多囊卵巢综合征的胰岛素抵抗代谢分析

目的研究多囊卵巢综合征（PCOS）患者胰岛素抵抗简易指标异常、胰岛素释放曲线异常、高雄激素血症、糖代谢异常的发生率,探讨其与肥胖的关系。方法 64例PCOS患者,分为肥胖型组（体重指数〉25kg/m2）和非肥胖型组,对两组进行临床体征评分、内分泌测定,口服75g葡萄糖行糖耐量及胰岛素释放实验。分别统计其两组以胰岛素抵抗指数（HOMA-IR）及空腹胰岛素作为胰岛素抵抗简易指标异常、胰岛素释放曲线异常、高雄激素血症、糖代谢异常的发生率,并行卡方检验。结果 64例PCOS患者,肥胖型组为27例（42.19%）,其胰岛素抵抗简易指标异常25例（92.59%）,胰岛素释放曲线异常26例（96.30%）,高雄激素血症18例（66.67%）,糖耐量受损16例（59.26%）;非肥胖型组37例（57.81%）,其胰岛素抵抗简易指标异常23例（62.16%）,胰岛素释放曲线异常27例（72.97%）,高雄激素血症14例（37.84%）,糖耐量受损8例（21.62%）。经卡方检验统计肥胖型组患者胰岛素抵抗简易指标异常、胰岛素释放曲线异常、高雄激素血症、糖代谢异常的发生率均明显高于非肥胖型组患者（P〈0.05）。结论肥胖型的PCOS患者更易出现胰岛素抵抗、胰岛素释放曲线异常、高雄激素血症及糖代谢异常。     

益气养阴化瘀方对多囊卵巢综合征模型大鼠高雄激素血症及胰岛素抵抗的影响

目的:为益气养阴化瘀方治疗多囊卵巢综合征(PCOS)提供实验依据。方法:SD雌性大鼠随机分为空白对照组(A组)、PCOS模型对照组(B组)、二甲双胍治疗组(C组,0.45g/kg·d)、益气养阴化瘀方高剂量治疗组(D组,43.2g生药/kg·d)、益气养阴化瘀方低剂量治疗组(E组,13.5g生药/kg·d),每组6只。B～E组给予hCG、精蛋白重组人胰岛素和葡萄糖液建PCOS模型,造模成功后各组动物分别喂服相应的药物14d,A、B组则喂服等量的生理盐水。观察各组大鼠血清睾酮(T)、胰岛素(Ins)水平,卵巢组织学特点,免疫组织化学染色SABC法检测大鼠子宫内膜葡萄糖转运蛋白4(GLUT4)、Ins的表达。结果:①C、D及E组体质量、卵巢脏器系数皆显著下降,与B组比有显著差异(P<0.05)。②B组大鼠卵巢体积明显增大,表面较苍白。高倍显微镜下可见卵泡囊性扩张,放射冠消失,颗粒层2～3层。C、D、E组卵巢大体外观有所缩小,高倍显微镜下可见卵泡囊性减小,颗粒层增加,可见黄体。③D、E组血清T、Ins水平较B组明显下降(P<0.05或P<0.01),下降幅度C组>D组>E组,但3组间无统计学差异(P>0.05)。④免疫组织化学染色显示B组大鼠子宫内膜GLUT4的表达明显低于A组(P<0.01);而C、D、E组较A组明显升高(P<0.05)。子宫内膜的Ins表达B组较A组明显升高(P<0.01),而C、D、E组均显著低于B组(P<0.05或P<0.01)。结论:益气养阴化瘀方在减轻PCOS模型大鼠体质量、卵巢脏器系数、改善高雄激素血症、胰岛素抵抗(IR)方面有疗效,高剂量组疗效比低剂量组明显,二甲双胍在以上各方面较益气养阴化瘀方疗效显著,但2种药物的疗效差异无统计学意义。本实验也证实了PCOS大鼠子宫内膜存在IR。     

