Ovarian morphology and prevalence of polycystic ovary syndrome in reproductive aged women with or without mild acne

Background Acne and hirsutism are common manifestations of hyperandrogenemia. They may also be a sign of underlying severe diseases. Aim To compare ovarian morphology and prevalence of polycystic ovary syndrome (PCOS) in reproductive aged women with or without mild acne and hirsutism. Methods 52 women with mild acne and 59 age‐matched controls were included in this study. Main outcome measures were the prevalence of PCOS, ovarian morphology, and ovarian stromal thickness in both groups, and acne and hirsutism subgroups. Patients in both groups were taking no hormonal therapy at that time. Androgen profiles were compared between the two groups. Results The prevalence of PCOS was 17.1% (19/111) in all women included in this study. In the acne group, the prevalence of PCOS was 26.9% (14/52), and significantly more prevalent than in control group [8.4% (5/59), P = 0.001]. Total ovarian volume was significantly larger and stromal thickness of the ovary was thicker in women with acne than women without acne. There were no statistically significant difference between the two groups in terms of dehydroepiandrosterone sulfate, and 17‐hydroxyprogesterone, respectively, while serum total testosterone levels were significantly higher (P < 0.05) in women with acne than those women in the control group. Conclusions Acne and hirsutism may not only cause cosmetic concern but may also be a sign of underlying PCOS. Therefore, women presenting with acne and/or hirsutism should be evaluated in terms of PCOS.     

Prevalence of non classical congenital adrenal hyperplasia due to 21‐hydroxylase deficiency in Greek women with acne: a hospital‐based cross‐sectional study

Aim To determine the prevalence and frequency of non classical congenital adrenal hyperplasia (NC‐CAH) due to 21‐OHD at the time of clinical presentation and at the peripubertal period in a substantial sample of Greek women with acne and to investigate the correlation of serum T, 17‐OHP and DHEA‐S with acne appearance at the time of clinical presentation. Methods One hundred and twenty‐three unselected women with hyperandrogenemic symptoms were examined. After the ACTH stimulation test, 6 (4.9%) women were diagnosed with NC‐CAH due to 21‐OHD. Results There was not any statistical significant difference in the frequency of peripubertal acne between NC‐CAH group of patients (6.4%) and patients with hyperandrogenemia of other aetiology (93%), mainly ovarian (P = 0.41). However, there was a statistical significant difference in the prevalence of acne at the time of clinical examination between the two groups (P = 0.04). Acne was present in 83.3% of women with NC‐CAH vs. 41.02% of women in the hyperandrogenic group without NC‐CAH. A statistically significant decrease of acne from the peripubertal time to the time of clinical examination in the group of women with hyperandrogenemia of other aetiology (?21.37%) was observed compared to women with NC‐CAH (P < 0.001). Conclusion We have shown that acne persists from peripubertal period to adult life in NC‐CAH women whereas it tends to diminish in women with hyperandrogenemia of other aetiology. Acne is a prominent finding in women with NC‐CAH. Serum concentrations of 17‐OHP after ACTH stimulation (17‐OHP_6O) should be investigated in women with persistent acne in adult life.     

女性痤疮与多囊卵巢综合征的相关性研究

目的 检测成年女性痤疮患者体内性激素水平的变化,探讨其与多囊卵巢综合征（PCOS）的相关性。方法 采用放射免疫分析法,对50例痤疮患者进行血清性激素水平测定和妇科经阴道超声检查。以30例正常成年女性为对照。结果 痤疮组睾酮、二氢睾酮、脱氢表雄酮及黄体生成素水平增高,与正常对照组比较差异有高度显著性（P＜0．001或P＜0．01）;雌二醇、卵泡刺激素、孕酮水平变化不明显（P均＞0．05）。50例中有28例患PCOS。对其中10例应用达英－35治疗,可降低血清雄激素水平。结论 高雄激素血症和PCOS与成年女性痤疮有关,且是其长期不愈的重要原因。达英－35对此类痤疮有较好疗效。     

