Premature ovarian failure

Premature ovarian failure is characterized by secondary oligomenorrhoea or amenorrhoea and serum follicle stimulating hormone (FSH) levels above 40 IU/l before or at the age of 40. The incidence is 1:1000 below age 30 and 1:100 below age 40. In the majority of cases a cause can not be identified. The chance to conceive spontaneously after premature ovarian failure is estimated at 5-10%. There is no treatment available to restore ovarian function and increase the pregnancy rate. In vitro fertilisation using oocyte donation is the only successful fertility treatment option. Climacteric symptoms can be treated with hormone replacement therapy. In the absence of symptoms and when bone mineral density is normal there is no need for hormone replacement therapy. In the near future cryopreservation of ovarian tissue will offer some hope to women at risk to develop premature ovarian failure, e.g. women from families with familial premature ovarian failure and women scheduled to undergo chemotherapy or radiotherapy at a young age.     

Premature ovarian insufficiency. Analysis of 30 cases

Premature menopause is a relatively rare disease but it has delicate consequences dominated by infertility problems. Most often, etiologic investigation is disappointing. Helped in some cases by the association to some auto-immune diseases or a previous treatment with chemotherapy or an irradiation may be useful to understand the origin of the premature ovarian failure. We analyse in this paper 30 cases of premature menopause to try to precise its etiologic factors, its diagnosis tools, the fertility prognostic and the therapeutic possibilities     

自身免疫性卵巢早衰

卵巢早衰的病因复杂 ,自身免疫是其中一个较重要的因素。该文从卵巢早衰与自身免疫性内分泌疾病的关系、卵巢早衰患者体内存在多种自身抗体及免疫异常、卵巢早衰的卵巢组织学表现等几个角度 ,分析了近年来有关自身免疫性卵巢早衰的研究以及相应的实验方法 ,证明自身免疫异常在卵巢早衰的发生发展中起到重要的作用。     

Chromosomally competent ovarian failure at adolescence

Three female adolescents are presented with delayed or incomplete secondary sexual development due to primary ovarian failure. All three patients had normal blood leukocyte and ovarian tissue karyotypes. The importance of performing a diagnostic laparoscopy with ovarian biopsy in the setting of chromosome competent ovarian failure (CCOF) is emphasized.     

卵巢功能衰退185例患者就诊症状分析

目的：对不同年龄段卵巢功能衰退患者的就诊症状及相关因素进行分析,以更好指导临床工作。方法选取2011年7月至2012年8月就诊于山西医科大学第一医院妇产科门诊,诊断为卵巢功能衰退患者共185例,其中卵巢早衰32例（包括卵巢早衰6例,过渡期卵巢衰竭26例）,围绝经期42例,绝经后111例。对患者的一般状况及就诊症状问诊并行绝经症状评分,整理数据资料进行组间比较及影响因素的统计学分析。结果就诊症状卵巢早衰组月经紊乱占第1位（81．3％）;围绝经期组与绝经后组潮热出汗占第1位（71．4％、55．9％）;组间比较,月经紊乱、潮热出汗、失眠、骨关节肌肉痛、心悸差异有统计学意义（χ2值分别为108．130、33．697、11．079、17．600、9．871,均P＜0．05）。绝经症状与年龄、文化程度有相关性（相关系数分别为0．420、0．549,均P＜0．05）。结论主要就诊症状卵巢早衰组为月经紊乱,围绝经期及绝经后组为潮热出汗;绝经后组骨关节肌肉痛发生率高于围绝经期,而卵巢早衰组无此症状;绝经症状随年龄增加而加重,文化程度越低绝经症状越重。     

卵巢早衰的临床诊治

卵巢早衰(premature ovarian failure,POF)导致40岁以前的妇女出现闭经、不孕、潮热多汗、性欲低下为主要特征的围绝经期症状,是一种较为严重的威胁生殖能力的疾病,严重影响了患者的身心健康和生活质量。POF的诊疗规范尚需完善,宗旨是早发现、早治疗,评估患者的卵巢储备功能,制定合理的、个体化雌孕激素替代治疗(hormone replacement therapy,HRT)方案。面对POF患者应采取积极的医疗行为-心理指导-社会生活综合治疗,提供科学的预防措施,并对其进行按期随访和关爱。     

