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。     

多囊卵巢综合征治疗的研究现状

多囊卵巢综合征(polycystic ovary syndrome,PCOS)是女性最常见的与代谢异常和生殖功能障碍密切相关的特殊疾病,PCOS的临床表现具有多样性和异质性,常表现为高雄激素血症的临床症状、持续性无排卵或稀发排卵、不孕等.流行病学研究表明,在美国、希腊和西班牙等地区,PCOS的发病率为4％～8％[1].采用不同的诊断标准,PCOS的发病率也有差异.按照2003年欧洲人类生殖与胚胎学会(ESHRE)和美国生殖医学学会(ASRM)推荐的鹿特丹诊断标准[2],最新的流行病学调查显示,PCOS的发病率高达18％[3].     

PCOS患者诱发排卵的方案

多囊卵巢综合征(polycystic ovarian system,PCOS)是育龄女性最常见的内分泌疾病,具有高度异质性,临床表现多样化。自1935年将其归纳为综合征以来,不仅对它的发病机制始终未获得一致的结论,甚至PCOS的诊断标准至今也未达成一致意见。目前,主要是参考2003年欧洲人类生殖和胚胎与美国生殖医学学会的(ESHRE/ASRM)鹿特丹专家会议推荐的标准。但对临床来说,是否诊断多囊卵巢综合征并不影响对该疾病的对症治疗,原则上都是如多毛和高雄激素血症则抗雄激素治疗,月经不调则行调整周期治疗,胰岛素抵抗的治疗,及对无排卵不孕则促排卵治疗等。但…     

月经稀发不孕患者256例临床分析

目的 观察月经稀发不孕患者的内分泌特征及子宫内膜病理改变.方法 对华中科技大学同济医学院附属同济医院2002-01-2005-08就诊的256例月经稀发不孕患者进行早期卵泡期超声检查,放免测定血清中卵泡刺激素（FSH）、黄体生成素（LH）、泌乳素（PRL）、睾酮（T）,并对部分患者的子宫内膜进行病理检查.结果 月经稀发患者中卵巢呈多囊性改变者（PCO）占77.34%.高雄激素血症者占16.4%,LH/FSH≥2者占45.7%.按照2003年鹿特丹欧洲生殖联会修订的标准,PCOS占月经稀发患者的77.3%.其中PCOS中子宫内膜呈分泌期改变占62.4%.结论 （1）月经稀发、PCO为PCOS 的最主要临床特征.（2）PCOS患者中内分泌异常以LH/FSH≥2为主,仅少数患者为高雄激素血症.（3）一部分PCOS患者诊刮其子宫内膜呈分泌期改变,表明其可能存在排卵.     

达英-35联合吡格列酮治疗多囊卵巢综合征的疗效观察

多囊卵巢综合征(polycystic ovary syndrome,PCOS)是育龄妇女最常见的内分泌及代谢异常性疾病,发病率占育龄期妇女5%～21%[1].PCOS具有高度异质性,不能治愈及进行性发展等特点,临床表现多样,主要症状为月经稀发或闭经、不孕、多毛、痤疮、肥胖,内分泌主要表现为高雄激素血症、胰岛素抵抗(insulin resistance,IR)及代偿性高胰岛素血症等.     

多囊卵巢综合征流行病学研究

多囊卵巢综合征(polycystic ovary syndrome, PCOS)是育龄妇女最常见的内分泌紊乱性疾病之一,我国育龄妇女患病率5.6%,也是引起无排卵性不孕的主要原因。PCOS以月经紊乱、多毛、不孕、高雄激素症等为主要表现,易发生胰岛素抵抗、高胰岛素血症、2型糖尿病(diabetes mellitus, T2DM)（非胰岛素依赖型）、高血脂、心血管疾病、代谢综合征、睡眠窒息、非酒精性脂肪肝、妊娠期糖尿病和妊娠期高血压疾病等,PCOS患病率与不同种族、地区、调查对象和诊断标准有关,大多数文献报道其患病率在5%～10%。     

多囊卵巢综合征胰岛素抵抗的新进展

多囊卵巢综合征((PCOS)是青春期及育龄妇女最常见的内分泌和代谢紊乱性疾病,其发病率占育龄妇女的5%-10%.PCOS的基本特征为长期不排卵或稀发排卵、卵巢多囊性增大和高雄激素血症等,此外还表现有胰岛素抵抗(IR)及胰岛β细胞功能失调.PCOS患者妊娠率降低,妊娠期自然流产、妊娠期糖尿病的患病率亦较普通人群高,同时子...     

