-37, α-1 acid glycoprotein in patients with polycystic ovary syndrome (PCOS) compared with controls and to evaluate their relation with hyperandrogenism and obesity. Forty-eight patients with PCOS (29 obese, 19 lean) and 40 healthy controls (20 obese, 20 lean) were enrolled. CRP, TNF-α, IL-27, IL-35, IL-37, α-1 acid glycoprotein, sex hormone-binding globulin (SHBG), dehydroepiandrosterone sulfate (DHEA-S) levels were measured. Levels of total testosterone, A4, DHEA-S were significantly higher in patients with PCOS than in controls both in the obese and lean groups, while levels of SHBG were significantly lower in all patients with PCOS than in all (p?p?p?p?p?相似文献   

The association of body mass index and biochemical hyperandrogenaemia in women with and without polycystic ovary syndrome

Objective

To investigate the association between BMI and different androgen parameters in women with PCOS and normal ovulatory women.

Study design

A cross sectional, observational study was carried out. A total of 286 patients aged 20–44 years were recruited. One hundred and sixty-five women had a diagnosis of PCOS and 121 women were ovulatory with no clinical or biochemical or ultrasound evidence of PCOS. The PCOS and non-PCOS groups were sub-divided into two subgroups based on BMI (BMI ≤ 30 kg/m² and BMI > 30 kg/m²). Androgen parameters measured were testosterone, androstenedione, free androgen index and sex hormone-binding globulin (SHBG). Testosterone and androstenedione were measured using tandem mass spectrometry. Free androgen index (FAI) was calculated using the formula: (testosterone/SHBG) × 100. Spearman rank correlations were used to determine relationship between BMI and androgens.

Results

The PCOS group had a higher BMI compared with the non-PCOS group (28.9 ± 5.8, 24.5 ± 4.1). Total testosterone, androstenedione, and FAI were significantly higher while SHBG was lower in the PCOS group. A correlation between BMI and total testosterone was not observed in either group. Positive correlations were observed between BMI and FAI in both PCOS (p < 0.001) and non-PCOS groups (p = 0.02) while a positive correlation was observed between BMI and androstenedione in the PCOS group (p = 0.001). SHBG correlated negatively with BMI in both groups.

Conclusion

A strong correlation exists between BMI and FAI but not with total testosterone, possibly due to the mediation of SHBG. Hyperandrogenaemia in the form of androstenedione seems to be augmented in PCOS with increasing BMI. A direct causal relationship between BMI and androgenaemia was not established.     

Comparison of clinical and laboratory characteristics of cases with polycystic ovarian syndrome based on Rotterdam’s criteria and women whose only clinical signs are oligo/anovulation or hirsutism

This study was an attempt to determine whether the hormonal and clinical profiles of polycystic ovarian syndrome (PCOS) or non-PCOS cases whose only admission signs were oligo/anovulation or hirsutism. This retrospective study comprised a total number of 118, age-matched, young Turkish women with initial admission signs and symptoms of menstrual disorders (MD) like oligo/anovulation or hirsutism. Of these, 66 cases were diagnosed as PCOS, based on 2003 Rotterdam criteria [presence of two of first three criteria such as oligo- and/or anovulation, signs of clinical hyperandrogenism (HA-c) and/or biochemical signs of hyperandrogenism (HA-b) and polycystic ovaries on ultrasonography after exclusion of specific identifiable disorders]. Fifty-two women were diagnosed as cases of oligo/anovulation or hirsutism before the era of PCOS Rotterdam’s consensus criteria. These two PCOS and non-PCOS cases were evaluated in terms of body mass index (BMI), waist-to-hip ratio, serum FSH, LH, estradiol (E2), dehydroepiandrosterone sulphate (DHEAS), androstendione (A) 17 hydroxyprogesterone (17-HP), fasting insulin, C-peptide levels, sex hormone-binding globulin (SHBG) and finally, ultrasonographic ovarian morphology. PCOS cases with unilateral and bilateral polycystic ovarian morphology on ultrasound scan were analyzed based on Rotterdam criteria. No statistically significant difference was detected among two groups, in terms of BMI, waist-to-hip ratio, serum FSH, LH, E2, fasting insulin, C-peptide levels (P > 0.05). However, blood levels of DHEAS, A and 17-HP were higher, whilst SHBG levels were remarkably lower (P = 0.008) in PCOS cases. Among PCOS group, hormonal and clinical characteristics did not differ, irrespective or uni- or bilaterality of ovarian morphology on ultrasonographic scan. Percentages of cases with androgenic alopecia, oily skin/acnea and increased ovarian volume were higher in PCOS group; whereas Ferriman–Gallwey score ≥ 8 were similar between two groups. Total but not free testosterone remained high in PCOS group (P < 0.01). In both PCOS and non-PCOS cases, a linear correlation was apparent between BMI and insulin levels (r _s = 0.69 and 0.32, P < 0.05, respectively). Among PCOS group, MD + HA-b + HA-c (n = 40) was present in 60.6% of subjects, MD + HA-b (n = 12) in 18.2%, and MD + HA-c (n = 14) in 21.2%. The three phenotypes did not differ in mean BMI, waist-to-hip ratio and biochemical characteristics. To conclude, non-PCOS women with only sign or symptom of oligo/anovulation or hirsutism had a more favorable endocrine milieu. These cases should be followed in vigilance in an aim to confront the development of short- and long-term adverse effects of impending PCOS in the future. Furthermore, different phenotypes of PCOS cases were clinically or biochemically similar in characteristics.     

