应用免疫组织化学方法定位多囊卵巢促性腺激素受体的研究

本文对２０例多囊卵巢综合征患者及１２例正常育龄妇女取卵巢组织，应用免疫组织化学方法观察卵促性腺激素受体的分布情况，结果显示：（１）正常卵巢ＬＨ、ＦＳＨ受体主要分布在颗粒细胞及卵泡膜；（２）ＰＣＯＳ的ＬＨ、ＦＳＨ受体主要分布在增生的卵泡膜，增生的间质细胞只含少量；颗粒细胞层退化，变薄，ＦＳＨ，ＬＨ受体较少；（３）正常卵巢及ＰＣＯＳ的白膜均不含ＦＳＨ、ＬＨ受体。     

绝经期促性腺激素诱导排卵的监护

为了探讨绝经期促性腺激素（ＨＭＧ）促排卵治疗时出现多胎、流产、卵巢过度刺激综合征（ＯＨＳＳ）的原因、预防及治疗。１９９３年１月～１９９８年１月我院共收治内分泌失调所致女性不孕妇女６８例并给予ＨＭＧ促排卵治疗。结果６８例病人共治疗１１９个月经周期,平均用药２４９支,９３个周期有排卵（７８．２％）。妊妊３８例（５５．９％）,７例流产（１８．４％）,１３例ＯＨＳＳ（１９．１％）,在妊娠病例中５例多胎（１     

GnRH—a在多囊卵巢综合征诱导排卵中的应用

报道３例多囊卵巢综合征（ｐｏｌｙｃｙｓｔｉｃ ｏｖａｒｙ ｓｙｎｄｒｏｍｅ，ＰＣＯＳ）患者用克罗米酚（ｃｌｏｍｉｐｈｅｎｅ ｃｉｔｒａｔｅ，ＣＣ）及人绝经期促性腺激素（ｈｕｍａｎ ｍｅｎｏｐａｕｓａｌ ｇｏｎａｄｏｔｒｏｐｉｎ，ｈＭＧ）长期脱敏方案。达到垂体抑制后联合用ｈＭ－人绒毛膜促性腺激素促排卵。３例患者各治疗１周期、２例妊娠、１例继续治疗。结果表明：对传统的ｈＭＧ促排卵疗法无效的ＰＣＯＳ患者     

高促性腺激素性闭经

目的：探讨高促性腺激素性闭经（ＨＧＡ）的致病因素、内分泌特点及治疗方法。方法：采用放免技术检测闭经病人血中ＦＳＨ、ＬＨ、Ｅ、ＰＲＬ、Ｔ值。结果：从３１２例闭经病人中筛选出ＨＧＡ４３例，占全部闭经患者的１３．８％。继发性闭经中，ＨＧＡ组占１３．２％，原发性闭经中，ＨＧＡ组占２７．３％，两组相比Ｐ＞０．０５。结论：对闭经病人应早期治疗，认真治疗，防止过早发展到绝经期阶段。     

低促性腺激素性功能减退两种治疗方法的探讨

观察低促性腺激素型性功能减退患应用两种治疗方法的效果。５例ＩＨＨ患使用ＧｎＲＨ脉冲式给药或ｈＣＧ＋ＴＰ肌注，定期测定血清中ＦＳＨ，ＬＨ，Ｔ变化。结果：治疗过程中，血清ＦＳＨ，ＬＨ，Ｔ均有所提高；治疗结束时，ｈＣＧ组血清Ｔ比治疗前增加４．３倍，ＧｎＲＨ组增加１．９倍；睾丸溶积比治疗前分别啬２．２倍和１．９倍。     

HMG—HCG捉排卵治疗席汉氏综合征

１９９３年１２月至１９９４年５月应用ｈＭＧ－ｈＣＧ治疗３例席汉氏综合征患者。共８个治疗周期，均促排卵成功，１例妊娠。１个治疗周期发生中度卵巢过度刺激综合征（ＯＨＳＳ）。结果提示在ｈＭＧ治疗前应给予雌－孕激素替代治疗３个周期以上；诱发排卵成败的关键是选择最佳的时机使用ｈＣＧ；排卵后应继续使用小剂量ｈＣＧ或孕酮维持黄体功能；同时应重视ＯＨＳＳ的防治。     