Incidence of polycystic ovaries in patients with late-onset or persistent acne: hormonal reports

Forty-six women affected by late-onset or persistent acne were studied in order to investigate the frequency of hormonal abnormalities and polycystic ovaries. Hirsutism, perioral distribution of acne lesions and irregular menses were recorded. Hormonal measurements and ovarian echographies were performed. Twenty-four patients were affected with polycystic ovaries, detected by ultrasound scanning. Among the acne patients, the women with ovarian abnormalities had higher values of androstenedione, dehydroepiandrosterone, dehydroepiandrosterone sulfate and luteinizing hormone (LH), and a higher LHT/follicle-stimulating hormone ratio than those with acne and without ovarian abnormalities. This study indicates the prevalence of polycystic ovaries in women with late-onset or persistent acne. Moreover, hormonal abnormalities indicate a subgroup of acne patients defined by the presence of ovarian disorders.     

伴多囊卵巢综合征的痤疮性激素水平变化及相关分析

为探讨成年女性痤疮患者血清性激素水平的变化及与多囊卵巢综合征（PCOS）的相关性，对60例成年女性痤疮患者进行血清性激素水平测定和妇科B超检查，其中24例伴PCOS痤疮患者行腹腔镜下微波治疗。结果发现患者组血清睾酮（T），黄体生成素（LH）高于对照组（P＜0．05），微波术后其T，LH值明显下降（P＜0．05），该手术对痤疮治愈率和总有效率分别为58．3％和91．7％，提示成年女性痊痤疮与PCOS有相关性，高雄激素血症可能是引起女性痤疮的主要因素之一。     

妊娠期痤疮患者雄激素和垂体激素水平研究

目的:探讨妊娠期痤疮患者体内性激素水平的改变。方法:采用化学发光酶免疫分析法测定50例妊娠患者血清中的黄体生成素(LH)、卵泡刺激素(FSH)和睾酮(T)的水平,并以50例正常孕妇做对照。结果:患者组LH和FSH显著高于对照组(P<0.05),T略高于对照组,差异无显著性(P>0.05)。结论:在妊娠期痤疮患者中雄激素水平不是发病的决定性因素。     

清肺利湿解毒方药治疗痤疮的临床观察及对血清相关性激素水平的影响

目的评价清肺利湿解毒方药治疗寻常性痤疮的疗效及安全性,并观察其对痤疮患者性激素的调节作用。方法 100例寻常性痤疮患者内服本科自拟清肺利湿解毒中药方治疗8周,评价其临床疗效及安全性,并观察50例患者治疗前后外周血中睾酮(T)、雌二醇(E2)、黄体生成素(LH)、促卵泡素(FSH)、催乳素(PRL)、孕酮(PRG)的变化。结果临床治愈38例(38.0%),显效47例(47.0%),有效率为85.0%,无不良反应。其中女性痤疮患者的T及PRL水平治疗前后有显著变化(P0.05),男性患者激素水平治疗前后均无明显变化(P0.05)。结论清肺利湿解毒方治疗寻常性痤疮具有明显的临床疗效,且无不良反应,其可能通过调节机体性激素水平达到治疗寻常痤疮的目的 。     

Assessment of androgens in women with adult-onset acne

BACKGROUND: Acne is generally recognized as a disorder of young adults; however, the referral of patients aged over 25 years with acne is increasing. Disturbed androgen production in the ovaries or adrenal gland and impaired plasma transport of androgens in women with adult-onset acne or acne associated with hirsutism have been described. METHODS: Thirty-five white women with adult-onset acne (onset after the age of 25 years) and hirsutism (A + H), 35 white women with adult acne without hirsutism (A - H), and 35 age-matched white female controls were recruited in this case-control study. Serum levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), total testosterone, dihydroepiandrosterone sulfate (DHEA-S), and sex hormone binding globulin (SHBG) were determined in all patients and compared. RESULTS: The mean SHBG, free androgen index (FAI), and DHEA-S were significantly different between A + H and control subjects. The only significant difference between A - H and control subjects was observed for DHEA-S. CONCLUSION: DHEA-S plays a key role in the pathogenesis of adult-onset acne. Measurement of circulating androgens, including DHEA-S, especially in patients presenting with adult-onset acne and hirsutism, is helpful, and patients with elevated levels can benefit from hormonal therapy.     

