青春期多囊卵巢综合征临床研究

青春期多囊卵巢综合征患者易出现脱发、痤疮、肥胖及毛发生长过度现象,易与青春期生理现象混淆,该症远期可能导致心血管疾病、2型糖尿病、妇科肿瘤、不孕症等并发症的发生,对患者身心健康、社交活动发展造成负面影响。本文就该症的临床研究意义、病因、临床特征及其防治等方面进行初步研究、探讨。     

Hirsutism in women

Hirsutism is excess terminal hair that commonly appears in a male pattern in women. Although hirsutism is generally associated with hyperandrogenemia, one-half of women with mild symptoms have normal androgen levels. The most common cause of hirsutism is polycystic ovary syndrome, accounting for three out of every four cases. Many medications can also cause hirsutism. In patients whose hirsutism is not related to medication use, evaluation is focused on testing for endocrinopathies and neoplasms, such as polycystic ovary syndrome, adrenal hyperplasia, thyroid dysfunction, Cushing syndrome, and androgen-secreting tumors. Symptoms and findings suggestive of neoplasm include rapid onset of symptoms, signs of virilization, and a palpable abdominal or pelvic mass. Patients without these findings who have mild symptoms and normal menses can be treated empirically. For patients with moderate or severe symptoms, an early morning total testosterone level should be obtained, and if moderately elevated, it should be followed by a plasma free testosterone level. A total testosterone level greater than 200 ng per dL (6.94 nmol per L) should prompt evaluation for an androgen-secreting tumor. Further workup is guided by history and physical examination, and may include thyroid function tests, prolactin level, 17-hydroxyprogesterone level, and corticotropin stimulation test. Treatment includes hair removal and pharmacologic measures. Shaving is effective but needs to be repeated often. Evidence for the effectiveness of electrolysis and laser therapy is limited. In patients who are not planning a pregnancy, first-line pharmacologic treatment should include oral contraceptives. Topical agents, such as eflornithine, may also be used. Treatment response should be monitored for at least six months before making adjustments.     

Current perspectives in polycystic ovary syndrome

Polycystic ovary syndrome has been viewed primarily as a gynecologic disorder requiring medical intervention to control irregular bleeding, relieve chronic anovulation, and facilitate pregnancy. A large body of evidence has demonstrated an association between insulin resistance and polycystic ovary syndrome. The former condition has an established link with long-term macrovascular diseases such as type 2 diabetes mellitus, hypertension, and atherosclerotic heart disease, consequences that also are observed in women with polycystic ovary syndrome. In addition, chronic anovulation predisposes women to endometrial hyperplasia and carcinoma. The purpose of this review is to examine the clinical course of this syndrome, which spans adolescence through menopause, and suggest a simple and cost-effective diagnostic evaluation to screen the large numbers of women who may be affected. Therapy, which should be individualized, should incorporate steroid hormones, antiandrogens, and insulin-sensitizing agents. Weight loss by way of reduced carbohydrate intake and gentle exercise is the most important intervention; this step alone can restore menstrual cyclicity and fertility, and provide long-term prevention against diabetes and heart disease. Treatment alternatives should be directed initially toward the most compelling symptom. Longitudinal care is of paramount importance to provide protection from long-term sequelae.     

Nurse-led peer support group: experiences of women with polycystic ovary syndrome

Title.  Nurse-led peer support group: experiences of women with polycystic ovary syndrome.
Aim.  This paper is a report of a study to explore the experiences of women with polycystic ovary syndrome attending a nurse-led support group.
Background.  Polycystic ovary syndrome is a common chronic endocrine disorder associated with high levels of psychological distress. It has been argued that healthcare providers should regularly review the psychological health of women with polycystic ovary syndrome, and that nurses can help women to adjust to the condition by providing education and support. Little is known about the means of providing social support for women with the syndrome, or of any benefits for patients.
Method.  Qualitative interviews were conducted with 13 female patients in 2006. The patients attended a support group at a public hospital in the United Kingdom. The data were analysed using deductive and inductive thematic analysis.
Findings.  The group provided both socio-emotional and informational social support. Participants reported that attending the group helped to reduce isolation, and provided an opportunity for social comparison and accessible and personally relevant information. Participants described the group as having had a major personal impact for them. They reported feeling empowered and direct positive effects on their self-management behaviours.
Conclusion.  Social support appears to be a key factor mediating the psychosocial impact in women with polycystic ovary syndrome. Healthcare providers should consider running such support groups or referring patients to them. Providing social support may alleviate distress and improve self-management.     