多囊卵巢综合征患者IVF-ET前达英-35预处理不同时间临床效果分析

目的:探讨不同的达英-35预处理时间对多囊卵巢综合征患者IVF-ET助孕结局的影响。方法:回顾性分析在我院接受IVF助孕的119个PCOS助孕周期。所有患者均接受达英-35预处理,根据达英-35预处理周期数分为A组(达英-35预处理时间≤3个月),B组(达英-35预处理时间>3个月),检测比较治疗前、后血清LH水平、睾酮水平、游离雄激素指数(FAI)、获卵数、空卵泡率、临床妊娠率、着床率、OHSS发生率等。结果:A、B组达英-35预处理前血清LH值分别为:5.96±3.03 IU/L、6.91±4.40 IU/L;FAI分别为:1.42±1.10、1.76±1.67,治疗后均明显下降,与治疗前比有显著统计学差异(LH:3.50±2.19 IU/L,3.78±0.21 IU/L,FAI:0.54±0.38,0.54±0.48,P<0.05);B组空卵泡率、OHSS发生率分别为17.4%、6.8%,均低于A组(30.2%,20.0%),受精率为83.5%,较A组(74.8%)高,差异均有统计学意义(P<0.05)。结论:IVF前达英-35预处理可以显著降低PCOS患者高LH、高雄激素水平;随着达英-35预处理时间延长,空卵泡率和OHSS发生率进一步下降,受精率得到改善。     

Influence of adiposity on leptin, LH and androgen levels in lean, overweight and obese PCOS patients

BACKGROUND: Leptin modulates hypothalamic-pituitary-gohadal axis functions. OBJECTIVE: To assess the influence of leptin on LH, and to investigate the potential association of leptin with body mass index (BMI) and androgen concentrations in women with polycystic ovary syndrome (PCOS). DESIGN: Levels of leptin, LH, FSH, E2, testosterone, and androstenedione were measured. PATIENTS: 91 patients with PCOS were included in this study. METHODS: Patients were stratified into three groups according to BMI: normal weight (NW group, N=31), overweight patients (OW group N=30) and obese PCOS patients (Ob group, N=30). Results-Hyperandrogenemia was present in the studied group. A significant correlation was observed between BMI and androgens (both P < 0.01), and between leptin levels and androgens (respectfully for androstenendione P < 0.01 and for testosterone P < 0.05). A positive correlation between the LH and leptin levels in NW (P < 0.05) and OW (P < 0.001) patients was noticed, while negative correlation is seen in the Ob group (P < 0.01). In OW patients the significant positive correlation between leptin levels and androstenendione was found (P < 0.001), after correction for BMI. A linear regression model indicated that leptin concentrations and BMI contributed negatively and significantly (P < 0.001) to LH concentrations. CONCLUSION: LH secretion in PCOS patients can be viewed as a consequence of the activity of different adipocyte and neuroendocrine factors. The attenuation in basal LH levels in obese PCOS women might be related to a leptin-resistant state.     

Adrenocortical steroid response to ACTH in different phenotypes of non-obese polycystic ovary syndrome

Background

Adrenal androgen excess is frequently observed in PCOS. The aim of the study was to determine whether adrenal gland function varies among PCOS phenotypes, women with hyperandrogenism (H) only and healthy women.