What every physician should know about polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is the most common endocrine cause of hirsutism, acne, and pattern alopecia. It is a heterogeneous syndrome of hyperandrogenic anovulation that is typically due to intrinsic ovarian dysfunction, which is often aggravated by insulin-resistant hyperinsulinemia with its risks of diabetes mellitus and metabolic syndrome and their complications. Because there are many pitfalls to androgen assays, evaluation for hyperandrogenemia is suggested in women with moderate or severe hirsutism or hirsutism equivalents, menstrual irregularity, acanthosis nigricans, or intractable obesity. An endocrinologic work-up is necessary to rule out other hyperandrogenic disorders that require specific therapy (e.g., virilizing tumors, nonclassic congenital adrenal hyperplasia, hyperprolactinemia, and Cushing's syndrome). Ultrasonography helps in the differential diagnosis and may demonstrate the polycystic ovaries that have recently been vetted as an alternative to oligo-anovulation as a diagnostic criterion. Management of PCOS is determined by symptomatology. For those women not desiring pregnancy, the most common therapies are oral contraceptive pills, antiandrogens (contraindicated in the absence of adequate contraception), and insulin-lowering treatments (which have little effect on hirsutism).     

多囊卵巢综合征患者胰岛素抵抗对甾体激素水平的影响

目的：探讨多囊卵巢综合征相关疾病糖代谢及甾体激素代谢方面的特征.方法：108例患者根据血睾酮水平及卵巢B超表现分为三组：多囊卵巢综合征（PCOS）组、多囊卵巢（PCO）组、单纯性卵巢高雄激素血症（OHA）组,18例正常妇女作为对照组.于月经期进行糖耐量试验（OGTT）,随后联合应用人绒毛膜促性腺激素（HCG）5000IU及人绝经促性腺激素（HMG） 150IU进行卵巢功能兴奋试验,观察糖代谢及甾体激素代谢情况.结果：基础状态下,LH及LH/FSH浓度PCOS组＞OHA＞ PCO组＞对照组,PCOS组显著高于对照组,PCO和OHA组相似.OHA和PCOS组T水平相似,对照组和PCO组相似,OHA和PCOS组T明显高于对照组和PCO组;OGTT后,三患者组O4点胰岛素水平、胰岛素/葡萄糖比值相似,高于对照组.结论：就糖代谢和甾体激素代谢而言,PCO和OHA分别是PCOS和正常对照妇女的一种中间状态,在临床的诊断和治疗上值得重视.     

青春期后女性痤疮患者血清性激素水平的研究

目的：检测青春期后女性痤疮患者体内性激素的水平。方法：采用放射免疫法对25岁以上的34例女性痤疮患者血清睾酮（T）、雌二醇（E2）、泌尿素（PRL）、黄体生成素（LH）和卵泡刺激素（FSH）进行了测定,并以32例正常女性作为对照。结果：患者组T显著高于对照组（P＜0．001）;E2和LH显著低于对照组（P＜0．001）;PRL和FSH无明显变化（P＞0．05）。结论：性激素异常可能是女性痤疮迟发和持久不退的主要原因。     

难治性多囊卵巢综合征患者采用腹腔镜下卵巢打孔术治疗临床应用价值探讨

目的:研究与探讨腹腔镜下卵巢打孔术治疗难治性多囊卵巢综合征患者的临床应用价值。方法:选取2010年4月至2015年5月在我院进行手术治疗的难治性多囊卵巢综合征患者320例,根据患者采用不同的手术方式分为对照组和观察组各160例,对照组采用B超作用下经阴道卵泡穿刺术治疗,观察组采用腹腔镜下卵巢打孔术治疗。比较两组患者手术后激素水平、排卵情况以及妊娠率,同时针对观察组激素水平进行术前和术后数据统计。结果:观察组术后与术前激素水平比较,差异具有统计学意义(P0.05);两组术后比较,观察组血清FSH升高,LH、T、LH/FSH明显降低,且差异具有统计学意义(P0.05);观察组的自然排卵率和妊娠率明显提高,流产率明显下降,差异具有统计学意义(P0.05)。结论:采用腹腔镜下卵巢打孔术治疗难治性多囊卵巢综合征具有显著的疗效,值得临床方面广泛推广。     