Identification of premature ovarian failure patients with underlying autoimmunity

Although known causes of premature ovarian failure (POF) include X chromosome deletions, radiation and chemotherapy, and genetic defects of the gonadotropin hormones or receptors, at least one third to one half of cases remain idiopathic. A significant proportion of patients with apparently idiopathic POF have some evidence for an autoimmune etiology. However, the only gold standard for detecting autoimmune causes of immune ovarian destruction has been invasive ovarian biopsy. Serum antibodies to ovarian and other self-tissue have been described in up to one third of women with POF, but the tests are not well standardized, not well correlated with ovarian histology, and highly variable. Recently, specific defects of expression of cell surface markers on peripheral blood lymphocytes have been shown to identify, in population-based studies, individuals destined to develop autoimmune pancreatic destruction and type I diabetes mellitus, even before any other evidence of autoimmunity. We, therefore, sought to test the ability of cell surface marker expression in women with POF to identify autoimmune defects. Seventeen women with POF, 11 of whom had positive antibody titers to ovary, thyroid, or antinuclear antibody, were studied on at least two occasions and compared in blinded fashion with normal controls and patients with autoimmune type I diabetes mellitus. The most useful marker for identifying autoimmunity was the surface density of conformationally correct HLA class I molecules on macrophages, a structure essential for T cell education. Using this marker, 7 of the 9 patients with autoantibodies and 3 of the 8 patients without autoantibodies were identified as having evidence of a defect in self-antigen presentation similar to that of type I diabetics (chi-square, p = 0.03). Subsequent testing identified antismooth muscle antibodies in 1 of the women with a defect of HLA class I molecules but no previously identified autoimmunity. In addition, there were increased numbers of CD8 T cells in both autoimmune POF and insulin-dependent diabetes mellitus (IDDM) patients. Exclusive to POF patients was a statistically significant increase in CD8 density on T cells. This was most prominent in POF patients with an underlying autoimmune etiology. These data further support a role for autoimmunity in POF patients and suggest that the further development of cell surface markers in combination with other diagnostic tests could result in diagnosis before the development of complete ovarian failure. The possibility for disease-specific therapy to prevent further autoimmune ovarian damage in selected POF patients is also envisioned.     

干细胞治疗卵巢早衰研究进展

早发性卵巢功能不全（premature ovarian insufficiency,POI）也被称为卵巢早衰,作为女性不孕症的主要原因之一,受到广泛关注,主要表现为低雌激素水平和高促性腺激素水平。POI的病因及机制复杂,目前无统一定论,在治疗上也主要采用补充雌激素等综合治疗。随着干细胞研究的深入,干细胞治疗POI成为新...     

曲普瑞林对化疗药物引起卵巢损伤的预防作用

目的:探讨化疗对卵巢的损害和促性腺激素激动剂(GnRHa)曲普瑞林对化疗中卵巢的保护作用及机制。方法:选用2～3月龄、体重(250±10)g的SD雌性大鼠40只,随机分为正常对照组、顺铂(DDP)组、GnRHa组及GnRHa+DDP组,比较用药后4组大鼠卵巢、子宫湿重和形态学变化,采用放射免疫法测大鼠血清雌二醇(E2)、卵泡生成素(FSH)水平,免疫组织化学方法检测4组大鼠卵巢中Bcl-2、Caspase-3的表达。结果:DDP组与对照组比较大鼠体重明显减轻(P<0.05),卵巢、子宫重量明显下降(P<0.05);光镜下DDP组各期卵泡总数显著减少,GnRHa使生长卵泡数、成熟卵泡数减少,初级卵泡数及总卵泡数增加。GnRHa+DDP组可见GnRHa能明显改善化疗药物对卵巢的损害,保存了大部分初级卵泡且总卵泡数增加。结论:GnRHa的先期预防性应用对化疗所致的大鼠卵巢损伤有一定的保护作用。     