罗格列酮和二甲双胍治疗胰岛素抵抗多囊卵巢综合征的临床研究

目的　探讨罗格列酮 (rosiglitazone)和二甲双胍 (metformin)分别对有胰岛素抵抗的多囊卵巢综合征(polycysticovarysyndrome,PCOS)患者促排卵治疗的疗效对比。 方法　选择 2 0 0 2年 2月至 2 0 0 3年 6月存在胰岛素抵抗的PCOS患者 94例 ,将其随机分为A、B、C 3组。A组 36例口服罗格列酮联合克罗米芬治疗 ;B组 30例口服二甲双胍联合克罗米芬 (clomiphenecitrate ,CC)治疗 ;C组 2 8例口服克罗米芬治疗。 3组用药时间均为 3个月经周期。比较 3组用药后的胰岛素抵抗指数 (homainsulin resistance ,HomaIR)变化和排卵的发生情况。结果　A组用药 2个月后HomaIR开始由 1 12± 0 4 9下降为 0 86± 0 4 2 ,用药 3个月HomaIR由 1 12± 0 4 9降为0 6 1± 0 36 ,两者比较差异有显著性意义 (P <0 0 5 ) ;B组用药 2个月后HomaIR无明显下降 ,用药 3个月HomaIR由 1 15± 0 5 2降为 0 83± 0 32 ,两者比较差异有显著性意义 (P <0 0 5 )。C组用药前后HomaIR无变化。治疗后 3个月排卵率A组为 76 9% ,明显优于B组的 6 6 8%和C组的 5 8 8% ,差异有显著性意义 (P <0 0 5 )。结论　罗格列酮比二甲双胍能更快更好地改善PCOS的胰岛素抵抗 ,提高促排卵成功率。     

补肾化痰活血法治疗多囊卵巢综合征30例

多囊卵巢综合征（PCOS）是以不孕、闭经或月经失调、多毛和肥胖为主要表现的临床症候群，临床症状以功能性高雄激素皿症、持续不排卵和胰岛素抵抗为特征。2005年3～6月笔者跟从导师王秀云以中医理论为指导，以补肾化痰活血为治疗原则，通过30例临床观察，疗效满意，现报告如下。     

Acantosis nigricans in polycystic ovary syndrome]

Acantosis Nigricans (AN) is a skin disease with rough or velvet areas present on neck or as hyperpigmented and wrinkled skin. AN often forms HAIR-AN syndrome consisted of hyperandrogenizm, insulin resistance and AN. We present AN and PCO syndrome in 13 yrs old girl treated by laparoscopic wedge resection. We concluded that laparoscopic procedure is a diagnostic measure and mode of PCO treatment. Decreased hyperandrogenizm resulted in AN appearance withdrawall.     

Pregnancy after treatment with the insulin-sensitizing agent troglitazone in an obese woman with the hyperandrogenic, insulin-resistant acanthosis nigricans syndrome

OBJECTIVE: To report a case of unassisted pregnancy after 5 months of troglitazone treatment in a severely hyperandrogenic, insulin-resistant woman with acanthosis nigricans (HAIR-AN) previously managed with depot leuprolide acetate (LA) plus oral contraceptive and dexamethasone therapy. DESIGN: Case report. SETTING: Private infertility clinic. PATIENT(S): A 28-year-old African-American woman with excessive obesity (body mass index = 42 kg/m2) and HAIR-AN syndrome. INTERVENTION(S): Androgen suppression with depot LA plus oral contraceptive and dexamethasone therapy, troglitazone treatment resulting in normalization of fasting insulin and testosterone, spontaneous menses, and an unassisted pregnancy. MAIN OUTCOME MEASURE(S): Luteinizing hormone and testosterone concentrations, fasting insulin and glucose levels, insulin-glucose ratios, hCG levels, and ultrasound examinations. RESULT(S): Spontaneous menses followed by an intrauterine pregnancy after 5 months of treatment with troglitazone, an insulin-sensitizing agent, in a woman with severe HAIR-AN syndrome whose hyperandrogenism previously could be normalized only with depot LA plus oral contraceptive therapy and dexamethasone. CONCLUSION(S): Troglitazone treatment resulted in attenuation of both hyperinsulinemia and hyperandrogenism in an obese woman with HAIR-AN and resulted in resumption of menses and a spontaneous pregnancy.     