醋酸曲普瑞林注射液联合炔雌醇环丙孕酮片治疗PCOS不孕症的效果及对相关激素水平的影响

目的探讨醋酸曲普瑞林注射液联合炔雌醇环丙孕酮片治疗多囊卵巢综合征(PCOS)不孕症的效果及对血清睾酮、促甲状腺素水平的影响。方法选取2015年3月至2017年3月湖北省武汉市中西医结合医院诊治的多囊卵巢综合征不孕症患者110例作为研究对象。按随机数字表法分为观察组和对照组,各55例。对照组予醋酸曲普瑞林注射液治疗,观察组予炔雌醇环丙孕酮片与醋酸曲普瑞林联合治疗,比较两组患者的治疗效果及雌激素、睾酮、促甲状腺激素等的水平及超氧化物歧化酶活性。结果观察组的总有效率为96.4%,对照组为80.0%,观察组高于对照组,差异具有统计学意义(P<0.05);在本研究中治疗前两组患者的睾酮、促卵泡激素、黄体生成素、超氧化物歧化酶、促甲状腺素的水平差异无统计学意义(P>0.05),治疗后促卵泡激素水平、超氧化物歧化酶活性均升高,且观察组升高较对照组更多,睾酮、黄体生成素、促甲状腺素水平均下降,且观察组下降更多,差异均具有统计学意义(P<0.05);观察组的累积排卵率为87.27%,累积妊娠率为72.73%,对照组分别为76.27%、45.45%,观察组高于对照组,差异具有统计学意义(P<0.05);观察组的痤疮、月经稀发、多毛症状少于对照组,差异具有统计学意义(P<0.05),两组患者在治疗过程中均未发生不良反应。结论醋酸曲普瑞林注射液联合炔雌醇环丙孕酮片治疗多囊卵巢综合征不孕症的效果较好,可有效提高排卵率、妊娠率,有效调节血性激素、促甲状腺素等激素的水平,增加超氧化物歧化酶活性,在临床上可广泛使用。     

补肾涤痰汤对多囊卵巢综合征合并不孕患者胰岛素抵抗程度、 性激素水平及妊娠情况的影响

目的探讨补肾涤痰汤对多囊卵巢综合征(PCOS)合并不孕患者胰岛素抵抗程度、性激素水平及妊娠情况的影响。方法选取2018年3月至2019年3月陵水黎族自治县人民医院收治的90例PCOS合并不孕患者作为研究对象。采用随机数字表法分为补肾涤痰汤组(n=45)和对照组(n=45)。对照组采用多囊卵巢综合征合并不孕常规治疗,补肾涤痰汤组在对照组基础上联合补肾涤痰汤治疗,治疗4个月后,检测并比较两组胰岛素抵抗指标[空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)]、性激素[雌二醇(E2)、黄体生成素(LH)、LH/卵泡刺激素(FSH)、睾酮(T)]水平的差异,记录两组排卵率、妊娠率及治疗期间药物相关不良反应的发生情况。结果治疗后,补肾涤痰汤组的FINS、HOMA-IR水平低于对照组,E2水平高于对照组,LH、LH/FSH、T的水平低于对照组,排卵率、妊娠率高于对照组,差异具有统计学意义(P<0.05)。治疗期间,两组药物相关不良反应发生情况比较,差异无统计学意义(P>0.05)。结论补肾涤痰汤在改善多囊卵巢综合征合并不孕患者胰岛素抵抗及激素水平紊乱、提升妊娠率方面具有积极作用。     

