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。     

多囊卵巢综合征患者胰岛素抵抗和高胰岛素血症的诊治

胰岛素抵抗(IR)是多囊卵巢综合征(PCOS)的重要病理生理改变。IR及高胰岛素血症是PCOS患者代谢异常的基本特征,也是PCOS患者内分泌代谢紊乱的主要特征之一。肥胖型PCOS患者高胰岛素血症发生率高达75％,非肥胖型PCOS患者约为30％ 。流行病学调查显示PCOS患者发生2型糖尿病、高血压、冠心病等疾病的风险明显增加,胰岛素抵抗可能在PCOS的发生 中起着重要作用。生活方式改变和胰岛素增敏剂是治疗的有效方法。     

多囊卵巢综合征的助孕策略

传统的多囊卵巢综合征 (polycysticovariansympton ,PCOS)的临床表现为闭经、多毛、肥胖、游离睾酮及黄体生成素 (LH) /卵泡刺激素 (FSH)增高 ,且常因排卵障碍而导致不孕 ,影响PCOS患者的生活质量。一、PCOS的发病机理目前 ,PCOS的发病机理尚不清楚 ,有关研究资料多来源于动物实验。多数研究认为 ,PCOS是代谢与内分泌紊乱的疾病 ,涉及内分泌、代谢、遗传、免疫等诸多因素。目前 ,关注的焦点是胰岛素抵抗和高胰岛素血症与发病有密切关系 ,其中高胰岛素血症与高雄激素存在微妙的关系 ,高雄激素是PCOS最具有特征的表现[1,2 ] 。从…     

多囊卵巢综合征动物模型的胰岛素抵抗表现

多囊卵巢综合征(PCOS)是育龄期妇女常见内分泌及代谢紊乱性疾病,病因不明,近年来越来越多的研究显示,高胰岛素血症和胰岛素抵抗在疾病发生发展过程中起到重要作用。进行疾病发生机制及治疗效果的研究通常应用动物模型,常见的多囊卵巢动物模型造模方法包括雄激素法、雄激素+人绒毛膜促性腺激素(hCG)法、雌激素法、来曲唑法、胰岛素+hCG法、孕激素+hCG法等。分析比较PCOS研究中常用的几种动物模型,探讨更适合研究胰岛素抵抗的动物模型。     

多囊卵巢综合征患者早期妊娠丢失的相关因素

多囊卵巢综合征是常见的女性内分泌疾病,其与早期妊娠丢失(early pregnancy loss,EPL)的关系日益受到重视。胰岛素抵抗/高胰岛素血症、雄激素过多症、高黄体生成素血症和肥胖等PCOS内在的病理生理特征是发生EPL的主要相关因素。通过改善生活方式,积极控制体质量及抗高雄激素血症、二甲双胍等药物治疗可以一定程度降低EPL的风险。     

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.     

饮食因素在多囊卵巢综合征治疗中的作用

多囊卵巢综合征(PCOS)是育龄期妇女常见内分泌疾病之一,多数患者伴有胰岛素抵抗(IR)或高胰岛素血症,即存在着远期并发2型糖尿病的危险。包括合理饮食、适量运动等减轻体质量的方式已成为PCOS患者重要的早期干预措施之一。很多研究发现,碳水化合物、蛋白质和脂类等饮食结构组成对PCOS患者减轻体质量,改善IR或高胰岛素血症有重要影响,认为碳水化合物、蛋白质和脂类的能量比例为4:3:3,血糖指数(GI)较低及富含多不饱和脂肪酸(PUFAs)的饮食结构更适宜PCOS患者减轻体质量,降低2型糖尿病的发病风险,为探讨饮食结构在PCOS发病机制中的作用提供了一定依据。     

多囊卵巢局部胰岛素抵抗

多囊卵巢综合征(PCOS)是糖代谢异常与生殖功能障碍高度关联的一种特殊疾病,也是开展能量代谢与生殖活动关系研究的难得临床模型。PCOS是以卵巢功能障碍为显著标志,但目前研究发现胰岛素抵抗主要限于胰岛素作用的经典靶组织———骨骼肌、脂肪、肝脏等。很显然,以卵巢组织外的胰岛素抵抗和高胰岛素血症来解释卵巢本身的功能异常可能是不准确的。此外,胰岛素抵抗和高胰岛素血症是PCOS和2型糖尿病的共同表现,且胰岛素敏感性下降均为35%～40%,但是卵巢功能障碍仅存在于PCOS患者,而不常见于2型糖尿病患者。这表明PCOS患者卵巢本身的糖代…     