Use of metformin in polycystic ovary syndrome.

OBJECTIVE: To review the use of the insulin-sensitizing agent metformin in women with polycystic ovary syndrome (PCOS). DATA SOURCES: Biomedical literature was accessed through MEDLINE (1996-March 2001) and the Iowa Drug Information Service. Key terms included metformin and polycystic ovary syndrome. DATA SYNTHESIS: A number of small clinical studies have examined the use of metformin in the treatment of PCOS. Women treated with metformin demonstrated normalization of endocrine function with minimal adverse effects. CONCLUSIONS: Metformin can be beneficial in normalizing menstrual irregularities and stimulating ovulation in previously anovulatory women. Metformin therapy is well tolerated by the majority of patients and should be considered for use in women with PCOS.     

新疆维吾尔族、汉族育龄妇女多囊卵巢综合征临床特征分析

目的:探讨新疆维吾尔族(维族)、汉族育龄妇女多囊卵巢综合征患者的临床特征.方法:问卷调查新疆部分地区2 867名育龄妇女,对检出的217例(汉族126例、维族91例)多囊卵巢综合征患者与同期166名正常妇女(对照组)比较其临床特征及激素水平.结果:(1)多囊卵巢综合征总体以及维族、汉族发生率分别为7.569%,8.675%,6.931%,以≤35岁育龄妇女多见.(2)与对照组相比多囊卵巢综合征组肥胖、多毛、痤疮及黑棘皮症的发生均高于对照组(P<0.05),体质量指数、腰臀比高于对照组(P<0.05).(3)多囊卵巢综合征组及对照组组内比较,维族高雄激素表现较汉族多见(P<0.05),尤其是多毛评分.(4)多囊卵巢综合征组肥胖患者的雌二醇、黄体生成素、黄体生成素/促卵泡素、睾酮、游离雄激素指数较非肥胖者高(P<0.05),而性激素结合球蛋白、胰岛素敏感指数、低密度脂蛋白低于非肥胖患者(P<0.05).结论:≤35岁育龄妇女是多囊卵巢综合征的主要群体;且维族在高雄激素、多毛方面表现较汉族突出,可能与种族差异有关;育龄期多囊卵巢综合征肥胖患者存在糖代谢和脂肪代谢方面的改变,应重视其胰岛素抵抗及肥胖对疾病发生、发展的影响.     

Insulin resistance syndrome, pre-diabetes, and the prevention of type 2 diabetes mellitus

Insulin resistance syndrome (IRS), also known as the metabolic syndrome, is now well recognized as a distinct pathological and clinical entity, with multiple significant ramifications for both the high-risk individual as well as the public health system. The primary contributory cause is obesity. Common manifestations associated with IRS may include atherosclerotic heart disease, hypertension, impaired glucose tolerance, dyslipidemia, polycystic ovary syndrome, and hypercoagulability. This review will present the features associated with the disorder, the accepted clinical diagnosis, available and potential treatment modalities, and ongoing or completed trials which suggest that progression from IRS to type 2 diabetes mellitus and early coronary heart disease may be prevented in adolescents and adults.     

