多囊卵巢综合征患者促甲状腺激素水平与代谢综合征相关性探讨

目的:探讨多囊卵巢综合征(PCOS)患者促甲状腺激素(TSH)水平及代谢综合征(MS)各项指标的相关性。方法:回顾性分析育龄期PCOS患者512例,分析TSH水平为0～7 mU/L的MS检出率及TSH与MS各项指标[腰围(WC)、收缩压(SBP)、舒张压(DBP)、空腹血糖(FPG)、高密度脂蛋白胆固醇(HDL-C)、甘油三酯(TG)、胰岛素抵抗指数(HOMA-IR)]的相关性,应用ROC曲线寻找预测MS的TSH临界值,并以此为截断值分两组,对MS的各项指标进行比较。结果:①随着PCOS患者的TSH水平(0～7 mU/L)升高,其MS发生率增加。②PCOS患者的TSH水平与WC、SBP、DBP、FPG、HOMA-IR、TG均呈正相关(r0,P0.05),与HDL-C呈负相关(r0,P0.05);其中TSH水平与WC及HDL-C为线性相关;合并MS的PCOS患者中,TSH水平仅与HDL-C呈负相关(r=-0.128,P0.05)。③以TSH=2.43 mU/L为截断值时,预测MS的灵敏度和特异度最高,分别为77.7%和64.1%。④TSH≥2.43 mU/L组的WC、FPG、HOME-IR、SBP、DBP水平与TSH2.43 mU/L组比较,差异有统计学意义(P0.05)。结论:PCOS患者的TSH水平与MS各项指标均有相关性,合并MS的PCOS患者HDL-C的相关性更高,TSH并不能作为预测PCOS患者是否合并MS的独立因素,但临床医生应更加关注TSH超过2.43 mU/L的PCOS患者。     

核因子-κB和肿瘤坏死因子-α与多囊卵巢综合征患者糖脂代谢指标相关性研究

目的探讨血清中核因子-κB(NF-κB)和肿瘤坏死因子-α(TNF-α)与多囊卵巢综合征(PCOS)患者糖脂代谢指标的相关性。方法选择80例PCOS患者为研究组,同期来院就诊的80例非PCOS不孕症患者为对照组。根据体质量指数(BMI)是否≥25 kg/m2,将研究组分为PCOS肥胖亚组(A组,40例)、PCOS非肥胖亚组(B组,40例);对照组分为非PCOS肥胖亚组(C组,40例)和非PCOS非肥胖亚组(D组,40例)。检测静脉血NF-κB、TNF-α及血糖血脂相关指标,并对各因素间关系采用Spearman相进行关性分析。结果 A组稳态胰岛素评价指数(HOMA-IR)、空腹胰岛素(FIN)、甘油三酯(TG)和低密度脂蛋白胆固醇(LDL-C)水平指标明显高于B组(P值分别为0.022、0.036、0.044、0.023)、C组(P值分别为0.014、0.029、0.021、0.018)及D组(P值分别为0.007、0.021、0.014、0.003),B组HOMA-IR及FIN指标高于C组(P值分别为0.041、0.033)及D组(P值分别为0.030、0.017);A组血清中总胆固醇(TC)水平高于D组(P=0.023);B组血清中TG和LDL-C水平高于D组(P值分别为0.032、0.026);A组血清中高密度脂蛋白胆固醇(HDL-C)水平低于D组(P=0.001);A组血清中NF-κB水平[(655.59±273.41)IU/L]高于B组[(502.84±165.48)IU/L](P=0.034)、C组[(352.10±132.45)IU/L](P=0.019)及D组[(319.62±112.57)IU/L](P=0.005),B组血清中NF-κB水平高于C组(P=0.039)及D组(P=0.031);A组血清中TNF-α水平[(86.18±18.32)ng/L]高于B组[(66.86±22.71)ng/L](P=0.042)、C组[(58.40±17.90)ng/L](P=0.029)及D组[(54.67±22.34)ng/L](P=0.013),B组血清中TNF-α水平高于D组(P=0.038);在相关性分析中显示,PCOS患者中NF-κB及TNF-α均与BMI、FIN、HOMA-IR、TG、LDL-C等指标有相关性(P0.05),且NF-κB与TNF-α也有相关性(P0.05)。结论 TNF-α可能与NF-κB相互作用共同参与PCOS的糖脂代谢紊乱的发生及发展,为临床治疗PCOS提供了新的思路。     