肥胖与多囊卵巢综合征

多囊卵巢综合征(PCOS)临床表现为月经稀发、闭经、肥胖、多毛、不孕。其病理生理特征为长期慢性无排卵、高雄激素血症、胰岛素抵抗和高胰岛素血症。超声检查双侧卵巢为多囊卵巢。具有上述2项代谢紊乱的患者诊断为PCOS。PCOS在育龄妇女的发病率高达5％～10％。目前认为该病不是单一因素所致，而是遗传因素与环境因素共同作用的结果，其确切病因有待于进一步深入研究，PCOS的临床特征之一是肥胖。本文就肥胖与PCOS的相互关系作一阐述。     

联合LC-MS和化学发光免疫法分析不同类型PCOS的雄激素水平

目的:利用液相色谱-质谱联用(LC-MS)方法和化学发光免疫分析法测定不同临床类型PCOS患者的血清雄激素水平,分析中国PCOS女性的高雄激素血症的生化特点。方法:纳入有排卵障碍和多囊卵巢的PCOS患者149例,根据血清睾酮(T)和硫酸脱氢表雄酮(DHEAS)值及F-G多毛评分情况分为两组:高雄组55例,非高雄组94例。同期选取输卵管性不孕患者82例作为对照组。化学发光法测定性激素结合球蛋白(SHBG)水平,计算游离雄激素指数(FTI)。LC-MS法测定各组血清睾酮、雄烯二酮(AD)和脱氢表雄酮(DHEA)。结果:高雄组的血清T水平及FTI值显著高于非高雄组及对照组(P0.05),非高雄组高于对照组(P0.05);高雄组、非高雄组的DHEAS及AD水平均高于对照组(P0.05);3组的DHEA水平比较,差异均无统计学意义。结论:血清T、AD、DHEAS及FTI均为诊断PCOS高雄激素血症的敏感指标;T及FTI是PCOS分型(高雄及非高雄)的主要依据;LC-MS和化学发光免疫分析法对PCOS高雄激素血症的诊断具有一致性。     

多囊卵巢综合征的病因及诊断标准

正多囊卵巢综合征(polycysti covary syndrome,PCOS)是育龄期女性一种常见的内分泌紊乱疾病,并且临床表型具有高度异质性。PCOS总体发病率为5%～10%,而在我国汉族育龄期女性中的发病率为5.6%。PCOS是以稀发排卵或不排卵、高雄激素或胰岛素抵抗(insulin resistance,IR)、多囊卵巢为特征的内分泌紊乱疾病。病征包括月经稀发或闭经、慢性无     