Treatment of metabolic syndrome

The metabolic syndrome is intended to identify patients who have increased risk of diabetes and/or a cardiac event due to the deleterious effects of weight gain, sedentary lifestyle, and/or an atherogenic diet. The National Cholesterol Education Program’s Adult Treatment Panel III definition uses easily measured clinical findings of increased abdominal circumference, elevated triglycerides, low high-density lipoprotein-cholesterol, elevated fasting blood glucose and/or elevated blood pressure. Three of these five are required for diagnosis. The authors also note that other definitions of metabolic syndrome focus more on insulin resistance and its key role in this syndrome. This review focuses on how treatment might affect each of the five components. Abdominal obesity can be treated with a variety of lower calorie diets along with regular exercise. Indeed, all of the five components of the metabolic syndrome are improved by even modest amounts of weight loss achieved with diet and exercise. For those with impaired fasting glucose tolerance, there is good evidence that a high fiber, low saturated fat diet with increased daily exercise can reduce the incidence of diabetes by almost 60%. Of note, subjects who exercise the most, gain the most benefit. Metformin has also been shown to be helpful in these subjects. Thiazolidinedione drugs may prove useful, but further studies are needed. Although intensified therapeutic lifestyle change will help the abnormal lipid profile, some patients may require drug therapy. This review also discusses the use of statins, fibrates, and niacin. Likewise, while hypertension in the metabolic syndrome benefits from therapeutic lifestyle change, physicians should also consider angiotensin converting enzyme inhibitor drugs or angiotensin receptor blockers, due to their effects on preventing complications of diabetes, such as progression of diabetic nephropathy and due to their effects on regression of left ventricular hypertrophy. Aspirin should be considered in those with at least a 10% risk of a coronary event over 10 years. Finally, three related conditions, nonalcoholic fatty liver disease, polycystic ovary syndrome and protease inhibitor associated lipodystrophy improve with therapeutic lifestyle change. Although metformin is shown to be useful with polycystic ovary syndrome, the data supporting drug therapy for the other syndromes is less convincing. More robust studies are needed before any firm recommendations can be made.     

Treatment of metabolic syndrome

The metabolic syndrome is intended to identify patients who have increased risk of diabetes and/or a cardiac event due to the deleterious effects of weight gain, sedentary lifestyle, and/or an atherogenic diet. The National Cholesterol Education Program's Adult Treatment Panel III definition uses easily measured clinical findings of increased abdominal circumference, elevated triglycerides, low high-density lipoprotein-cholesterol, elevated fasting blood glucose and/or elevated blood pressure. Three of these five are required for diagnosis. The authors also note that other definitions of metabolic syndrome focus more on insulin resistance and its key role in this syndrome. This review focuses on how treatment might affect each of the five components. Abdominal obesity can be treated with a variety of lower calorie diets along with regular exercise. Indeed, all of the five components of the metabolic syndrome are improved by even modest amounts of weight loss achieved with diet and exercise. For those with impaired fasting glucose tolerance, there is good evidence that a high fiber, low saturated fat diet with increased daily exercise can reduce the incidence of diabetes by almost 60%. Of note, subjects who exercise the most, gain the most benefit. Metformin has also been shown to be helpful in these subjects. Thiazolidinedione drugs may prove useful, but further studies are needed. Although intensified therapeutic lifestyle change will help the abnormal lipid profile, some patients may require drug therapy. This review also discusses the use of statins, fibrates, and niacin. Likewise, while hypertension in the metabolic syndrome benefits from therapeutic lifestyle change, physicians should also consider angiotensin converting enzyme inhibitor drugs or angiotensin receptor blockers, due to their effects on preventing complications of diabetes, such as progression of diabetic nephropathy and due to their effects on regression of left ventricular hypertrophy. Aspirin should be considered in those with at least a 10% risk of a coronary event over 10 years. Finally, three related conditions, nonalcoholic fatty liver disease, polycystic ovary syndrome and protease inhibitor associated lipodystrophy improve with therapeutic lifestyle change. Although metformin is shown to be useful with polycystic ovary syndrome, the data supporting drug therapy for the other syndromes is less convincing. More robust studies are needed before any firm recommendations can be made.     

Polycystic ovary syndrome: it's not just infertility

Recent diagnostic and pharmacologic developments have focused renewed attention on polycystic ovary syndrome. Clinical features of the syndrome include anovulation, hyperandrogenism and menstrual dysfunction, but several other abnormalities, including hyperinsulinemia, luteinizing hormone hypersecretion, elevated testosterone levels and acyclic estrogen production, have been documented. Accompanying obesity and lipid abnormalities compound the risk of developing diabetes mellitus or cardiovascular disease, and chronic anovulation increases the risk for endometrial cancer. A careful history and physical examination should guide diagnostic testing. Slowly progressive hyperandrogenic symptoms with anovulation of peripubertal onset often represent polycystic ovary syndrome. Treatment goals include symptom management and the identification and prevention of potential cardiovascular risks. Treatment should take into account the patient's desire for fertility. Advances in transvaginal ultrasonography and infertility treatments, including newer medications, have facilitated assisted reproduction in patients with polycystic ovary syndrome. Ongoing pharmacologic research focusing on the treatment of insulin resistance appears promising in reversing the longterm complications of the syndrome.     