A rare case of ovarian carcinoid causing heart failure

Carcinoid tumours are rare tumours of the neuro-endocrine system. They most commonly present in the gut; however, they can present in other organs. In all, 0.3% of carcinoid tumours are ovarian in origin. Subsequently, very few cases of ovarian carcinoid affecting the heart have been reported and this case adds to the literature on this. There are very few reports in the literature of ovarian carcinoid and even fewer on cardiac failure due to carcinoid. Generally, carcinoid heart disease only affects the right-sided valves, sparing the mitral and aortic valves. We present the case of a patient who had an ovarian carcinoid tumour excised successfully and had been asymptomatic for 14 years prior to an incidental finding of right valvular signs on echocardiography, before subsequently right heart failure deemed to be secondary to ovarian carcinoid heart disease. The diagnosis is generally made on the findings of right-sided heart failure and the valvular abnormalities on echocardiogram (isolated pulmonary and tricuspid involvement). If the tumour is present at the same time as the development of heart failure, cardiac function can improve with timely tumour resection; however, cardiac disease can occur despite tumour removal.     

50例卵巢早衰临床分析

目的 探讨卵巢早衰发生的相关因素,为卵巢早衰的预防提供重要依据.方法 对50例卵巢早衰患者和50例正常绝经妇女从病史、生活习惯、性格、哺乳时间、环境因素等方面进行对照分析.结果 50例卵巢早衰患者中,月经初潮年龄≤13岁的发生率为68%,有家族遗传史的为18%,哺乳时间≤6个月的为48%,夜间11点以后入睡的为52%,性格内向的为70%,接触有毒物质的为42%,均比对照组高.经统计学分析、卡方检验,差异有统计学意义（P＜0.05）.结论 （1）哺乳喂养可预防卵巢早衰.（2）良好的生活习惯、健康的心态、开朗的性格以及少接触有毒物质对预防卵巢早衰具有重要的临床意义.     

卵巢早衰免疫因素的相关研究

目的:探讨卵巢早衰患者抗核抗体,HLA-DR+细胞水平及定位,分析免疫因素在致病中的意义。方法:应用免疫学实验技术,流式细胞术及免疫双荧光法检测100例卵巢早衰患者,60例低促性腺激素性闭经患者,60例自然绝经妇女,60例正常育龄妇女的抗核抗体、抗双链DNA抗体、ENA多肽抗体系列、CD3+、HLA-DR+、CD3+HLA-DR+细胞水平。结果:①染色体核型正常的卵巢早衰患者抗核抗体阳性率为26.53%(26/98),染色体核型异常的卵巢早衰患者抗核抗体均为阴性。染色体核型正常的卵巢早衰患者抗核抗体阳性率均明显高于低促性腺激素组、自然绝经组、育龄组(P<0.05),未发现有明显的特殊核抗原成分;13例ANA阳性POF患者经治疗后ANA转为阴性;②卵巢早衰患者外周血HLA-DR抗原表达增加,CD3+HLA-DR+(活化T细胞)增加,与自然绝经组和育龄组比较,差异均有显著意义(P=0.001,P=0.003);6例POF患者经激素替代后CD3+HLA-DR+水平未见明显降低。结论:部分染色体核型正常的卵巢早衰患者机体存在免疫系统异常状态,免疫因素可能是染色体核型正常的卵巢早衰患者的致病原因。     

Preservation of ovarian function and minimizing premature ovarian failure during chemotherapy using gonadotropin-releasing hormone analogs

