多囊卵巢综合征与代谢综合征

多囊卵巢综合征(PCOS)是一种病因未明的异质性疾病，其与代谢综合征密切相关，被认为是一种天然的代谢综合征疾病。PCOS患者除存在胰岛素抵抗外，β细胞功能亦有损伤。约50％的PCOS患者超重或肥胖，大多为中心性肥胖，其原因与高胰岛素血症相关。由于胰岛素抵抗和肥胖的影响，PCOS患者常合并血脂异常，患心血管疾病的危险性增高。PCOS的治疗以提高胰岛素敏感性为主，包括减重及应用二甲双胍、噻唑烷二酮类、右手性肌醇等药物治疗。     

多囊卵巢综合征与代谢综合征

多囊卵巢综合征(PCOS)是一种病因未明的异质性疾病,其与代谢综合征密切相关,被认为是一种天然的代谢综合征疾病。PCOS患者除存在胰岛素抵抗外,β细胞功能亦有损伤。约50%的PCOS患者超重或肥胖,大多为中心性肥胖,其原因与高胰岛素血症相关。由于胰岛素抵抗和肥胖的影响,PCOS患者常合并血脂异常,患心血管疾病的危险性增高。PCOS的治疗以提高胰岛素敏感性为主,包括减重及应用二甲双胍、噻唑烷二酮类、右手性肌醇等药物治疗。     

多囊卵巢综合征与代谢综合征

多囊卵巢综合征(PCOS)临床定义为月经过少伴随男性化现象,表现为痤疮、多毛等雄激素增高,常合并胰岛素抵抗(IR)、高胰岛素血症、黄体激素促卵泡成熟激素比值增高、腹型肥胖、不育。B超示多囊卵巢有重要诊断意义。PCOS常为糖尿病的前躯表现,应受到重视。一、PCOS和代谢综合征(MS)的相互重叠性。PCOS患者中有 30%伴有糖耐量受损( IGT), 7 5%合并糖尿病。PCOS患者与体重相当的女性对照组比较,高胰岛素血症和IR的发生率更高,程度更严重。超过 40%的 PCOS患者伴有肥胖。伴有的肥胖的患者与体重相当的对照组及低体重的PCOS患…     

重视多囊卵巢综合征患者的代谢异常

育龄妇女多囊卵巢综合征的患病率约为6%,其发病年龄有年轻化趋势.越来越多的研究提示多囊卵巢综合征患者存在胰岛素抵抗,常常引起患者的糖脂代谢异常,以及潜在的心血管疾病风险增加.因此,应当积极控制多囊卵巢综合征的代谢异常.     

多囊卵巢综合征胰岛素抵抗的发生机制

多囊卵巢综合征（PCOS）是一种发病多因性、临床表现多态性的综合征，以慢性持续的无排卵和高雄激素血症为基本病理生理改变。研究证实胰岛素抵抗（IR）可能是PCOS发生发展的主要因素之一，本文就PCOS-IR发生机制的研究进展作一综述。     

多囊卵巢综合征患者一级亲属代谢表型及心血管疾病风险的分析

为明确多囊卵巢综合征(PCOS)患者一级亲属的代谢表型改变及心血管疾病风险是否升高,比较110名PCOS患者一级亲属与年龄及体重相匹配的85名非PCOS正常女性一级亲属的代谢表型和心血管疾病风险的差异.PCOS患者一级亲属中母亲和父亲的糖耐量受损发生率分别是51.4％和57.5％.与非PCOS对照的一级亲属相比,PCOS患者一级亲属中空腹胰岛素水平、稳态模型评估的胰岛素抵抗指数、胰岛素曲线下面积及超敏C反应蛋白水平明显升高,而胰岛素敏感指数和高分子量脂联素水平明显降低(P＜0.05).PCOS患者的一级亲属中除姐妹外,父母亲及兄弟的总胆固醇、低密度脂蛋白胆固醇和甘油三酯水平明显高于正常对照组(P＜0.05).PCOS患者一级亲属的代谢表型存在明显的胰岛素抵抗特征,即糖耐量受损、高脂血症、高炎症水平,提示其心血管疾病风险明显增高.     

