多囊卵巢综合征胰岛素抵抗与子宫内膜病变

近年临床资料分析,胰岛素抵抗与多囊卵巢综合征(PCOS)患者子宫内膜增生存在很高的一致性,且PCOS患者患子宫内膜癌的几率高。近年研究发现,胰岛素除有促代谢的作用外,其促细胞生长、增生的作用越来越受到重视,且与多种肿瘤的发生机制有关。PCOS胰岛素抵抗与子宫内膜病变的机制可从几方面分析:胰岛素抵抗影响体内性激素水平;胰岛素本身促进细胞增殖分化;胰岛素抵抗影响体内胰岛素样生长因子的水平;胰岛素抵抗与基因表达异常的细胞协同促进细胞增生,加速了细胞恶变。     

多囊卵巢综合征胰岛素抵抗与子宫内膜病变

近年临床资料分析,胰岛素抵抗与多囊卵巢综合征(PCOS)患者子宫内膜增生存在很高的一致性,且PCOS患者患子宫内膜癌的几率高.近年研究发现,胰岛素除有促代谢的作用外,其促细胞生长、增生的作用越来越受到重视,且与多种肿瘤的发生机制有关.PCOS胰岛素抵抗与子宫内膜病变的机制可从几方面分析:胰岛素抵抗影响体内性激素水平;胰岛素本身促进细胞增殖分化;胰岛素抵抗影响体内胰岛素样生长因子的水平;胰岛素抵抗与基因表达异常的细胞协同促进细胞增生,加速了细胞恶变.     

多囊卵巢综合征的胰岛素抵抗

胰岛素抵抗 (ｉｎｓｕｌｉｎｒｅｓｉｓｔｅｎｃｅ ,ＩＲ)是多囊卵巢综合征(ｐｏｌｙｃｙｓｔｉｃｏｖａｒｙｓｙｎｄｒｏｍｅ ,ＰＣＯＳ)患者主要和常见的代谢紊乱。多囊卵巢综合征和胰岛素抵抗是两种复杂的、牵涉广泛病理生理变化的病症。自 1980年 ,Ｂｕｒｇｈｅｎ[1] 等发现ＰＣＯＳ与高胰岛素血症相关后 ,对ＰＣＯＳ的胰岛素抵抗进行了广泛和深入的研究[2～ 4] ,本文对此进行简要的综述。1　胰岛素抵抗的概念1 1　胰岛素抵抗的定义胰岛素抵抗的定义目前仍不完全统一。根据美国糖尿病协会 (ＡｍｅｒｉｃａｎＤｉａｂｅｔｅｓＡｓｓｏｃ…     

多囊卵巢综合征患者子宫内膜综合管理

多囊卵巢综合征(PCOS)是育龄期女性最常见的妇科生殖内分泌疾病之一。PCOS患者存在排卵障碍、胰岛素抵抗、高胰岛素血症、代谢综合征等多种内分泌异常,可通过多种机制刺激子宫内膜增生,导致不同程度的子宫内膜疾病。对PCOS患者及时地进行子宫内膜规范管理,可有效避免子宫内膜疾病的发生发展,并降低因子宫内膜病变导致的器官切除及生育功能丧失。本文综述了PCOS患者子宫内膜管理的必要性及综合措施,以期为改善PCOS患者健康提供依据。     

多囊卵巢综合征患者的胰岛素抵抗

多囊卵巢综合征（peOS）是女性常见的生殖功能障碍性疾病,主要表现为卵巢的雄激素过多及无排卵,其发生率占生育年龄妇女的5％－10％卜］。此外,PCOS患者也存在糖代谢异常,主要表现为胰岛素抵抗（IR）及代偿性高胰岛素血症,其糖耐量低减的发生率也占生育年龄妇女的10％［'］。现就关于poOS的IR基础及临床方面研究进展作一综述。一、胰岛素作用及IR（一）胰岛素作用的细胞机理胰岛素是人体最重要的代谢激素,也是唯一降糖激素。胰岛素的生物学作用主要是调节糖代谢和脂代谢,还通过调控基因表达和蛋白质合成等进一步影响相应器官的…     