饮食因素在多囊卵巢综合征治疗中的作用

多囊卵巢综合征(PCOS)是育龄期妇女常见内分泌疾病之一,多数患者伴有胰岛素抵抗(IR)或高胰岛素血症,即存在着远期并发2型糖尿病的危险.包括合理饮食、适量运动等减轻体质量的方式已成为PCOS患者重要的早期干预措施之一.很多研究发现,碳水化合物、蛋白质和脂类等饮食结构组成对PCOS患者减轻体质量,改善IR或高胰岛素血症有重要影响,认为碳水化合物、蛋白质和脂类的能量比例为4:3:3,血糖指数(GI)较低及富含多不饱和脂肪酸(PUFAs)的饮食结构更适宜PCOS患者减轻体质量,降低2型糖尿病的发病风险,为探讨饮食结构在PCOS发病机制中的作用提供了一定依据.     

多囊卵巢综合征胰岛素抵抗患者的临床特征

目的探讨多囊卵巢综合征(polycystic ovary syndrome PCOS)胰岛素抵抗患者的临床表现特征.方法选择诊断为PCOS、及糖负荷后60 min或120 min血胰岛素≥160 mIU/L的患者37例为胰岛素抵抗PCOS Ⅰ组.随机选择胰岛素及糖负荷60 min、120 min血胰岛素正常的PCOS患者37例为对照组PCOSⅡ组.对比两组PCOS患者早卵泡期或闭经状态下各项性激素、卵巢体积、体重指数(body mass index BMI).结果①PCOS Ⅰ组的平均睾酮(testosteroneT)值、雄烯二酮(androstenedione A)值、BMI均显著高于PCOSⅡ组(P＜0.05).②PCOS Ⅰ组中高水平睾酮、特别是高水平雄烯二酮及肥胖患者的构成比显著高于PCOSⅡ组(P＜0.05);而高LH患者则显著低于PCOSⅡ组(P＜0.05).结论在胰岛素抵抗的PCOS患者中,几乎全部伴有雄烯二酮的异常升高,高雄激素血症是其特有的临床特征.胰岛素抵抗并非PCOS共同表现特征,它在一定程度上与体重有一定的依存关系,提示对PCOS伴有肥胖的患者特别要注意胰岛素抵抗的可能.     

多囊卵巢综合征患者子宫内膜不典型增生的药物转化分析

目的:分析多囊卵巢综合征(PCOS)患者子宫内膜不典型增生的药物转化疗效及安全性。方法:回顾性分析17例PCOS子宫内膜不典型增生患者,其中9例曾用孕激素治疗未转化者为A组;8例未曾治疗者为B组,均检测口服葡萄糖耐量试验(OGTT)并同时行胰岛素释放试验,以检测患者是否存在胰岛素抵抗(IR)及高胰岛素血症。17例患者均采用口服避孕药联合二甲双胍治疗。结果:17例PCOS患者均存在IR及高胰岛素血症,经药物治疗3~6个周期后,内膜不典型病变均成功转化。结论:采用口服避孕药联合二甲双胍治疗PCOS合并IR的子宫内膜不典型增生患者是一种临床上实用、有效的治疗方法。     

Comparison of two insulin sensitizers,metformin and myo-inositol,in women with polycystic ovary syndrome (PCOS)

Insulin resistance (IR) plays a pivotal role in PCOS. Insulin-sensitizer agents such as metformin and inositols have been shown to improve the endocrine and metabolic aspects of PCOS. The purpose of this study is to compare their effects on the clinical and metabolic features of the women with PCOS. Fifty PCOS women with IR and/or hyperinsulinemia were randomized to treatment with metformin (1500?mg/day) or myo-inositol (4?g/day). IR was defined as HOMA-IR >2.5, while hyperinsulinemia was defined as a value of AUC for insulin after a glucose load over the cutoff of our laboratory obtained in normal women. The Matsusa Index has been calculated. The women have been evaluated for insulin secretion, BMI, menstrual cycle length, acne and hirsutism, at baseline and after 6 months of therapy. The results obtained in both groups were similar. The insulin sensitivity improved in both treatment groups. The BMI significantly decreased and the menstrual cycle was normalized in about 50% of the women. No significant changes in acne and hirsutism were observed. The two insulin-sensitizers, metformin and myo-inositol, show to be useful in PCOS women in lowering BMI and ameliorating insulin sensitivity, and improving menstrual cycle without significant differences between the two treatments.     