促卵泡生成素,黄体生成素和胰岛素对多囊卵巢病人颗粒细胞甾 …

目的 研究在促卵泡生成素（ＦＳＨ）促黄体生成素（ＬＨ）和胰岛素（ＩＮＳ）刺激作用下多囊卵巢综合征（ＰＣＯＳ）病人与正常卵巢的颗粒细胞甾体激素产生的异同。方法 对１８例月经周期正常妇女卵泡期的３３个卵泡和８例ＰＣＯＳ的１００个肺泡的颗粒细胞行体外培养,利用放射免疫法测定培养液中的甾体激素水平,比较了两组颗粒细胞在ＦＳＨ,ＬＨ和ＩＮＳ刺激作用下下雌二醇（Ｅ２）和孕酮（Ｐ）的养液中的甾体激素水平,比较了     

国产GnRH—a联合HMG治疗克罗米芬抵抗的多囊卵巢综合征

目的 探讨促性腺激素释放激素激动剂（ＧｎＲＨ－ａ）在多囊卵巢综合征（ＰＣＯＳ）诱导排卵中的作用。方法 对８例用克罗米芬无反应的ＰＣＯＳ患者，采用国产ＧｎＲＨ－ａ长期脱敏方案，达到垂体抑制后联合用国产ＨＭＧ－ＨＣＧ促排卵，共治疗１７个周期。结果 １４个周期排卵（排卵率为８２．４％），６例妊娠（周期妊娠率３５．３％，累计妊娠率７５．０％），５例足月活产（４例单胎，１例双胎），１例流产。１个周期出现重度     

促超排的卵巢过度刺激临床分析

目的：为了避免和减少过度刺激综合征（ＯＨＳＳ）发生,有效地提高排卵率和妊娠率。方法：选择促超排卵治疗的６４７例发生ＯＨＳＳ的资料进行总结分析,于月经或激素撤血的第３～５天开始用克罗米酚（ｃｃ）／绝经期促性腺激素（ＨＭＧ）或卵泡激素（ＦＳＨ）,ｃｃ每日１００ｍｇ连服５天,ＨＭＧ或ＦＳＨ每日７５ｕ连用５天,每８～１０天Ｂ超测卵泡,当主卵泡直径在１．５ｃｍ以上,每日量不变,若在１．１ｃｍ以上,增至每日１５０ｕ至直径达２～２．３ｃｍ,然后根据卵泡大小用ＨＣＧ的剂量。当卵巢直径〈５ｃｍ用ＨＣＧ１００００ｕ肌注,卵巢直径在５～５．９ｃｍ用ＨＣＧ６０００～～１００００Ｕ,卵巢直径≥６ｃｍ时不用ＨＣＧ,改用其他方法诱导排卵。结果：妊娠率４２．３５％（２７４／６４７）,ＯＨＳＳ发生率１３．６％（８８／６４７）。结论：强调严格掌握     

hMG—hCG周期治疗原发性闭经妊娠成功1例

ｈＭＧ－ｈＣＧ周期治疗原发性闭经妊娠成功１例徐仙张莉赵君利何秉洁绝经期促性腺激素（ｈＭＧ）与绒毛膜促性腺激素（ｈＣＧ）联合应用，对下丘脑—垂体性排卵障碍所致的不孕症疗效满意［１］。我们采用国产ｈＭＧ及ｈＣＧ治疗原发闭经１例诱发排卵成功并妊娠，足月分娩...     