关于青春期多囊卵巢综合征胰岛素抵抗的探讨

目的　探讨青春期多囊卵巢综合征 (PCOS)胰岛素抵抗 (IR)和葡萄糖耐量减低 (IGT)的发生率。方法　选择 2 0 0 3年 2～ 9月复旦大学附属妇产科医院 2 9例 14～ 19岁的青春期PCOS患者 ,测定体重指数 (BMI)、腰臀比 (WHR)、卵巢体积、血清卵泡刺激素 (FSH)、黄体生成激素 (LH)和睾酮 (T) ,并行口服糖耐量试验 (OGTT)和胰岛素释放试验 ,根据空腹血糖 /胰岛素之比 (GIR)将其分为IR组 15例和非IR组 14例。结果　所有研究对象的空腹血糖均正常 ,两组间卵巢体积、LH/FSH比值、T水平无明显差异 (P >0 0 5 ) ,IR组BMI、WHR、曲线下葡萄糖面积 (AUC葡萄糖)和曲线下胰岛素面积 (AUC胰岛素)均高于非IR组 (P <0 0 5 ) ,而非IR组LH水平高于IR组 (P <0 0 5 ) ;IR组IGT患者占 4 0 0 % ,高于非IR组的 7 1% ,相关分析则显示GIR与BMI、WHR、空腹胰岛素水平、AUC葡萄糖 和AUC胰岛素 呈负相关。结论　肥胖和BMI正常者青春期PCOS均存在IR ,表现IR的青春期PCOS患者更易发生IGT ,要重视青春期PCOS患者IR的评估以及IGT的筛选。     

多囊卵巢综合征患者组织胰岛素抵抗

多囊卵巢综合征（PCOS）是一种发病多因性、临床表现呈多态性的内分泌综合征。其发病原因至今尚未阐明，近年大量研究表明胰岛素抵抗（IR）与PCOS之间关系密切，胰岛素抵抗可能是PCOS发生发展的主要因素之一。胰岛素作用的经典靶器官是肝脏、脂肪及肌肉。目前，对PCOS患者组织胰岛素抵抗的研究主要有脂肪、肌肉、卵巢及子宫内膜．对其作一综述。     

多囊卵巢综合征患者组织胰岛素抵抗

多囊卵巢综合征(PCOS)是一种发病多因性、临床表现呈多态性的内分泌综合征.其发病原因至今尚未阐明,近年大量研究表明胰岛素抵抗(IR)与PCOS之间关系密切,胰岛素抵抗可能是PCOS发生发展的主要因素之一.胰岛索作用的经典靶器官是肝脏、脂肪及肌肉.目前,对PCOS患者组织胰岛素抵抗的研究主要有脂肪、肌肉、卵巢及子宫内膜,对其作一综述.     

多囊卵巢综合征临床内分泌代谢对子宫内膜病变的 …

目的 探讨多囊卵巢综合征（ＰＣＯＳ）患者临床内分泌代谢改变对子宫内膜病变的影响。方法 用组织学方法检测９４例ＰＣＯＳ患者子宫内膜病理改变,用放射免疫学方法测定血清泌乳素,黄体生成激素,卵泡刺激素,雌二醇,睾酮,雄烯二酮水平,８２ 时行糖耐量及胰岛素释放实验。结果 （１）７０例ＰＣＯＳ患者子宫内膜为无排卵型,其中增殖期内膜４５例,增殖症２５例（单纯增生２３例,不典型增生２例）;２４例为排卵型子宫内膜     

多囊卵巢综合征患者胰岛素抵抗/高胰岛素血症与子宫内膜癌

多囊卵巢综合征(polycystic ovarian syndrome,PCOS)是以排卵稀发、无排卵,高雄激素血症及胰岛素抵抗为特征的内分泌、代谢紊乱症候群。胰岛素抵抗及其伴随的高胰岛素血症是PCOS患者重要的病理生理改变。由于胰岛素具有促进内膜细胞增殖,抑制内膜细胞凋亡,促进胰岛素样生长因子及血管内皮生长因子生成,促进黄体生成素释放激素及促黄体生成素生成及降低体内脂联素水平等作用,可能是PCOS患者罹患内膜癌的危险因素,故对PCOS患者胰岛素抵抗/高胰岛素血症与子宫内膜癌的关系进行探讨。     