Visceral adiposity index as a predictor of clinical severity and therapeutic outcome of PCOS

Polycystic ovary syndrome (PCOS) is a common endocrine-metabolic disease which often accompany with abnormal fat distribution. Visceral adiposity has association with abnormal lipid metabolic, pro-inflammatory activity, insulin resistance (IR) and hyperandrogenism. Increased visceral adiposity raises the risk of metabolic syndrome, type 2 diabetes and cardiovascular (CV) events, and aggravates ovulatory dysfunction and hyperandrogenism in PCOS women. Visceral adiposity index (VAI), a simple surrogate maker of visceral adipose dysfunction and visceral adiposity, is a predictor of IR, and link hyperinsulinemia, hyperandrogenism and anovulation. This review aims to discuss the visceral adiposity situation in PCOS women, and suggests that VAI may be a useful predictor of clinical severity and therapeutic outcome of PCOS.     

Endocrine-metabolic effects of the treatment with pioglitazone in obese patients with polycystic ovary syndrome.

The hyperandrogenism found in polycystic ovary syndrome (PCOS) can be a consequence of hyperinsulinemia as a result of peripheral insulin resistance. Metformin and insulin sensitizers have become a potential therapeutic tool for treating these patients; however, there are few studies with pioglitazone in PCOS. Elevated luteinizing hormone/follicle-stimulating hormone (LH/FSH) ratios and LH hyper-responsivity to stimulation with gonadotropin-releasing hormone (GnRH) are common findings in PCOS. The reason why hyperinsulinemia produces hyperandrogenism and whether insulin action on the pituitary alters gonadotropin liberation remain unknown. In the present study, we evaluated the effect of pioglitazone (30 mg/day for 2 months) on insulin response to an oral glucose tolerance test (OGTT), serum levels of androgens and sex hormone-binding globulin (SHBG), and pituitary gonadotropin response to GnRH stimulation in 15 obese PCOS women. We found a significant decrease in insulin response to the OGTT and also in total and free testosterone levels, an increase in SHBG and a reduction in the LH response to GnRH stimulation after pioglitazone treatment. In conclusion, this short-term treatment with pioglitazone decreased hyperinsulinemia and hyperandrogenemia in obese PCOS patients, and there was a significant reduction in LH response to GnRH stimulation. Further research should be carried out to establish the risks and benefits of pioglitazone, which would assist in the physiopathologic comprehension of PCOS.     

d-Chiro-inositol and its significance in polycystic ovary syndrome: a systematic review

Background.?The pathogenesis of polycystic ovary syndrome (PCOS) has been linked to the development of insulin resistance and hyperinsulinemia. The objective of this study is to investigate the effects of insulin sensitising agents such as d-chiro-inositol (DCI) on ovulation and insulin resistance in women with PCOS.

Methods.?This was a systematic review done in an Academic Department of Obstetrics and Gynaecology in the UK of all studies published on PCOS and DCI up till May 2010. Patients were women with PCOS receiving DCI or where the relationship between insulin resistance and DCI had been investigated. Ovulation rates and changes in insulin sensitivity were the main outcome measures.

Results.?Less DCI-IPG was released in PCOS women compared to controls and this seems to correlate positively with insulin resistance and hyperinsulinemia evident in these patients. DCI administration had beneficial effects on ovulation, anthropometric and metabolic markers in PCOS women by enhancing insulin. The effects of metformin in improving insulin action in PCOS women was achieved though the release of DCI-IPG mediators.

Conclusions.?Heterogeneity observed in the methodologies of each study, the scarcity of relevant studies and the small sample sizes used prohibit reliable conclusions to be drawn. Therefore, more studies must be conducted in the future to evaluate accurately the effects of DCI in PCOS.     

Insulin resistance,polycystic ovary syndrome,and type 2 diabetes mellitus

Objective: To review the definition and prevalence of two insulin resistance (IR)-associated phenotypes, polycystic ovary syndrome (PCOS) and type 2 diabetes mellitus, as well as the risk and nature of their simultaneous presentation.