微创手术联合药物治疗多囊卵巢综合征伴不孕对卵巢功能及生育能力的影响

目的:探讨微创手术联合药物治疗多囊卵巢综合征(PCOS)伴不孕对卵巢功能及生育能力的影响。方法:选取2014年1月至2015年1月92例PCOS伴不孕患者纳入研究对象,采用随机数字表法分为对照组和治疗组各46例。对照组单纯服用达英-35治疗,观察组在对照组的基础上联合采用腹腔镜辅助卵巢打孔术(LOD)。比较两组血清激素水平、血流动力学、生育能力等指标。结果:治疗后3个月经周期,观察组血清FSH、PRL、T、LH水平明显低于对照组,E2水平明显高于对照组(P0.05),PI、PSV、EDV均明显低于对照组(P0.05);随访1年,观察组排卵率、自然妊娠率、足月分娩率均明显高于对照组(95.65%vs.60.87%,91.30%vs.30.43%,778.57%vs.50.00%)(P0.05)。结论:腹腔镜微创手术联合达英-35治疗有助于改善多囊卵巢综合征合并不孕患者血清激素水平与血流动力学,进而改善卵巢功能,促进排卵及自然妊娠。     

PRL水平变化与内分泌失调性不孕症相关性研究

目的:探讨泌乳素(PRL)水平变化与内分泌失调性不孕症的相关性。方法:选取我院120例不孕症患者作为观察组,其中根据月经周期紊乱与否分为月经紊乱组(82例)和月经正常组(38例),另选取同期健康体检者120例作为对照组,测定观察组和对照组的PRL、雌二醇(E_2)、卵泡刺激素(FSH)、睾酮(T)和促黄体激素(LH)水平。结果:观察组患者的PRL、FSH及LH水平明显高于对照组,差异比较均有统计学意义(P0.05);观察组的T和E_2水平明显低于对照组,差异比较均有统计学意义(P0.05);月经紊乱组的PRL、FSH及LH明显高于月经正常组,差异比较均有统计学意义(P0.05),但T及E_2与月经正常组相比无显著性差异(P0.05);观察组患者的PRL与LH呈正相关(r=0.528,P=0.000),与FSH存在明显正相关(r=0.529,P=0.000),与E_2负相关(r=-0.548,P=0.000),与T无相关性(r=0.052,P=0.081)。结论:内分泌失调性不孕症患者的PRL水平明显高于正常人群,其与E_2、FSH、LH存在明显相关性,PRL的水平检测对内分泌失调性不孕症的临床诊断具有重要意义。     

血清ES、VEGF水平和多囊卵巢综合征患者血清胰岛素及卵巢间质血流的相关性分析

目的探讨分析血清内皮抑素(endostatin,ES)、血管内皮生长因子(vascular endothelial growth factor,VEGF)水平和多囊卵巢综合征(polycystic ovarian syndrome,PCOS)患者血清胰岛素及卵巢间质血流的相关性。方法选取2016年8月至2018年3月滕州市妇幼保健院诊治的85例PCOS患者作为研究对象。将这85例患者设为PCOS组,选择同期在滕州市妇幼保健院健康体检的60例健康女性作为对照组,检测两组受试者血清胰岛素水平、性激素水平、ES以及VEGF水平,并采用经阴道多普勒超声监测受试者卵巢间质血流,记录受试者搏动指数(pulse index,PI)以及阻力指数(resistance index,RI),分析ES以及VEGF水平与各指标相关性。结果 PCOS组患者黄体生成素(luteinizing hormone,LH)、睾酮(testosterone,T)水平显著高于对照组,差异具有统计学意义(P<0.05),两组雌二醇(estradiol,E2)、促卵泡刺激素(follicle stimulating hormone,FSH)以及泌乳素(prolactin,PRL)水平比较差异无统计学意义(P>0.05)。PCOS组患者PI、RI显著低于对照组,差异具有统计学意义(P<0.05),而PCOS组患者胰岛素(insulin,Ins)、VEGF以及ES水平显著高于对照组,差异具有统计学意义(P<0.05)。PCOS患者血清VEGF水平与PI、RI呈显著负相关关系,差异具有统计学意义(P<0.05),与Ins呈显著正相关关系,差异具有统计学意义(P<0.05);患者ES水平与PI、RI呈显著负相关关系,差异具有统计学意义(P<0.05),与Ins呈显著正相关关系,差异具有统计学意义(P<0.05)。结论 PCOS患者血清VEGF以及ES水平显著升高,二者表达与卵巢间质血流增加以及胰岛素水平增加密切相关,可能影响PCOS疾病发展过程。     