吡格列酮对多囊卵巢综合征伴胰岛素抵抗患者的疗效观察

目的了解吡格列酮对多囊卵巢综合征伴胰岛素抵抗的疗效。方法选择2003年1月～2005年10月于我院就诊的多囊卵巢综合征伴胰岛素抵抗的患者为研究对象，予吡格列酮口服12周。检测治疗前后BMI、血脂、外周胰岛素敏感度（SI）、FSH、LH、游离睾酮、硫酸脱氢表雄酮（DHEAs）、雄烯二酮、性激素结合球蛋白（sHBG）等指标。结果①BMI治疗前后差异无显著性（P〉0．05），血胆固醇、甘油三酯、低密度脂蛋白于治疗后均降低（P〈0．05），SI于治疗后升高（P〈0．05）；②FSH治疗前后差异无显著性（P〉0．05），LH、游离睾酮、DHEAS、雄烯二酮于治疗后均下降（P〈0．05），SHBG于治疗后升高（P〈0．05）。结论吡格列酮可改善多囊卵巢综合征患者的胰岛素抵抗，进而改善高雄激素症，恢复排卵月经。     

Effect of orlistat or metformin in overweight and obese polycystic ovary syndrome patients with insulin resistance

The aim of this study was to evaluate the effect of orlistat or metformin combined with Diane-35 on anthropometric, hormonal and metabolic parameters in overweight and obese polycystic ovary syndrome (PCOS) patients with insulin resistance (fasting insulin?>?10?mIU/L). A total of 240 PCOS women were randomly allocated to orlistat plus Diane-35(OD group), metformin plus Diane-35(MD group), orlistat plus metformin plus Diane-35(OMD group) or Diane-35 (D group). Body weight, BMI, waist and hip circumference, blood pressure, endocrine profile, lipid profile and insulin resistance were assessed at baseline and after 3 months. Significant reductions in waist and hip circumference, serum LH, total testosterone and uric acid were observed in all groups compared with baseline. TG and TC significantly decreased in the OD group. Homeostasis model assessment insulin resistance (HOMA-IR) index was reduced in the OD (p?=?.015), MD (p?=?.001) and OMD (p?=?.004) groups. Body weight, BMI, systolic BP and HDL-C significantly changed in the OD and OMD group compared with the D group (p?相似文献   

部分卵母细胞浆内单精子注射的临床结局及影响受精率的相关因素分析 #br#

目的分析中国南方多囊卵巢综合征（polycystic ovary syndrome,PCOS）患者中胰岛素抵抗的发生情况及其与代谢综合征（metabolic syndrome,MetS）发生的相关性。方法回顾性分析中山大学孙逸仙纪念医院2004年1月至2008年10月初诊的578例PCOS患者各表征胰岛素抵抗指标的发生率,及其与代谢综合征发生的关系。结果 PCOS患者中,332例（57.4%）稳态模型测定（HOMA-IR）〉75th,133例（23.0%）空腹胰岛素（FIN）〉95th,73例（12.6%）胰岛素释放实验2h胰岛素（2h-INS）〉150mU/L,49例（8.5%）FIN和2h-INS同时超标,157例（27.2%）发生高胰岛素血症（HIN）,FIN和/或2h-INS超标。FIN升高、2h-INS升高、HIN和HOMA-IR超标者,代谢综合征发生率分别为40.6%、41.1%、39.5%和26.8%。与指标正常者比较,其发生代谢综合征的风险明显增加（P〈0.001）。结论应用不同表征胰岛素抵抗的指标得到的PCOS患者胰岛素抵抗的发生率存在差异,但是存在任一胰岛素抵抗指标异常的患者合并代谢综合征的风险显著高于无高胰岛素血症及HOMA-IR正常者。因此,判断和纠正PCOS患者的胰岛素抵抗对于预防代谢综合征的发生有临床意义。     

Relationship between insulin resistance and gonadotropin dissociation in obese and nonobese women with polycystic ovary syndrome