Design: Review of published literature.

Result(s): Insulin resistance affects between 10% and 25% of the general population. Two common disorders frequently associated with IR are PCOS, affecting 4% to 6% of reproductive-aged women, and type 2 diabetes mellitus, which is observed in about 2% to 6% of similarly aged women. Overall, about 50% to 70% of women with PCOS and 80% to 100% of patients with type 2 diabetes mellitus have variable degrees of IR. Insulin resistance and its secondary hyperinsulinemia appear to underlie many of the endocrine features of PCOS in a large proportion of such patients. The risk of type 2 diabetes mellitus among PCOS patients is 5- to 10-fold higher than normal. In turn, the risk of PCOS among reproductive-aged type 2 diabetes mellitus patients appears to be similarly increased.

Conclusion(s): It remains to be determined whether PCOS and type 2 diabetes mellitus represent no more than different clinical manifestations of the same IR syndrome, with their phenotypic differences due to the presence or absence of a coincidental genetic defect at the level of the ovary or pancreas, respectively, or representing the result of etiologically different subtypes of IR syndromes.     

抗苗勒管激素与非肥胖型多囊卵巢综合征合并胰岛素抵抗的关系

目的:探究抗苗勒管激素(AMH)与非肥胖型多囊卵巢综合征(PCOS)合并胰岛素抵抗(IR)的关系。方法:研究纳入102例非肥胖型PCOS患者为PCOS组,其中PCOS合并IR组(n=48),单纯PCOS组(n=54),50名非肥胖型健康人作为对照组。比较3组血清AMH水平以及AMH水平与PCOS合并IR的关系。结果:PCOS合并IR组血清AMH水平和HOMA-IR高于单纯PCOS组和对照组,差异有统计学意义(均P0.001)。PCOS组AMH水平与HOMAIR呈正相关(r=0.704,P0.001)。结论:非肥胖型PCOS患者合并IR血清AMH水平升高,AMH水平与PCOS合并IR相关。     

Body weight, hyperinsulinemia, and gonadotropin levels in the polycystic ovarian syndrome: evidence of two distinct populations.

OBJECTIVE: To investigate the impact of body weight (BW) and insulin levels on gonadotropin and androgen levels in women with the polycystic ovarian syndrome (PCOS). DESIGN: Comparative study of endocrinologic parameters in PCOS women. SETTING: University Hospital Reproductive Endocrinology Unit. PATIENTS: Thirty obese and 19 nonobese women with PCOS. Seven obese and 7 nonobese normal women. MAIN OUTCOME MEASURES: Serum concentrations of insulin, testosterone, androstenedione, luteinizing hormone (LH), follicle-stimulating hormone. Serum LH response to gonadotropin-releasing hormone (GnRH) administration and assessment of insulin resistance by the continuous infusion of glucose with model assessment (CIGMA) test. RESULTS: Fasting insulin levels correlated with body mass index (BMI). Basal LH levels correlated inversely with BMI. Nonobese women with PCOS had a higher LH response to GnRH than obese women with PCOS. Only obese women with PCOS showed insulin resistance and fasting hyperinsulinemia. CONCLUSIONS: The data suggest that women with PCOS may be divided into two subgroups: those with obesity, insulin resistance, hyperinsulinemia, and normal/minimally elevated LH levels and those with normal BW, elevated LH levels, and normoinsulinemia.     

多囊卵巢综合征血浆瘦素的改变及相关影响因素的研究

目的探讨多囊卵巢综合征(PCOS)患者血浆瘦素(leptin)水平的变化及其相关影响因素。方法用放射免疫学方法检测63例PCOS患者血浆leptin、血清泌乳素、促黄体生成素、卵泡刺激素、雌二醇、睾酮、雄烯二酮水平,同时行糖耐量及胰岛素释放实验。用相关分析探讨leptin与体重指数(BMI)、性激素、血糖、胰岛素和胰岛素敏感指数的关系。结果PCOS患者空腹胰岛素(r=0.6,P<0.01)和BMI(r=0.351,P<0.01)与血浆瘦素呈显著正相关,且空腹胰岛素对瘦素的影响更显著。结论瘦素可能与PCOS的胰岛素抵抗、高胰岛素血症密切相关。