多囊卵巢综合征的遗传学研究进展

多囊卵巢综合征（ＰＣＯＳ）是一种异质性疾病,患者常有高胰岛素血症,其发生非胰岛素依赖型糖尿病的危险性也增加。近来的遗传学研究发现有多种基因参与了其发病,其中以胰岛素基因等为最重要。     

多囊卵巢综合征的遗传学研究进展

多囊卵巢综合征 (PCOS)是一种异质性疾病 ,患者常有高胰岛素血症 ,其发生非胰岛素依赖型糖尿病的危险性也增加。近来的遗传学研究发现有多种基因参与了其发病 ,其中以胰岛素基因等为最重要。     

多囊卵巢综合征患者胰岛素抵抗分析及干预措施探讨

近年来 ,随着对胰岛素抵抗 ( IR)的深入研究 ,发现许多与内分泌及代谢有关疾病的患者均存在 IR。目前已发现多囊卵巢综合征 ( PCOS)与 IR关系密切。为了探讨 PCOS中 IR的程度和地位及有效干预措施 ,我们对 30例 PCOS患者的 IR进行了分析 ,并采用二甲双胍 (格华止 )进行治疗观察。现报告如下。1　资料与方法　　 1 999～ 2 0 0 2年 ,在我院临床诊断为 PCOS的患者30例 ( PCOS组 ) ,年龄 1 6～ 2 8岁。均有月经稀发或闭经、多毛及痤疮 ,其中 1 6例呈单相体温。常规测量其身高、体重 ,计算体重指数 ( BMI) ;测空腹血糖及胰岛素 ,…     

多囊卵巢综合征与胰岛素抵抗

多囊卵巢综合征是以胰岛素抵抗（ＩＲ）为特征的内分泌代谢性疾患。其胰岛贮备功能及葡萄糖耐量正常提供了与ＮＩＤＤＭ、肥胖患者不同的遗传学基础；人类的卵巢组织存在着胰岛素受体但无ＩＲ，由ＩＲ所致的高胰岛素血症通过胰岛素的促性腺作用使卵巢合成过多的雄激素、通过对ＧｎＲＨ反应增强使ＬＨ分泌亢进但无高峰等内分泌变化，导致其男性化特征、卵巢多囊变、长期不排卵、月经紊乱及Ｘ综合征等临床表现     

Elevated fasting insulin is associated with cardiovascular and metabolic risk in women with polycystic ovary syndrome

AimsPCOS is associated with various immediate and long term health complications. The aim of this study was to investigate the association of serum fasting insulin concentration with cardiovascular and metabolic risk factors in women with polycystic ovary syndrome.MethodsA total of 349 women, 249 women with polycystic ovary syndrome and 100 age-matched healthy controls, were recruited in this case-control study. Fasting insulin and various other biochemical, hormonal and clinical parameters were measured in all participants. The correlation of insulin with cardiometabolic risk factors was evaluated in PCOS women with normal and high serum insulin concentration.ResultsFasting Insulin, BMI, WHR, FAI, LH: FSH, HOMA, QUICKI were significantly higher in PCOS women compared with healthy controls (p < 0.01). Fasting insulin showed a positive correlation with more cardiovascular and metabolic risk factors in PCOS compared to controls. The BMI, BAI, LAP, HOMA IR, QUICKI and FAI were significantly higher (all p < 0.05) in PCOS patients with higher insulin levels than with PCOS women with normal levels.ConclusionFasting insulin is an important determinant in the pathogenesis of obesity and hyperandrogenism in PCOS. It is associated with an increased risk of cardiovascular and metabolic disorders in women with PCOS.     