青春期和育龄期多囊卵巢综合征的临床生化特征分析比较

目的:探讨青春期多囊卵巢综合征(PCOS)患者的临床生化特征.方法:收集2010年8月至2012年10月四川大学华西二院妇产科门诊收治的126例青春期PCOS患者(青春期组)和368例育龄期PCOS患者(育龄期组),分析和比较两组患者的临床及生化指标.结果:(1)青春期组患者的初潮年龄(12.59±1.39)显著低于育龄期组(13.28±5.36)(P＜0.05),但均在正常范围内;高雄症状的程度和发生率均显著高于育龄期组(P＜0.05),体重指数(BMI)、腰围、腰臀比(WHR)和平均舒张压均显著低于育龄期组(P＜0.05);(2)两组的平均血睾酮(T)、LH、FSH、LH/FSH及FINS、HOMA-IR、HDL无显著差异(P＞0.05).青春期组的平均空腹血糖(FPG)、胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白(LDL)、TC/HDL及LDL/HDL均显著低于育龄期组(P＜0.05);(3)青春期组的腰围≥80cm、收缩压≥130mmHg和FPG ≥5.6mmol/L的发生率显著低于育龄期组(P＜0.05).结论:青春期PCOS患者具有PCOS特征性的高雄、代谢障碍问题,需加以关注,并及早治疗.     

高胰岛素血症与多囊卵巢综合征的发病关系

目的了解高胰岛素血症(HI)与多囊卵巢综合征(PCOS)发病的关系。方法检测记录2007年8月至2007年12月华中科技大学同济医学院附属协和医院97例PCOS患者年龄、身高、体重、腰围、臀围、Ferrimarr-Gallwey(F-G)评分、痤疮评分及体重指数(BMI),放射免疫法测定血清促黄体生成素(LH)、促卵泡生成素(FSH)、泌乳素(PRL)、睾酮(T)、脱氢表雄酮(DHEA)、雄烯二酮(A)、空腹血糖(FPG)和胰岛素(FINS)、口服糖耐量试验(OGTT)和胰岛素释放试验(IRT),计算腰臀比(WHR)、LH/FSH比值、葡萄糖及胰岛素曲线下面积(AUC)、胰岛素敏感指数(ISI)、稳态模型指数(HOMA),ISI和HOMA-IR评估胰岛素抵抗(IR)的程度,HOMA-IS评价胰岛B细胞功能。结果 97例患者中有60例伴有HI,HI者中肥胖及糖耐量异常(IGT)者均多于非高胰岛素血症(NHI)者(P均0.05),腰围、臀围及BMI也均高于NHI者(P均0.05),HI患者30、60和120min血糖、IRT各时点胰岛素值、IAUC、HOMA-IR均明显高于NHI患者(P均0.05),而HI者ISI则明显低于NHI者(P0.01)。相关分析结果显示,HOMA-IR与腰围、臀围、BMI、FPG、FIN、GAUC、IAUC、HOMA-IS均成正相关(P均0.01)。结论 HI与PCOS患者肥胖尤其腹型肥胖的发生及PCOS糖代谢紊乱密切相关。早期干预HI对预防PCOS远期并发症具有积极意义。     

肥胖与非肥胖青春期PCOS患者内分泌、代谢指标对照研究

目的研究肥胖与非肥胖青春期多囊卵巢综合征(PCOS)患者内分泌、代谢指标。方法选取我院2014年3月~2015年3月收治的PCOS患者30例作为研究对象。按照肥胖与非肥胖将其分为对照组和实验组,各15例。对比两组患者的促卵泡生成素(FSH)、促黄体生成素(LH)、雌二醇(E2)、排卵期催乳素(PRL)、生长激素(GH)值,以及三酰甘油(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)指标。结果两组患者的各项指标值与GH值比较,LH和GH指标比较,差异有统计学意义(P0.05);两组患者的代谢指标比较,差异无统计学意义(P0.05)。结论肥胖与非肥胖青春期PCOS患者内分泌、代谢指标均有差异,与PCOS早期的发病机制存在密切关联。     