OBJECTIVE: To test the interdependence between insulin resistance (IR) and gonadotropin dissociation (GD) in polycystic ovary syndrome (PCOS). DESIGN: Cross-sectional prospective study. SETTING: Clinical research center. PATIENT(S): Thirty-two PCOS patients aged 19-34 years; 16 obese (BMI > or = 27) and 16 nonobese (BMI < 27). INTERVENTION(S): A 75-g oral glucose tolerance test (OGTT) and a 100-microg i.v. GnRH test were performed on different days. Blood was taken at 0, 30, 60, 90, 120, and 180 minutes in each test. Serum glucose, insulin, LH, and FSH were measured. MAIN OUTCOME MEASURE(S): Area under the curve was calculated for glucose, insulin, and glucose-to-insulin ratio (GIR), and for LH, FSH, and LH-FSH ratio. RESULT(S): Glucose, insulin, and GIR were not modified significantly during the GnRH test, nor LH, FSH and LH-FSH ratio throughout the OGTT. There were no significant differences in GIR response of patients with and without GD, nor in LH-FSH ratio of patients with and without IR, after OGTT and GnRH test. However, obese patients with IR had a significantly larger (P<.04) area under the curve for LH-FSH ratio than those without IR after GnRH test, but not after OGTT test. CONCLUSION(S): Insulin resistance and GD do not appear to be related events in PCOS, suggesting that each one might be determined by different genetic disorders. However, IR can affect GD after chronic stimulation in obese patients.     

The correlation of plasma homocysteine with insulin resistance in polycystic ovary syndrome

AIM: This study aims to investigate the existence of any relationship between homocysteine levels and insulin resistance in Turkish women with polycystic ovary syndrome. METHODS: A case-controlled, cross-sectional, observational study was undertaken in a total of 94 infertile Turkish women who required professional help in the Department of Infertility of Dr Zekai Tahir Burak Women's Health Research and Education Hospital. The correlation between serum homocysteine with age, body mass index, hormone profile, fasting insulin and glucose concentrations and insulin resistance were examined in patients with polycystic ovary syndrome and the results were compared to those of women with normal ovaries, who served as a control group. RESULTS: The mean serum fasting glucose and insulin levels, thus insulin resistance index of women with polycystic ovary syndrome, were significantly higher than those of the control subjects. The mean serum homocysteine levels were significantly higher in women with polycystic ovary syndrome than those in the control group. A positive correlation was detected between the mean homocysteine, the insulin resistance index determined by homeostasis model assessment and the fasting insulin levels in polycystic ovary syndrome patients. CONCLUSIONS: Serum homocysteine levels are elevated in women with polycystic ovary syndrome, and this elevation is associated with the serum insulin level rather than androgen excess. The intense treatment of hyperhomocysteinemia in women with polycystic ovary syndrome might improve reproductive outcome and contribute to protection from cardiovascular risks.     

Association between anti-Mullerian hormone and insulin resistance in non-obese adolescent females with polycystic ovary syndrome

Objective: The present study was designed to evaluate the association between anti-Mullerian hormone (AMH) and insulin resistance (IR) in non-obese adolescent females with polycystic ovary syndrome (PCOS) with and without IR.

Methods: Seventy-seven consecutive non-obese patients were recruited and distributed into three groups according to diagnoses of PCOS and IR. Group I included 27 females diagnosed with PCOS and IR, group II included 18 females diagnosed with PCOS but without IR, and group III included 32 controls without PCOS.

Results: Group I had significantly higher AMH levels compared to group II and group III (p?p?p?=?0.004). There was a significant positive correlation between serum AMH and HOMA-IR levels in adolescent females with PCOS (p?=?0.003).

Conclusion: We found that serum AMH levels were higher in non-obese adolescent females with PCOS and IR than in PCOS patients without IR and the healthy controls. There was a significant positive correlation between AMH levels and IR in non-obese adolescent females with PCOS.     

Anti-Mullerian hormone and insulin resistance in polycystic ovary syndrome

Introduction: Polycystic ovary syndrome (PCOS) is a prevalent disease affecting women of reproductive age. It may be associated with metabolic disorders such as insulin resistance (IR) and obesity. The anti-Mullerian hormone (AMH) levels seem to be higher in patients with PCOS.