多囊卵巢综合征患者肥胖和高雄激素血症与胰岛素抵抗的相关性

收集多囊卵巢综合征(PCOS)患者101例,招募30名正常健康志愿者。根据血清雄激素水平及稳态模型评估的胰岛素抵抗指数(HOMA-IR)水平分层分析肥胖、高雄激素和胰岛素抵抗的关系。结果显示,101例PCOS患者中39.8％患者体重正常,24.5％超重,35.7％肥胖。将PCOS患者分为正常雄激素组(睾酮＜0.51 μg/L)和高雄激素组(睾酮≥0.51 μg/L),两组体重指数(BMI)、空腹血糖(FPG)、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)及HOMA-IR均无统计学差异。将PCOS患者分为非胰岛素抵抗组(HOMA-IR＜2.29)和胰岛素抵抗组(HOMA-IR≥2.29),两组血清睾酮水平无统计学差异,胰岛素抵抗组的BMI、FPG、TG、TC、LDL-C明显高于非胰岛素抵抗组(P＜0.05或P＜0.01),HDL-C明显低于非胰岛素抵抗组(P＜0.01)。HOMA-IR与BMI显著相关(P＜0.01),而与血清睾酮水平无显著相关性,提示PCOS患者体重增加与HOMA-IR的相关性独立于血清睾酮水平。     

Brothers of women with polycystic ovary syndrome are characterised by impaired glucose tolerance,reduced insulin sensitivity and related metabolic defects

Aims/hypothesis Since it has been shown that polycystic ovary syndrome (PCOS) is highly inherited and characterised by insulin resistance, we hypothesised that male siblings of PCOS women would also be insulin resistant. Thus, our aim was to assess insulin sensitivity and metabolic parameters in brothers of women with PCOS and male control individuals. Methods Seventeen brothers of PCOS women and 28 male control volunteers were assessed with 75 g OGTTs and euglycaemic–hyperinsulinaemic clamps. PCOS index women were identified using criteria developed at the 1990 National Institutes of Health conference. Results Brothers and control individuals were similar in terms of BMI, waist circumference, percentage body fat and BP. However, brothers had increased triacylglycerol (p = 0.02), plasminogen activator inhibitor-1 (PAI-1; p = 0.02), factor VIII (p = 0.02), 2 h glucose (p < 0.001), AUC_glucose (p < 0.001) and AUC_insulin (p < 0.001). Insulin sensitivity was reduced by 38% in brothers (p < 0.001), and this was primarily due to a 65% decrease in insulin-stimulated non-oxidative carbohydrate metabolism (p < 0.001). These differences remained significant after adjustment for age and BMI, except for triacylglycerol, PAI-1 and fasting glucose. The main findings also persisted after excluding individuals with impaired glucose tolerance or diabetic siblings. Significant interactions with BMI status were found for sex hormone-binding globulin, androstenedione, PAI-1 and AUC_insulin, which were significantly altered only in obese brothers (vs control individuals). Conclusions/interpretation Brothers of PCOS women are characterised by decreased insulin sensitivity and glucose tolerance, as well as hypercoagulability, independently of obesity. Therefore, brothers of PCOS women may have inherited the insulin resistance and metabolic syndrome typical of PCOS.     

多囊卵巢综合征的药物治疗

多囊卵巢综合征是一种涉及多系统的内分泌疾病,常伴有代谢紊乱和心血管疾患.传统的治疗药物包括口服避孕药、促排卵药、抗雄激素药等,新的治疗药物包括双胍类、噻唑烷二酮类、他汀类、芳香化酶抑制剂等.本文就多囊卵巢综合征药物治疗的研究进展作一综述.     

The prevalence of metabolic syndrome in patients with polycystic ovary syndrome: A systematic review and meta-analysis

IntroductionPolycystic ovary syndrome (PCOS) is an endocrinopathy with unknown pathophysiology among women of reproductive age. Several studies have been conducted to determine the prevalence of metabolic syndrome (MetS) among PCOS patients. However, the results were contradictory. The present study was conducted to evaluate the prevalence of MetS in PCOS patients using the related published data.MethodThe present systematic review was perfumed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search was done using MeSH keywords in databases of PubMed, Scopus, Embase, CINAHL, Web of Science, Cochrane Library, EBSCO, and Google scholar search engine as well as the reference list of the retrieved papers without time limit until October 2018. We used Cochran's Q test and I² Index to evaluate the heterogeneity among the studies and the random effects model was used to combine the results. Data analysis was performed using Stata ver. 11.1.ResultsForty six studies including 8946 patients with PCOS were included in the final analysis. Total heterogeneity was high (I²: 91.43%, P < 0.001). The prevalence of MetS in PCOS patients was estimated to be 30% (95%CI: 27–33). Subgroup analysis based on MetS diagnostic criteria showed an estimated prevalence of 0.27% (95%CI: 0.18–0.37), 0.30% (95%CI: 0.27–0.34), 0.32 (95%CI: 0.25–0.39), 0.32 (95%CI: 0.27–0.37) and 0.24 (95%CI: 0.14–0.34) for IDF, NECP-ATPIII, AHA NHLBI, CDS, and unknown criteria, respectively.ConclusionConsidering the prevalence of MetS in PCOS patients, diagnosis of MetS in PCOS patients is necessary to reduce the mortality and morbidity rates.     