胰岛素抵抗及高胰岛素血症与多囊卵巢综合征发病关系的探讨

目的:了解胰岛素抵抗(IR)及高胰岛素血症(HI)与多囊卵巢综合征(PCOS)发病的关系.方法:选择诊断为PCOS的患者97例,分为高胰岛素血症组(HI组)60例和非高胰岛素血症(NHI组)37例.检测记录两组患者年龄、身高、体重、腰围、臀围、Ferrimarr-Gallwey(F-G)评分、痤疮评分及体重指数(BMI);放射免疫法测定血清促黄体生成素(LH)、促卵泡生成素(FSH)、泌乳素(PRL)、睾酮(T)、脱氢表雄酮(DHEA)、雄烯二酮(A)、空腹血糖(FPG)和胰岛素(FINS);行口服糖耐量试验(OGTT)和胰岛素释放实验(IRT).结果:97例患者中有60例伴有HI,HI组患者腰围、臀围及BMI均高于NHI组(P＜0.05),HI组30分钟、60分钟及120分钟血糖、IRT各时点FINS值、胰岛素曲线下面积(AUC)、稳态模型指数(HOMA)均明显高于NHI组(P均＜0.05),而胰岛素敏感性指数(ISI)则明显低于NHI组(P＜0.01).结论:IR与HI可促进PCOS患者肥胖尤其腹型肥胖的发生,并与PCOS糖代谢紊乱密切相关.早期干预对预防PCOS远期并发症具有积极意义.     

体质量指数正常的多囊卵巢综合征伴胰岛素抵抗患者的临床特征及胰岛素抵抗影响因素分析

目的:观察体质量指数(BMI)正常的多囊卵巢综合征(PCOS)伴胰岛素抵抗(IR)患者的临床及生化表现,探讨其临床特征及IR的影响因素。方法:收集2015年8月至2016年6月就诊于黑龙江中医药大学附属第一医院妇科门诊的BMI正常(18.5 kg/m~2≤BMI≤23.9 kg/m~2)的PCOS患者116例,其中PCOS伴IR患者50例,PCOS不伴IR患者66例,分析、比较两组的临床特征、性激素水平、糖脂代谢水平,采用Spearman或Pearson相关分析稳态模型胰岛素抵抗指数(HOMA-IR)的影响因素。结果:1PCOS伴IR组患者腰臀比、多毛评分明显高于PCOS不伴IR组患者,差异有统计学意义(P0.05);2PCOS伴IR组患者空腹葡萄糖(FPG)、空腹胰岛素(FINS)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL)显著高于PCOS不伴IR组患者,差异有统计学意义(P0.05),PCOS伴IR组患者高密度脂蛋白(HDL)显著低于PCOS不伴IR组患者,差异有统计学意义(P0.05);3对BMI正常的PCOS患者进行相关分析,HOMA-IR与年龄、BMI、卵泡刺激素(FSH)、黄体生成激素(LH)、LH/FSH、睾酮(T)、硫酸脱氢表雄酮(DHEAS)、雄烯二酮(AND)无关(P0.05);与腰臀比(r=0.386)、FPG(r=0.459)、FINS(r=0.981)、TC(r=0.360)、TG(r=0.343)和LDL(r=0.467)呈正相关(P0.01),与性激素结合球蛋白(SHBG)(r=-0.220,P0.05)、HDL(r=-0.288,P0.01)呈负相关。结论:BMI正常的PCOS伴IR患者腰臀比、多毛评分及糖、脂代谢指标较无IR的PCOS患者均有改变。BMI正常的PCOS患者的IR与腰臀比、FPG、FINS、TC、TG、LDL及SHBG、HDL相关。     