Objective: The present study was designed to evaluate the association between AMH and insulin in women with PCOS with and without IR.

Methods: Cross-sectional study, including 86 patients, selected and divided into three groups: Group A: 26 women with PCOS and IR; Group B: 30 women with PCOS and without IR; and Group C: 30 controls without PCOS.

Results: We found significant difference between serum AMH levels in the group of women with PCOS and without IR when compared to the control group, thus showing that PCOS and IR play an important role in elevating the levels of this hormone. When the groups were compared with each other following adjustment for BMI, serum AMH levels were significantly higher in the group of women with PCOS and IR.

Conclusion: AMH levels are significantly higher in patients with PCOS, particularly in those women with PCOS and IR. Nevertheless, larger samples are required to confirm these findings.     

N-acetyl-cysteine treatment improves insulin sensitivity in women with polycystic ovary syndrome

Objective: To evaluate the effect of N-acetyl-cysteine (NAC) on insulin secretion and peripheral insulin resistance in subjects with polycystic ovary syndrome (PCOS).

Design: Prospective data analysis.

Setting: Volunteer women in an academic research environment.

Patient(s): Six lean and 31 obese subjects, aged 19–33 years.

Intervention(s): Patients were treated for 5–6 weeks with NAC at a dose of 1.8 g/day orally. A dose of 3 g/day was arbitrarily chosen for massively obese subjects. Six of 31 obese patients with PCOS were treated with placebo and served as controls.

Main Outcome Measure(s): Before and after the treatment period, the hormonal and lipid blood profile and insulin sensitivity, assessed by an hyperinsulinemic euglycemic clamp, were evaluated and an oral glucose tolerance test (OGTT) was performed.

Result(s): Fasting glucose, fasting insulin, and glucose area under curve (AUC) were unchanged after treatment. Insulin AUC after OGTT was significantly reduced, and the peripheral insulin sensitivity increased after NAC administration, whereas the hepatic insulin extraction was unaffected. The NAC treatment induced a significant fall in T levels and in free androgen index values (P<.05). In analyzing patients according to their insulinemic response to OGTT, normoinsulinemic subjects and placebo-treated patients did not show any modification of the above parameters, whereas a significant improvement was observed in hyperinsulinemic subjects.

Conclusion(s): NAC may be a new treatment for the improvement of insulin circulating levels and insulin sensitivity in hyperinsulinemic patients with polycystic ovary syndrome.     

High plasma level of long Pentraxin 3 is associated with insulin resistance in women with polycystic ovary syndrome

Objectives: Polycystic ovary syndrome (PCOS) is characterized by insulin resistance. Chronic low-grade inflammation has been anticipated to play role in the pathogenesis of both insulin resistance and atherosclerosis. Pentraxin 3 (PTX3) is an inflammatory mediator synthesized in a variety of cells and tissues including heart, vascular endothelial cells, macrophages and adipocytes. In the present study, serum PTX3 level and its relationship with insulin resistance were investigated in patients with PCOS. Materials and Methods: Forty patients with PCOS and 40 age- and body mass index (BMI)-matched healthy controls were enrolled in the study. PTX3 and high-sensitivity C-reactive protein (hs-CRP) levels were determined by enzyme immunoassay (EIA). Insulin resistance was calculated by the homeostasis model assessment of insulin resistance (HOMA-IR) formula. Results: Plasma levels of PTX3, hs-CRP and HOMA-IR scores were all significantly higher (p?=?0.021, p?=?0.002 and p?=?0.0001, respectively) in women with PCOS compared with healthy controls. Blood PTX3 level correlated positively with hs-CRP, BMI, waist-to-hip ratio (WHR), HOMA-IR and negatively with high-density lipoprotein cholesterol level (p?<?0.05, for all). After adjustment for age and BMI, PTX3, total testosterone levels and BMI remained as independent predictors of HOMA-IR scores (p?<?0.05, for all). Conclusion: PTX3 level is increased in patients with PCOS in concordance with insulin resistance.