Comparison of Hormonal and Metabolic Characteristics and Ovary Response to Induced Ovulation in Amenorrheic and Oligomenorrheic Women with PCOS

Objective To compare differences in endocrine and metabolic characteristics and response to induced ovulation treatment between oligomenorrheic and amenorrheic women with polycystic ovary syndrome (PCOS). Methods A total of 154 infertile PCOS patients presenting with oligomenorrhea or amenorrhea were retrospectively analysed, the differences in endocrine and metabolic characteristics and induced ovulation outcome parameters between oligomenorrheic and amenorrheic women were compared. Results Total follicle count, serum levels of total testosterone (TT), luteotropic hormone (LH) and insulin resistant index (HOMA-IR) were significantly higher in amenorrheic patients compared with oligomenorrheic patients (P<0.05). There were no differences in age, body mass index (BMI), follicle stimulating hormone (FSH), glucose, insulin levels and lipid level between the two groups. During clomiphene citrate (CC) and hMG induced ovulation (203 cycles), the ovulation rate in amenorrheic group was significantly lower than that of oligomenorrheic group (84.62% vs 96.80%, P<0.01). The duration to reach a dominant follicle, the cycles need to add hMG and the total dose of hMG were higher in women with amenorrhea compared with those with oligomenorrhea. No significant differences were found between the two groups in the total number of mature follicles, estradiol level and endometrial thickness on the day of hCG administration and pregnancy rate. Conclusion The degree of cycle irregularity might be a simple and effective clinical parameter to estimate the degree of metabolic and endocrine disorders and response to induced ovulation.     

月经中期血清雄激素水平对多囊卵巢综合征促排卵中妊娠预测作用研究

目的探讨围排卵期血清睾酮(testosterone,T)水平对氯米芬(clomiphene citrate,CC)抵抗的多囊卵巢综合征(P-COS)病人妊娠的预测作用。方法 60名CC抵抗的PCOS病人随机分为A组和B组。A组患者予以维生素E 100mg;B组患者予以二甲双胍1000mg;口服,每日2次,连续3个月作为预治疗。随后A组患者予以二甲双胍(1000mg口服,每日2次)、CC、尿促性腺激素(HMG)、人绒毛膜促性腺激素(HCG)促排卵;B组患者予以CC/HMG/HCG促排卵,连续3个月。另选30名正常排卵妇女作为对照组(C组)。促排卵周期及正常周期中测定患者排卵前后血清中生殖激素水平,并对妊娠和非妊娠周期排卵前后生殖激素水平进行比较。结果实验组A、B两组中共56人完成141治疗周期,A组中临床妊娠、非妊娠周期排卵后血清睾酮(T)水平分别为0.74±0.11ng/ml和0.95±0.16ng/ml,差异有显著意义(P=0.001);B组中临床妊娠、非妊娠周期排卵后T分别为0.70±0.04ng/ml和0.85±0.09ng/ml,差异有显著意义(P<0.001);C组30个周期中妊娠和非妊娠者排卵后血清T分别为0.73±0.05ng/ml和0.71±0.07ng/ml,差异无统计学意义(P>0.05);A、B组妊娠周期排卵后T水平与正常组相比差异无显著性,而非妊娠周期A、B组排卵后T水平显著高于C组(P<0.001)。结论二甲双胍治疗的CC抵抗的PCOS病人,排卵后血清T水平对妊娠具有一定的预测价值。     

卵泡穿刺配合人工授精治疗多囊卵巢综合征引起的不孕

目的 :探讨一种有效治疗多囊卵巢综合征 (PCOS)性不孕。方法 :对 12例PCOS患者 15个周期采用促性腺激素刺激卵泡发育 ,配合经阴道B超下卵泡穿刺术释放卵子 ,再行人工授精的方案治疗。结果 :治疗周期中获得妊娠 4例 ,妊娠率为 2 6 .6 7% ;治疗后第 2次月经周期中 1例自然妊娠 ,其它病例在 3个月内月经恢复正常 ,但之后 5例月经周期延长 ,2例复发闭经 ;患者血中LH和睾酮值治疗后明显低于治疗前 (P <0 .0 5 )。结论 :卵泡穿刺配合人工授精 ,能迅速阻断PCOS的病理环节 ,具有创伤较小、疗效确切、简便等优点 ,可作为治疗PCOS性不孕一种选择。     