镜像综合征15例临床诊治分析

目的探讨镜像综合征的临床特点、诊断及治疗方法。 方法回顾性分析2008年1月至2015年3月广州医科大学附属第六医院收治的15例镜像综合征患者的临床资料。 结果(1)发病原因：15例镜像综合征患者中14例为Bart′s水肿胎,另一例原因不明;(2)临床表现：15例病例中,5例出现少尿或无尿,3例血压升高、2例上腹痛、1例出现头痛;(3)实验室检查：15例母体均出现不同程度贫血、血液稀释、低蛋白血症及D-二聚体升高,5例肌酐升高、13例尿酸升高、13例酸中毒;(4)超声及病理检查：15例超声检查均提示胎儿水肿,胎盘厚度平均值为(70.87±14.12)mm,胎盘病理检查均提示胎盘绒毛水肿;(5)母体并发症：12例产后出血、6例胎盘粘连、5例急性肾功能衰竭、3例急性心功能衰竭、2例急性肺水肿、1例胎盘早剥、1例羊水栓塞、1例弥散性血管内凝血、1例代谢性脑病。 结论母体水肿伴随胎儿水肿和(或)胎盘水肿即可确诊镜像综合征,除了出现类似子痫前期的临床表现外,还表现血液稀释的显著特点。镜像综合征一经确诊,如病情不可逆,应果断终止妊娠。     

女性盆腔腹膜结核12例诊治分析

目的：探讨女性盆腔腹膜结核的临床特点和诊治依据，避免误诊。方法：回顾分析12例女性盆腔腹膜结核患者的病史，临床表现及诊治经过，结果：入院初诊盆腔腹膜结核3例，诊断准确率25％，3例剖腹探查病理确诊，2例盆腔包块穿刺活检病理确诊，7例诊断性抗结核治疗确诊。确诊后治疗效果满意。结论：女性盆腔腹膜结核临床表现多样，需综合分析病史，症状，辅助检查，提高诊断准确率，本病可伴有血清CA125升高，抗结核抗体的诊断价值有待进一步研究。     

双胎输血综合征产前干预二例

<正>病例1患者29岁,孕3产1,本次妊娠为自然受孕,孕期定期产前检查未见异常。孕13~(+1)周在外院超声检查提示单绒毛膜双羊膜囊双胎妊娠,胎儿颈项透明层厚度检查正常,早期唐氏筛查提示21-三体综合征和18-三体综合征低风险;孕21周再次超声检查提示双胎输血综合征,遂转至广州医科大学附属第三医院产前诊断科进行诊治。患者进行     

Obstetrical treatment of retroplacental hematoma based on the clinical observation of 12 cases

Based on a critical review of the specialized literature and on the analysis of 12 personal cases, the author develops a few considerations on the obstetrical treatment of retroplacental hematoma. Once the diagnosis of RPH has been established in 12 cases, the hypovolemia, anemia (possibly hemorrhagic shock), coagulation disorders are corrected and an abdominal caesarean section is performed. In 2 cases, the caesarean section was followed by a hemostatic hysterectomy, and in one of these 2 cases, a bilateral ligation of the hypogastric arteries was also performed. With the current advances of intensive treatments, the risk induced by caesarean section is much less severe than the one which could incur from a calculated delay. Emergency caesarean section reduces this delay and represents a prophylaxis of fetal and maternal complications (which may be sudden and irreversible, because of the unpredictable extension of the RPH).     

Acanthosis nigricans: clinical predictor of abnormal glucose tolerance in Asian women with polycystic ovary syndrome.

The aim of this retrospective study was to assess whether acanthosis nigricans is a predictive factor for abnormal glucose tolerance (AGT) in Asian women with polycystic ovary syndrome (PCOS). Data from the record forms and electronic form of 121 PCOS women who consecutively attended the Reproductive Endocrinology and Infertility Unit were reviewed. In accordance with the unit's guidelines, all women received a physical examination, had anthropometric measurements taken and underwent as a 75-g oral glucose tolerance test after diagnosis. Their age, body mass index (BMI) and waist/hip ratio (WHR) was 29.1+/-6.1 years, 27.4+/-6.8 kg/m2 and 0.84+/-0.6 (mean+/-standard deviation), respectively. The prevalence of AGT was 42.9%, with 1.6% having impaired fasting glucose, 32.3% having impaired glucose tolerance and 9.1% having type 2 diabetes mellitus. The PCOS women with acanthosis nigricans had significantly higher BMI, WHR, fasting glucose, 2-h post-load glucose, fasting insulin, 2-h post-load insulin and prevalence of AGT compared with those without acanthosis nigricans. By logistic regression analysis, acanthosis nigricans and WHR were independent predictors for AGT, with an odds ratio (95% confidence interval) of 2.7 (1.1-7.1) and 10.1 (1.8-20.7), respectively. In conclusion, acanthosis nigricans was demonstrated as a predictive factor for AGT in Asian women with PCOS.