育龄期妇女体毛状况调查及其在多囊卵巢综合征诊断中的初步应用

目的探讨适合济南市多囊卵巢综合征（PCOS）患者的多毛诊断标准。方法按照Ferriman．Gallwey（F-G）体毛评价方法,对623例济南市汉族育龄期妇女（普通群体组）、131例PCOS患者（PCOS组）及84例非PCOS不孕患者（非PCOS对照组）,上唇、下颌、上臂、大腿、胸部、上腹、下腹、背上部、腰骶部9个激素相关部位与前臂、小腿2个激素无关部位的体毛分布情况进行调查;并分别以不同的临界值评价各组妇女的多毛发生率。结果（1）普通群体组妇女的激素相关部位体毛总分（F-G总分）、激素无关部位体毛总分均呈偏态分布,其第95百分位数均为2分;F-G总分与其激素无关部位体毛总分呈正相关关系（r=0．310,P〈0．01）。（2）以F-G总分≥2分为临界值,多毛发生率非PCOS对照组为4．8％（4／84）,PCOS组为48．1％（63／131）,两组比较,差异有统计学意义（X^2=47．68,P〈0．01）;以国外的多毛诊断标准F-G总分≥6分为临界值,非PCOS对照组无多毛病例,PCOS组1例,两组比较,差异无统计学意义（X^2=0．64,P=0．42）。（3）普通群体组妇女中F-G总分与年龄呈负相关关系（X^2=-0．128,P〈0．01）,与上唇、胸部、下腹的体毛评分呈正相关关系（r=0．712、0．594、0．522,P均〈0．01）。PCOS组患者F—G总分与上唇、下腹、胸部的体毛评分呈正相关关系（r=0．879、0．710、0．682,P均〈0．01）,非PCOS对照组与上唇的体毛评分密切相关（r=0．950,P〈0．01）。（4）多毛（F-G总分≥2分）发生率分别与普通群体组妇女下腹、上唇、胸部（列联系数：0．489、0．461、0．420,P均〈0．01）及PCOS组患者上唇、胸部、下腹（列联系数：0．560、0．532、0．503,P均〈0．01）相关。结论（1）F-G总分〉12分是适宜于济南市妇女的多毛诊断临界值。（2）以F-G总分〉12分为诊断标准,PCOS患者存在显著的多毛现象。（3）上唇、胸部、下腹是育龄期普通群体妇女和PCOS患者多毛的主要部位。     

Definitions, prevalence and symptoms of polycystic ovaries and polycystic ovary syndrome

Polycystic ovarian morphology is seen on ultrasound in approximately 22% of women. Polycystic ovary syndrome (PCOS) is a common and perplexing endocrine disorder of women in their reproductive years, with a prevalence of up to 10%. Clinical expression of the syndrome varies but commonly includes menstrual cycle disturbance, hyperandrogenism, insulin resistance and obesity. Recently, the European Society for Human Reproduction and Embryology and the American Society for Reproductive Medicine (ESHRE/ASRM) achieved a new consensus regarding the definition of PCOS. This is now defined as the presence of any two of the following three criteria: (i) polycystic ovaries; (ii) oligo-/anovulation; and/or (iii) clinical or biochemical evidence of hyperandrogenism. This revised definition provides an international framework for the clinical assessment of PCOS and for future research and collaboration.     

Evidence-based approach for the use of ultrasound in the management of polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is a complex endocrinopathy, affecting 5-10% of women in the reproductive age group, with a wide spectrum of phenotypes. The cardinal features are hyperandrogenism, ovulatory dysfunction and/or polycystic ovary (PCO) appearance. Three major diagnostic criteria for PCOS have been proposed by the National Institute of Health (NIH 1990), the Rotterdam European Society for Human Reproduction and Embryology/American Society for Reproductive Medicine sponsored PCOS Consensus Workshop Group (ESHRE/ASRM 2003) and the recent task force of the Androgen Excess Society (AES 2006). The PCO appearance is not a prerequisite for the diagnosis of PCOS. The aim of this review was to assess the available evidence in order to highlight the role of ultrasound in the diagnosis and management of PCOS. The evidence supports positive correlation between ultrasound features and biochemical indices of PCOS suggesting that ultrasound could play a role in prediction of PCOS severity and prognosis. Recent advances in ultrasonography resulted in a change of emphasis on the relative importance of total ovarian volume, follicle number and ovarian stromal changes in the diagnosis of PCO. In particular, ovarian stromal area/total area (S/A) ratio seems to have the most efficient diagnostic performance for hyperandrogenism. Three-dimensional (3D) ultrasound is a relatively new imaging modality that has the potential to improve the sensitivity and specificity of ultrasound without adding much to the practical management of the syndrome. In addition to its role in the definition of PCO, ultrasound is helpful to predict fertility outcome in patients undergoing treatment.     