多囊卵巢综合征患者血清apelin蛋白水平及意义

目的 检测多囊卵巢综合征(PCOS)患者血清apelin蛋白水平并探讨其变化意义.方法 50名PCOS患者及20名健康对照者的空腹血糖、胰岛素、胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白水平应用化学发光法检测,卵泡刺激素、黄体生成素、雌二醇,孕酮、催乳素、睾酮的血清浓度采取磁酶免疫法测定,血清apelin水平采用酶联免疫法测定.结果 PCOS组apelin血清浓度明显高于对照组(P＜0.05);其中PCOS体重指数(BMI)≥25 kg/m2患者血清apelin水平高于PCOS BMI ＜25 kg/m2患者(P＜0.05);PCOS患者血清apelin水平与胰岛素抵抗(IR)、BMI、腰臀比(WHR)呈正相关(r=0.43,P ＜0.007;r =0.38,P ＜0.02;r =0.456,P ＜0.003),与高密度脂蛋白(HDL,r=-0.456,P＜0.005)呈负相关;二项Logistic回归分析显示apelin与PCOS发病有关(P＜0.05).结论 PCOS患者血清apelin水平升高,可能参与胰岛素代谢及血管舒缩.     

减重手术对多囊卵巢综合征的治疗作用

多囊卵巢综合征(PCOS)是女性常见的内分泌疾病,PCOS容易合并肥胖和代谢综合征,但其代谢紊乱的危害容易被忽视.减重手术可以有效降低体重,恢复下丘脑-垂体轴正常功能,降低心血管风险、提高妊娠几率,预防或逆转代谢综合征.故减重手术可推荐作为PCOS女性尤其是合并代谢综合征患者的有效治疗手段.     

多囊卵巢综合征患者超长链脂肪酸的变化及其与肥胖、胰岛素抵抗的关系

目的 了解多囊卵巢综合征（PCOS）患者血浆超长链脂肪酸（VLCFAs）的变化,并分析各种脂肪酸与肥胖、胰岛素抵抗的关系.方法 收集符合2003年鹿特丹会议诊断标准的18 ～40岁PCOS患者205例,另选择年龄匹配的同期因输卵管因素或男方因素所致不孕的女性117例作为正常对照组.检测血清激素水平,并用气相色谱质谱联用仪（GC-MS）检测血浆10种VLCFAs水平.两组间比较采用f检验,计量资料的多因素分析采用多元逐步回归分析.结果 与正常对照组相比,PCOS患者血浆中存在多种超长链脂肪酸代谢紊乱,包括花生四烯酸（C20：4n-6）/二十碳三烯酸（C20：3n-6）较正常对照组降低,而花生烯酸（C20：ln-9）、二十碳五烯酸（C20：5n-3）、w-3二十二碳五烯酸（C22：5n-3）、二十二碳六烯酸（C22：6n-3）、C20：3n-6、二十二碳四烯酸（C22：4n-6）、二十碳二烯酸（C20：2n-7）均较正常对照组升高（t=0.539 ～6.155,均P＜0.05）.在PCOS患者中,与非肥胖组相比,肥胖组C20：0升高,C20：3n-6、C20：2n-7均下降（t=-0.927、2.452、0.767,均P＜0.05）.与非胰岛素抵抗（IR）组比较,IR组C20：0升高,C20：2n-7及C22：5n-3均降低（t=2.064、2.195、2.183,均P＜0.05）.多元逐步回归分析结果显示C20：2n-7是肥胖的独立危险因素,而C20：0是胰岛素抵抗的独立危险因素.结论 PCOS患者存在超长链脂肪酸代谢紊乱.C20：2n-7的下降可能是PCOS患者肥胖的影响因素,而C20：0的升高则可能是PCOS患者胰岛素抵抗的影响因素.