Evaluation of: Del Mastro L, Boni L, Michelotti A et al. Effect of the gonadotropin-releasing hormone analogue triptorelin on the occurrence of chemotherapy-induced early menopause in premenopausal women with breast cancer: a randomized trial. JAMA 306(3), 269-276 (2011). This study is a randomized, open-label, Phase III trial, conducted in 16 Italian centers that enrolled 281 patients between 2003 and 2008. The recruited patients were prospectively and randomly allocated to either chemotherapy alone or combined with monthly triptorelin gonadotropin-releasing hormone analog, started before chemotherapy and repeated every month throughout chemotherapy. The clinical and tumor characteristics of the patients in the control or treatment groups were similar. A total of 12 months after ending chemotherapy, the premature ovarian failure rate was 25.9% in the chemotherapy-alone group versus 8.9% in the chemotherapy and gonadotropin-releasing hormone analog group, an absolute difference of -17% (95% CI: -26 to -7.9%; p < 0.001). The odds ratio for treatment-induced premature ovarian failure was 0.28 (95% CI: 0.14-0.59; p < 0.001). The authors concluded that use of gonadotropin-releasing hormone analog chemotherapy in premenopausal breast cancer patients can significantly reduce the occurrence of chemotherapy-induced early menopause.     

补肾养血法治疗卵巢早衰的临床效果分析

目的探讨中医药治疗卵巢早衰的临床疗效,寻求治疗该病的新方法。方法选择2010年9月—2014年9月收治的卵巢早衰患者32例作为研究对象,给予补肾养血汤治疗,1剂/d,早晚分服,3个月为1个疗程。观察患者临床疗效并比较治疗前后患者E2、FSH、LH水平变化情况。计量资料采用配对t检验,P0.05为差异有统计学意义。结果治疗后,患者血清E2水平为(128.00±31.40)pmol/L,明显高于治疗前的(48.60±19.10)pmol/L,FSH、LH水平分别为(48.70±25.70)、(17.90±3.40)U/L,显著低于治疗前的(66.50±18.20)、(46.30±12.80)U/L,差异均有统计学意义(均P0.05)。补肾养血汤治疗卵巢早衰总有效率为71.88%。结论补肾养血汤治疗卵巢早衰能显著改善患者临床症状及血清FSH、LH、E2水平,从根本上调整患者内分泌功能,提高体内雌激素水平,恢复卵巢功能,无明显不良反应,是治疗卵巢早衰的安全、有效方法。     

预防卵巢早衰关键靠自已

有人曾比喻女性拥有两座花园:表象花园——脸,秘密花园——卵巢。卵巢是女性重要的生殖器官,它起到维持内分泌系统平衡,保持女性特征及正常生理代谢的作用。卵巢与女性的青春密切相关,因为雌激素促进女性附件器官的生长发育,同时又使女性保持第二性征特点。因此,保持青春焕发,女性们呵护好自己的卵巢显得尤为重要。     

卵巢早衰动物模型的研究进展

卵巢早衰是由多种病因所致的卵巢功能衰竭,病理生理表现较复杂,卵巢早衰的病因迄今尚不清楚.以往认为染色体突变、卵泡刺激素和促黄体生成激素及其受体变异、代谢异常或药物作用、放射损伤和病毒感染、免疫性因素等可能是卵巢早衰的原因.由于卵巢早衰的病因尚不清楚,目前仍无非常理想的卵巢早衰动物模型.在长期的临床治疗过程中发现,化疗、放疗都会引起卵巢功能衰竭,故而,现在的卵巢早衰模型多是以这两种方法制造的.此外还有免疫型、手术型、药物型卵巢早衰动物模型出现.该文将近年国内外学者根据卵巢早衰的基本病因建立的较成熟动物模型作以综述.     

中医药剂治疗卵巢早衰的临床观察

卵巢早衰是指妇女在40岁以前绝经者.临床上患者表现为闭经、不孕,兼有面色潮红、烘热汗出、情绪波动、白带减少、性欲低下、阴部干燥,生殖器及第二性征逐渐退化的类更年期症状.     

卵巢早衰30例临床分析

目的:探讨卵巢功能早衰早期诊断的方法和治疗措施。方法:30例患者填写危险因素调查问卷,并于卵泡期、黄体期进行内分泌激素测定,检查B超,根据结果应用激素替代治疗。结果:30例有一定的危险因素暴露史,其卵泡刺激素(FSH)、黄体生成素(LH)上升明显,施加干预治疗后欲行经的患者均能正常行经,部分甚至受孕。结论:在卵巢衰竭典型症状出现之前,根据辅助检查可早期诊断卵巢早衰,早期治疗可提高妇女生活质量。