Hirsutism and oligomenorrhea are appropriate screening criteria for polycystic ovary syndrome in adolescents

Abstract

We evaluated the association of hirsutism and oligomenorrhea (persistent menstrual cycles?>?45 days) as screening criteria for the detection of biochemical hyperandrogenism (BH) and polycystic ovaries (PCOM) during adolescence and determined which androgens, granulosa cell hormone, ultrasonographic parameters have the best association with polycystic ovary syndrome (PCOS). Hirsute girls with oligomenorrhea (N?=?26 Hirs/Oligo group) and non-hirsute girls with regular cycles (N?=?63, C group) were studied. Prevalence of BH and PCOM, diagnostic performance of androgens and ultrasound parameters for PCOS diagnosis were analyzed. BH and PCOM prevalence were higher in the Hirs/Oligo girls than in the C girls (76.9% versus 25.5%; 92.3% versus 33.3%, respectively; p?<?0.0001). A complete PCOS phenotype (Hirs/Oligo with BH and PCOM) was observed in 73.1% of the Hirs/Oligo group. The presence of both BH and PCOM was observed in 7.9% of the C group. The parameters with the best diagnostic performance were free androgen index ≥6.1, testosterone ≥2.4?nmol/L, follicle number ≥12 and ovarian volume ≥10?ml anti-Müllerian hormone (AMH) exhibited a low diagnostic accuracy. Hirsutism and persistent menstrual cycle over 45 days are highly associated with BH and PCOM suggesting that the presences of both criteria are necessary for the diagnosis of PCOS during adolescence.     

Prevalence of polycystic ovaries and polycystic ovary syndrome in lesbian women compared with heterosexual women

OBJECTIVE: To determine the prevalence of polycystic ovaries (PCO) and polycystic ovarian syndrome (PCOS) in lesbian women compared with heterosexual women undergoing fertility treatment. DESIGN: A prospective observational study. SETTING: The London Women's clinic and The Hallam Medical Center. Tertiary referral fertility setup. PATIENT(S): Six hundred eighteen women undergoing ovarian stimulation with or without IUI treatment between November 2001 and January 2003. Of these, 254 were self-identified as lesbians and 364 were heterosexual women. INTERVENTION(S): Baseline pelvic ultrasound examination and blood tests conducted to measure biochemical parameters such as FSH, LH, E(2), PRL, T, androstenedione (A), sex hormone-binding globulin (SHBG), and DHEAS were performed between day 2 and 3 of each woman's menstrual cycle. Tubal patency tests were performed by hysterosalpingography or laparoscopy. MAIN OUTCOME MEASURE(S): Biochemical parameters. RESULT(S): Eighty percent of lesbian women, compared with 32% of the heterosexual women, had PCO on pelvic ultrasound examination. Thirty-eight percent of lesbian women, compared with 14% of heterosexual women, had PCOS. There were no significant differences in the androgen concentrations between lesbian and heterosexual women with normal ovaries. However, lesbian women with PCO and PCOS had significantly higher androgen concentrations compared with heterosexual women with PCO and PCOS. Tubal disease was as common in lesbian women as in heterosexual women. CONCLUSION(S): There is a significantly higher prevalence of PCO and PCOS in lesbian compared with heterosexual women. Lesbian women with either PCO or PCOS had more pronounced hyperandrogenism than did heterosexual women with either PCO or PCOS.     

Consensus on women's health aspects of polycystic ovary syndrome (PCOS): the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in females, with a high prevalence. The etiology of this heterogeneous condition remains obscure, and its phenotype expression varies. Two widely cited previous ESHRE/ASRM sponsored PCOS consensus workshops focused on diagnosis (published in 2004) and infertility management (published in 2008), respectively. The present third PCOS consensus report summarizes current knowledge and identifies knowledge gaps regarding various women's health aspects of PCOS. Relevant topics addressed-all dealt with in a systematic fashion-include adolescence, hirsutism and acne, contraception, menstrual cycle abnormalities, quality of life, ethnicity, pregnancy complications, long-term metabolic and cardiovascular health, and finally cancer risk. Additional, comprehensive background information is provided separately in an extended online publication.     

Prevalence of polycystic ovary syndrome in women seeking treatment from community electrologists. Alabama Professional Electrology Association Study Group.