抗苗勒管激素对卵泡发育的影响

目的探讨血清抗苗勒管激素（AMH）水平对促排卵效果的影响。方法排卵障碍患者70例。其中多囊卵巢综合征（PCOS）40饲（PCOS组）,非PCOS者30例（非PCOS组）,尿促性素（hMG）促排卵。月经周期2～3d（基础日）及注射绒促性素（hCG）日抽取空腹静脉血测AMH、雌激素（E）及雄激素（T）水平,分析血清AMH水平与促排卵效果的关系。20例健康妇女做正常对照。结果PCOS组血清基础AMH为（48．2±18．3）pmol／L,明显高于非PCOS组及对照组（P〈0．01）．后两组间的基础AMH差异无统计学意义。非PCOS组基础AMH水平低者,促排卵药用量大,获得的成熟卵泡少;而PCOS组基础AMH水平低者促排卵药用量小,获得的成熟卵泡多。结论血清基础AMH水平对不同排卵障碍患者的影响是不同的,PCOS患者血清基础AMH水平低,促排卵效果好,而非PCOS患者血清基础AMH水平低,预示促排卵效果差。     

二甲双胍治疗多囊卵巢综合征的疗效

目的观察二甲双胍单用及联合应用氯菧酚胺治疗多囊卵巢综合征（PCOS）患者的疗效。方法30例PCOS患者应用二甲双胍治疗3及6个周期，比较治疗前、后的体重指数、腰臀比、月经周期、排卵率、受孕率、空腹血糖、胰岛素、稳态模式评估胰岛素抵抗指数（HOMA—IR）、性激素和血脂的变化。22例加用氯菧酚胺治疗3个周期，观察月经周期、卵泡反应、排卵率及受孕率。结果二甲双胍治疗3及6个周期后，空腹胰岛素、HOMA—IR、总睾酮、游离睾酮、黄体生成素均显著下降（P值均〈0．01）；排卵率分别为43％及54％，受孕者各2例。联合治疗组排卵率为74％，4例受孕。结论二甲双胍治疗可显著改善PCOS患者的胰岛素抵抗、高雄激素血症、性激素异常及月经紊乱，改善卵泡发育，增加排卵率，提高受孕机会。     

Study of Combined Use of Clomiphene Citrate and Gonadotropins on the Infertile Patients with PCOS

Objective To investigate the efficacy and safety of combined use of clomiphene citrate (CC) and gonadotropins (Gn) on the infertile patients with PCOS. Methods A total of 367 infertile patients with PCOS were included in this retrospective study. Patients received CC from menstrual cycle day 3 until the day of triggering and human menopausal gonadotrophins (hMG) from menstrual cycle day 5 until the ovulation day. Gn duration and doses, serum LH and estradiol levels, transferable embryos, incidence of OHSS, frozen-thawed embryo implantation and clinical pregnancy rates were compared among CC plus hMG, long and short protocols. Results Gn duration and doses, blood estrogen level, transferable embryos and incidence of OHSS in the group of CC plus hMG were decreased significantly than those of long and short protocols. No differences were observed in the frozen-thawed embryo implantation and clinical pregnancy rates among three groups. Conclusion Mild stimulation of CC combined with hMG on infertile patients with high risk for OHSS is safe and efficient.     