女性体重指数与H-P-O轴驱动性的相关性分析

目的:探讨体重指数(BMI)增加对女性下丘脑-垂体-卵巢轴驱动性的影响。方法:按BMI将患者分为对照组(18.5BMI22.9kg/m2,162例)、超重组(23.0BMI24.9kg/m2,112例)和肥胖组(BMI≥25.0kg/m2,122例),采取放射免疫法测定FSH、LH、E2基础数值,比较3组患者的月经周期变化。结果:(1)超重组患者的FSH、LH、E2基础值分别为(6.32±1.71)m IU/ml、(4.21±1.64)m IU/ml、(123.96±49.81)pmol/ml,肥胖组分别为(5.97±1.48)m IU/ml、(3.97±1.69)m IU/ml、(112.46±43.3)pmol/ml,两组均较对照组明显减低(P0.05);(2)超重组与肥胖组患者的月经紊乱比例分别为46.4%和55.7%,明显高于对照组(17.9%)(P0.05);(3)超重组和肥胖组的FSH/LH比值分别为1.73±0.77、1.78±0.86,呈FSH与LH比值倒置状态。结论:BMI增加的患者可能减慢下丘脑GnRH脉冲发生器,使H-P-O轴驱动减弱,继发性引起垂体促性腺激素释放减慢,导致卵泡发育迟缓、月经周期延长、黄体功能不足、自然流产甚至不孕症。     

口服避孕药联合二甲双胍治疗多囊卵巢综合征疗效观察

目的观察口服避孕药联合二甲双胍治疗多囊卵巢综合征(PCOS)的疗效。方法选择2001年11月至2004年6月在昆明医学院第一附属医院就诊的PCOS患者90例,随机分为A、B、C3组。A组32例,口服妈富隆联合二甲双胍治疗;B组40例,口服达因-35联合二甲双胍治疗;C组18例,单用妈富隆治疗。3组用药时间均为3个月。测定患者血清卵泡刺激素(FSH)、黄体生成素(LH)和睾酮(T),测量腰/臀比值(WHR)及体质指数(BMI)并进行治疗前后的比较。结果A、B两组治疗后LH、LH/FSH、T及WHR均较治疗前明显降低(P<0.05或P<0.01)且两组间差异无显著性(P>0.05);C组治疗后LH、LH/FSH、T较治疗前明显降低(P<0.01),但WHR明显升高(P<0.05)。A、B、C3组治疗后各项指标比较LH、LH/FSH及T差异无显著性(P>0.05),而C组WHR明显高于A、B两组(P<0.01)。结论口服避孕药联合二甲双胍治疗PCOS疗效优于单用口服避孕药。妈富隆与达因-35疗效比较,差异无显著性。     

多囊卵巢综合征患者抗苗勒氏管激素水平与代谢综合征的相关性探讨

目的:探讨PCOS患者AMH水平与代谢综合征(MS)的相关性。方法:选取安徽医科大学第一附属医院生殖中心收治的PCOS患者184例,于月经第2~5天检测基础性激素、空腹血糖、胰岛素、血脂、血AMH值。按MS标准将PCOS患者分为合并MS组和未合并MS组,比较两组的年龄、身高、体重、BMI、腰围、臀围、WHR、血压、性激素、糖代谢、脂代谢等指标差异。按AMH水平分为高AMH组(AMH≥10ng/ml)和低AMH组(AMH10ng/ml),比较两组的性激素、糖脂代谢指标的差异。将总AMH、高AMH、低AMH分别与代谢指标之间进行相关性分析。结果:合并MS组与未合并MS组的AMH值比较,差异无统计学意义。高AMH组和低AMH组的LH、LH/FSH、T值比较,差异有统计学意义;两组的FPG、INS、HOMA-IR、TG、TC、HDL、LDL-C等比较,无显著差异。低水平AMH与INS、HOMA-IR呈负相关性,总AMH以及高水平AMH与INS、HOMA-IR、TC、TG、HDL、LDL、VLDL等均无关。结论:PCOS患者的AMH高低水平与LH、LH/FSH、T有关,与FPG、INS、HOMA-IR、TG、TC、HDL、LDL-C等代谢紊乱无关;低水平的AMH值与糖代谢异常呈负相关,未来更易发展成MS。     

Prevalence and cytologic manifestations of human papilloma virus (HPV) types 6, 11, 16, 18, 31, 33, 35, 42, 43, 44, 45, 51, 52, and 56 among 500 consecutive women.