化疗对卵巢恶性生殖细胞肿瘤术后患者卵巢功能的影响

目的:观察卵巢恶性生殖细胞肿瘤(MOGCT)患者行保留生育功能术后并进行化疗对卵巢功能的影响。方法:选取我院肿瘤科收治的45例MOGCT并行术后辅助化疗患者作为研究对象,选取同时期收治的年龄相近且具有生育需求并给予手术切除但术后未行化疗的45例卵巢良性肿瘤患者作为对照组,观察组给予BEP方案进行化疗,比较两组术前、术后6个月以及术后12个月的血清黄体生成素(LH)、促卵泡生成素(FSH)、雌二醇(E2)水平,观察化疗组患者化疗期间月经异常的发生情况。结果:术后6个月,对照组患者的LH、FSH、E2水平接近于正常水平,化疗组中的LH、FSH水平明显高于对照组,而E2水平则低于对照组,组间比较差异有显著性意义,术后12个月化疗组LH、FSH水平与6个月时相比明显下降,而E2水平显著升高,术后12个月,两组LH、FSH、E2水平组间比较无明显差异(P0.05)。在化疗期间,共有34例(75.6%)患者出现月经异常,其中有19例(42.2%)为停经,15例(33.3%)为月经量减少,随着化疗周期的延长,停经以及月经减少患者数量升高。结论:MOGCT患者在术后化疗期将出现性激素水平改变以及月经异常,主要表现为血清促性腺水平升高、雌激素水平下降、月经异常,但具有可逆性。     

Prevalence of polycystic ovaries in women with acne

Summary The prevalence of polycystic ovaries was determined by pelvic ultrasound imaging in 119 women (mean age, 23.6±6.06 years; range, 14–45 years) with acne but with no menstrual disorders, obesity, or hirsutism, and in 35 healthy controls (mean age, 25±5.8 years; range, 21–40 years). Polycystic ovaries were found in 54 out of 119 patients with acne (45.37%) and in 6 out of 35 controls (17.14%). The results of this study indicate that polycystic ovaries are common in women with acne and not necessarily associated with menstrual disorders, obesity, or hirsutism.     

The frequency of polycystic ovary syndrome in females with resistant acne vulgaris

Background Acne vulgaris in females may be resistant to treatment in spite of topical and systemic therapy for a sufficient period. In this condition, acne may be a manifestation of underlying endocrine conditions such as polycystic ovary syndrome (PCOS). Objective To evaluate the frequency of PCOS in females with resistant acne vulgaris. Patients and methods This case‐controlled study was conducted in the Department of Dermatology and Venereology in The Teaching Hospital in Al‐Najaf during the period from October 2007 to November 2008. One hundred and twenty‐three female patients with resistant acne vulgaris were included in this study. One hundred and twenty‐three women, age‐matched, without acne were enrolled as a control group. Detailed history, clinical examination, abdominal ultrasound study, and hormonal assays were obtained for the patients and the control group. Results One hundred and twenty‐three females with resistant acne were included; their ages ranged from 17 to 40 years with a mean of 25.016 ± 6.041 (SD). One hundred and twenty‐three control women without acne were enrolled; their ages ranged from 17–40 years with a mean of 26.014 ± 6.251 (SD). The patients and the control group are age‐matched (P = 0.192). It was found that 63 patients (51.2%) with resistant acne have PCOS in comparison to only eight control women (6.2%). The difference is highly significant. Conclusion Polycystic ovary syndrome is an important contributing factor in females with resistant acne vulgaris.