Methods

The study included 119 non-obese patients with PCOS (age: 22.2?±?4.1y, BMI:22.5?±?3.1?kg/m²), 24 women with H only and 39 age and BMI- matched controls. Among women with PCOS, 50 had H, oligo-anovulation (O), and polycystic ovaries (P) (PHO), 32 had O and H (OH), 23 had P and H (PH), and 14 had P and O (PO). Total testosterone (T), SHBG and DHEAS levels at basal and serum 17-hydroxprogesterone (17-OHP), androstenedione (A4), DHEA and cortisol levels after ACTH stimulation were measured.

Results

T, FAI and DHEAS, and basal and AUC values for 17-OHP and A4 were significantly and similarly higher in PCOS and H groups than controls (p?<?0.05 for all) whereas three groups did not differ for basal or AUC values of DHEA and cortisol. Three hyperandrogenic subphenotypes (PHO, OH, and PH) compared to non-hyperandrogenic subphenotype (PO) had significantly and similarly higher T, FAI, DHEAS and AUC values for 17-OHP, A4 and DHEA (p?<?0.05). All subphenotypes had similar basal and AUC values for cortisol.

Conclusion

PCOS patients and women with H only have similar and higher basal and stimulated adrenal androgen levels than controls. All three hyperandrogenic subphenotypes of PCOS exhibit similar and higher basal and stimulated adrenal androgen secretion patterns compared to non-hyperandrogenic subphenotype.

     

Body fat composition and distribution in women with polycystic ovary syndrome

Objectives. The aims of the present study were to compare the distribution and accumulation of body fat in women with polycystic ovary syndrome (PCOS) and healthy controls matched for age and body mass index (BMI), and to investigate the association between androgen levels, insulin resistance and fat distribution.

Materials and methods. Thirty-one PCOS women and 29 age- and BMI-matched healthy control women were evaluated in terms of subcutaneous adipose tissue thickness determined with a skinfold caliper and body composition analyzed by bioelectrical impedance analysis. Blood samples were obtained for determination of follicle-stimulating hormone, luteinizing hormone, 17β-estradiol, 17-hydroxyprogesterone, basal prolactin, testosterone, dehydroepiandrosterone sulfate, sex hormone-binding globulin (SHBG), androstenedione, insulin and glucose levels. Insulin sensitivity was estimated by fasting glucose/insulin ratio and free androgen index (FAI) was calculated as 100 × testosterone/SHBG. Differences between means were analyzed by Student's t test or the Mann–Whitney U test according to distribution of the data. Correlation analysis was performed between the body fat distribution and parameters concerning insulin resistance and androgens.

Results. FAI was significantly higher in patients with PCOS compared with the control group (p = 0.001). Fasting insulin was significantly higher and fasting glucose/insulin ratio was significantly lower in the PCOS group vs. controls (p = 0.03 and 0.001, respectively). There was significantly less subcutaneous adipose tissue in the controls than the PCOS women at the triceps (p = 0.04) and subscapular region (p = 0.04). Waist-to-hip ratio of PCOS women was significantly higher than that of control subjects (p = 0.04).

Conclusion. Upper-half type body fat distribution is linked with PCOS, high free testosterone levels and insulin resistance.     

Polycystic ovary syndrome resembling histopathological alterations in ovaries from prenatal androgenized female rats

Background

The polycystic ovary syndrome (PCOS) affects approximately 6-10% of women of reproductive age and is characterized by chronic anovulation and hyperandrogenism. However, a comprehensive understanding of the mechanisms that dictate androgen overproduction is lacking, which may account for inconsistencies between measures of androgen excess and clinical presentation in individual cases.

Methods

A rat model of PCOS was established by injecting dehydroepiandrosterone sulfoconjugate (DHEAS) into pregnant females. Rats were administered with DHEAS (60?mg/kg/d) subcutaneously (s.c.) for all 20?days of pregnancy (Group A), or for the first 10?days (Group B), or from day 11 to day 20 (Group C). Controls were administered with injection oil (0.2?ml/day) s.c. throughout pregnancy (Group D). The litter rate, abortion rate, and offspring survival rate in each group were recorded. Serum androgen and estrogen were measured and the morphological features of the ovaries were examined by light and electron microscopy in the offspring of each group.

Results

We found that rats injected with DHEAS throughout pregnancy (group A) lost fertility. Rats injected with DHEAS during early pregnancy (group B) exhibited more serious aberrations in fertility than both Group C, in which rats were injected with DHEAS during late pregnancy (P?Conclusions Our results indicate that androgen excess during pregnancy can decrease rat fertility. Excess androgen at the early stage of pregnancy causes high reproductive toxicity, leading to abnormality of ovarian morphology and functions in female offspring.