The prevalence and associated cytologic manifestations of cervical infection with human papillomavirus (HPV) types 6, 11, 16, 18, 31, 33, 35, 42, 43, 44, 45, 51, 52, and 56 were studied among 500 consecutive women attending the Harborview Medical Center Sexually Transmitted Diseases (STD) Clinic in Seattle, WA. Using radiolabeled-probes without prior amplification of DNA, HPV DNA was detected in cervical specimens from 120 (24%) of the women and was found to be more prevalent than Chlamydia trachomatis (13%), Neisseria gonorrhoeae (12%), or mucopurulent cervicitis (20%). High-risk HPV types 16 or 18 were present alone in 5% of the women; intermediate-risk types 31, 33, 35, 45, 51, 52, or 56 in 3%; and low-risk types 6, 11, 42, 43, and 44 in 5%. In an additional 8% HPV DNA was detected but could be characterized only as being type 6, 11, 16, 18, 31, 33, or 35. Each grouping of HPV types was equally associated with squamous intraepithelial lesions (SILs) of the cervix. In the absence of SIL and koilocytosis, the cytologic changes associated with HPV infection included frequent binucleation and variation in nuclear size and chromatin distribution. Parakeratosis and hyperkeratosis without nuclear atypia were not associated with HPV DNA. The natural history and clinical significance of these HPV-associated lesions remain to be defined.     

Cystosarcoma phyllodes: epidemiology, pathohistology, pathobiology, diagnosis, therapy, and survival

Cystosarcoma phyllodes is a very rare tumor which maybe difficult to diagnose clinically. The epidemiology and pathobiology are different from those of breast carcinoma. Risk factors, multicentricity, bilaterality, as associated with breast carcinoma, are not observed in patients with cystosarcoma phyllodes. Although the term "sarcoma" indicates a malignant tumor, only 10%-30% of cystosarcomas are histologically diagnosed as malignant; clinical diagnosis of malignancy does not exceed 10%. Axillary node involvement is rare, but hematogenous spread of cystosarcoma occurs into lung, pleura, bone, and liver. Clinically, cystosarcoma is a large (usually 3-5 cm in diameter) painless tumor with sudden growth acceleration especially during pregnancy. Cystosarcoma is usually circumscribed, containing firm and soft areas. The differential diagnosis has to include fibroadenoma, fibrocystic disease, mastitis, abscess, and medullary carcinoma. Neither clinical, mammographic or sonographic signs exist to predict a benign or malignant tumor. Therapy of cystosarcoma is not uniformly agreed upon. Radical, modified-radical, and simple mastectomy and tumorectomy are typical treatments; therapeutic results are the same for each treatment modality. For histologically diagnosed malignant cystosarcoma, the relative 5-year survival rate is about 80%. Clinically, malignant metastatic cystosarcoma is incurable; radiotherapy, endocrine treatment, and polychemotherapy are all ineffective. Because of the specific tumor pathobiology of cystosarcoma and its rarity, evaluation of treatment modalities and comparison of survival rates are difficult.     

Use of anti-infective agents during lactation: Part 2--Aminoglycosides, macrolides, quinolones, sulfonamides, trimethoprim, tetracyclines, chloramphenicol, clindamycin, and metronidazole.

Because many antibiotics are excreted into breast milk, it can be difficult for a practitioner to choose an antibiotic for a lactating patient that will have minimal risks to her nursing infant. This article is the second of a three-part series discussing the use of anti-infective agents during lactation. The authors review general information regarding use and common side effects for several classes of antibiotics. They also summarize information, including documented milk concentrations, milk-to-plasma ratios, and other pharmacokinetic properties, in a table that can help practitioners choose antibiotics that may be considered safe to use in the lactating mother.     

Severe, gestational, non-familial, non-genetic hypertriglyceridemia

Severe hypertriglyceridemia is a rare condition in pregnancy. All the cases of severe gestational hypertriglyceridemia that have been reported previously in the literature were caused by genetic mutations or familial hypertriglyceridemia secondary to lipoprotein lipase deficiency or apolipoprotein C-II deficiency. We report the first case of severe, non-genetic, non-familial, pregnancy-induced hypertriglyceridemia. The genetic underlying causes were excluded by molecular genetic investigation. The reported case was managed solely by strict dietary control. Hypertriglyceridemia was diagnosed incidentally during pregnancy, in this case, while taking a blood sample to check her hemoglobin level. Acute pancreatitis, which is a relatively common life threatening complication of this condition, was avoided. This report reviews the subtypes of hyperlipidemia, clinical picture, antenatal management and its effect on pregnancy and vice versa. It is important that the clinician has a clear understanding of the normal lipid profile during pregnancy, the clinical picture, the potential complications, available treatment options of hypertriglyceridemia particularly during pregnancy. The timing and route of delivery should be individualized.