应用hMG/HCG超促排卵治疗不孕症50例

为了研究国产人类绝经期促性腹激素（hMG）配伍绒促性素（HCG）的超促排卵作用，50例病人90个周期接受了hMG／HCG超排卵治疗。自月经周期第5天开始肌注hMG75u，用B超、宫颈粘液评分及血雌激素、孕激素监测排卵，当优势卵泡平均直径≥18mm时，停用hMG，肌注HCG5000u促排卵。结果显示：hMG／HCG促排卵治疗排卵率为91.0％，妊娠率为24.0％，卵巢过度刺激综合征（OHSS）发生率为44.0％、OHSS发生时妊娠率显著升高达45．4％，尤以多囊卵巢综合征明显。结论：hMG／HCG超排卵治疗不孕症有较好的疗效，国产hMG治疗效果基本与国外产品相近。     

Changes in serum FSH, LH and ovarian follicular growth during electroacupuncture for induction of ovulation

Changes in serum FSH, LH and follicular sizes were observed in chronically anovulatory patients during electroacupuncture treatment (EAT) for induction of ovulation. 7 cases were diagnosed as PCOD, 3 as dysfunctional uterine bleeding, and 1 as hypogonadotropic amenorrhea. Among them 8 cases complained of infertility for 2.7 years on average. Ovulation was confirmed by pregnancy or the combination of biphasic BBT and ultrasonographic evidence. During one cycle with 3-day EAT on acupoints Ren 3, 4, Extra 16 and Sp 6, ovulation resulted in 5 patients (ovulatory group) and among the 5 cases, 3 of 4 infertile cases became pregnant. The other 5 cases remained in anovulation (anovulatory group); of them 3 cases got biphasic BBT, but no typical ovulatory signs were found on ultrasonography; 2 cases remained in monophasic BBT. Serum FSH, LH values were elevated in ovulatory group, and FSH pulsatile frequency increased significantly during EAT (from 2.10 +/- 0.42/4h to 3.70 +/- 1.64/4h), but not in anovulatory group. No apparent changes were found in serum LH pulsatile frequency and pulsatile amplitudes of FSH and LH in this study. In ovulatory group diameters of ovarian follicles increased markedly, while diameters of anovulatory group stopped to grow at 14-16 mm. It is suggested that ovulation may be induced by EAT via a regulation on hypothalamic-pituitary function leading to normal secretion of FSH and LH.     

二甲双胍联合达英-35治疗多囊卵巢综合征24例效果观察

目的观察达英-35联合二甲双胍治疗多囊卵巢综合征(PCOS)的临床效果。方法将48例PCOS患者随机分为两组,A组24例(单独应用达英-35治疗),B组24例(应用达英-35联合二甲双胍治疗),两组患者均治疗3个周期。观察两组患者用药前后体重指数、血糖、胰岛素水平及血清性激素等指标。结果两组患者治疗后LH/FSH、LH、T较治疗前均明显下降(P<0.01),B组患者PG 1 h、PG 2 h、FlNS、INS 1 h、INS 2 h、LDL明显降低,差异均有统计学意义(P<0.01)。结论 PCOS患者应用达英-35联合二甲双胍治疗,可明显改善PCOS患者的胰岛素敏感性及脂代谢紊乱,纠正高雄激素血症,是治疗PCOS较为理想的选择。     

基于鹿特丹标准诊断的多囊卵巢综合征患者月经类型及其意义

目的 分析基于鹿特丹标准诊断的中国人多囊卵巢综合征(PCOS)患者不同月经类型的临床资料及内分泌代谢指标,以指导临床治疗.方法 将符合鹿特丹标准的2100例PCOS患者按闭经、月经稀发、月经规律进行分组,分别进行代谢及内分泌等指标的比较.结果 (1)闭经组多毛、多囊卵巢发生率均高于月经稀发组(P＜0.01).(2)闭经组的血清搞睾酮最高,月经稀发组最低(P＜0.01);黄体生成素(LH)在闭经组最高(P＜0.01),在月经稀发组和月经规律组问差异无统计学意义(P＞0.05);黄体生成素/卵泡刺激素(LH/FSH)在月经规律组增高明显(P＜0.01).(3)口服葡萄糖后2 h血糖在闭经组显著增高(P＜0.01).结论 符合鹿特丹标准的不同月经类型的PCOS患者具有不同的临床表现及代谢、内分泌特点,对于不同月经类型PCOS患者的治疗也应该个体化.