OBJECTIVE: To determine the prevalence of the polycystic ovary syndrome (PCOS) among women seeking electrology, clients presenting to nine electrology centers completed a questionnaire. STUDY DESIGN: Women with potential risk factors were referred to the University of Alabama at Birmingham. They underwent a detailed history and physical examination, including hirsutism scoring by a modified Ferriman-Gallwey (F-G) method. Serum was assayed for total testosterone, sex hormone binding globulin and dehydroepiandrosterone sulfate. RESULTS: Three hundred fifteen (40%) of 779 patients had potential risk factors for hyperandrogenism and were referred. Eighty-two (26%) completed their evaluation. Six were excluded secondary to prepubertal or menopausal status. Of the remaining 76 patients, 20% had F-G scores of 7 or 8, 13% had scores of 9 or 10, and 21% had scores > 10. Forty-nine (64%) patients reported irregular menstrual cycles. Sixty-four patients were not receiving hormonal therapy: 25 reported regular menstrual cycles, and 39 reported irregular cycles. Seventeen (68%) of the 25 had at least one abnormal androgen value, while 33 (85%) of the 39 women had at least one abnormal value (nonsignificant difference). Overall, PCOS was evident in 39 of the 76 women, or 12% of the 315 patients who were referred for further evaluation. CONCLUSION: Thirty-nine of the 315 referred patients (12%) fulfilled the diagnostic criteria for PCOS. However, they were not receiving medical care for this condition. In addition, this percentage is a conservative estimate in that 74% of the referred patients did not pursue a medical evaluation. Therefore, efforts to educate both electrologists and their clients of the possibility of underlying endocrine disorders and subsequent metabolic morbidity should be undertaken.     

Characteristics of different phenotypes of polycystic ovary syndrome in a Bulgarian population.

AIM: Our aim was to investigate the percentage occurrence of different phenotypes of polycystic ovary syndrome (PCOS) in a Bulgarian population, and their clinical, biochemical and hormonal characteristics. METHODS: The study included 70 women with PCOS, diagnosed according to the European Society of Human Reproduction & Embryology/American Society for Reproductive Medicine criteria. The women were divided into four phenotypes: hyperandrogenism (HA) + oligo-/anovulation (OA) + polycystic ovaries at ultrasound (PCO) (full-blown syndrome, phenotype A); HA + OA (former National Institutes of Health definition, phenotype B); OA + PCO (phenotype C); and HA + PCO (phenotype D). Serum levels of testosterone, immune-reactive insulin, sex hormone-binding globulin, dehydroepiandrosterone sulfate and lipid metabolism parameters were measured. Free androgen index and homeostasis model assessment of insulin resistance were calculated. Body mass index and waist-to-hip ratio were assessed. RESULTS: The percentages of phenotypes A, B, C and D in a Bulgarian population are 58.6%, 11.4%, 10.0% and 20.0%, respectively. The women with the classical form of PCOS (phenotypes A and B) were more obese, had more strongly expressed hyperandrogenemia, and were more insulin-resistant compared with the women of phenotypes C and D. CONCLUSION: There is a significant difference in anthropometric, hormonal and metabolic indices between the classical form and the clinical variants of PCOS in the studied Bulgarian population.     

Efficacy of an oral contraceptive containing drospirenone in the treatment of women with polycystic ovary syndrome.

OBJECTIVE: To investigate the efficacy of a combined oral contraceptive containing 30 microg ethinyloestradiol and 3 mg drospirenone in the treatment of hyperandrogenism affecting women with the polycystic ovary syndrome (PCOS). METHODS: Prospective open study of 20 women for six cycles. At the beginning and at the end of the study the following values were determined: the Ferriman-Gallwey (F-G) score, body mass index, waist/hip ratio, serum levels of testosterone, SHBG, immune reactive insulin (IRI), glucose, the free androgenic index, and insulin resistance (HOMA-IR). RESULTS: All 20 women completed six cycles of therapy. The medication was well tolerated. At the end of the study there was a significant improvement of hirsutism, expressed in the decrease of the F-G score, accompanied by a decrease of testosterone and an increase of SHBG values. The carbohydrate metabolism was not affected significantly. CONCLUSION: The combined oral contraceptive containing 30 microg ethinyloestradiol and 3 mg drospirenone is an effective drug in the treatment of hyperandrogenism in women with PCOS; it elicits few side effects and does not significantly influence insulin resistance.