Hirsutism in women. Effective therapy that is safe for long-term use

Hirsutism should be considered part of the androgen-excess syndrome unless another cause (e.g., masculinizing tumor, androgenic-drug use) can be established. Medical evaluation for transient or late-onset androgen excess, polycystic ovary syndrome, and insulin resistance is important because of the risks associated with chronic androgen excess. Treatment of insulin resistance with antiandrogen and/or insulin-lowering therapy can reduce ovarian testosterone levels and hirsutism. Simple laboratory evaluation (i.e., measuring total and free testosterone, DHEAS, and androstenedione) identifies about half of patients with hyperandrogenism. More extensive evaluation and testing are required in the remaining half. Combination therapies, specifically oral contraceptives along with antiandrogen agents, are the most effective. Studies suggest that addition of low-dose GnRH agonist therapy prolongs remission of hirsutism. Most methods produce improvement within 6 months, with continued improvement at 12 months. Successful treatment results in finer hair, decreased rate of growth, decreased need for cosmetic camouflage or removal, and improved appearance. All methods, whether used continuously or intermittently, should be considered long term.     

Insulin gene polymorphism and premature male pattern baldness in the general population.

Insulin is found in hair follicles and may play a role in the regulation of androgen metabolism and the hair growth cycle, which are relevant to the loss of scalp hair known as male pattern baldness. An excess of dihydrotestosterone on balding scalp indicates that the condition is androgen dependent. Premature male pattern baldness may be the male phenotype of familial polycystic ovary syndrome, a condition characterized by high levels of androgens and insulin that has been linked to insulin gene polymorphism. Therefore, we studied possible associations between relevant insulin gene polymorphisms and premature male pattern baldness in the general community. We examined the distribution of three dimorphic restriction fragment length polymorphisms: HphI, PstI and FokI in cases consisting of 56 men aged 18-30 years with significant baldness, and in 107 control men aged 50 years or more with no indication of baldness. No significant differences between cases and controls in allele, genotype or haplotype frequencies were identified. We conclude that, in the general population, the insulin gene is not associated with premature male pattern baldness.     

Ultrasound criteria in the diagnosis of polycystic ovary syndrome (PCOS)

Not all women with the polycystic ovary syndrome (PCOS) on ultrasound (US) will have the syndrome, and clinical and biochemical features of PCOS may be present without US features. The sensitivity of US in detecting PCOS was, therefore, prospectively determined in 72 women (32 PCOS and 40 controls). The most sensitive features were the presence of 10 or more follicles (82% and 69% in the left and right ovary) and a peripheral distribution of follicles (81.8% and 71.9% in the left and right ovary). Although ovarian enlargement and stromal brightness were not as sensitive as the previous criteria, stromal brightness was most specific. Combining all the criteria predicted a diagnosis of PCOS or control correctly in 86.4% of cases. This study shows that established US criteria of polycystic ovaries remain of value in the diagnosis of PCOS; however, the discrepancy between the left and right ovaries is an interesting but unexplained finding.     

多囊卵巢综合征生酮饮食治疗临床路径

多囊卵巢综合征(PCOs)是常见的妇科内分泌疾病,以高雄激素表现、持续无排卵、卵巢多囊样改变为特征,易导致育龄妇女不孕.PCOS病因尚不清楚,肥胖等代谢相关性疾病与PCOS关系密切.生活方式干预是PCOS的首选基础治疗,减重是有效的治疗措施.与传统饮食相比,生酮饮食能够较快降低体质量.基于《生酮饮食干预多囊卵巢综合征中...     

Plasma thiols and androgen levels in polycystic ovary syndrome.

Homocysteine is a risk factor for ischemic heart disease; similarly as is hyperlipidemia or insulin resistance, which frequently occur in women with polycystic ovary syndrome. We examined the relationships between thiols and hormonal status or insulin resistance in 40 women (aged 25.8 +/- 7 years) with polycystic ovary syndrome and in 11 controls (33 +/- 5 years). Blood levels of homocysteine, glutathione, total and high density lipoprotein (HDL)-cholesterol, triglycerides, insulin, sex hormone-binding globulin, testosterone, androstenedione, dehydroepiandrosterone sulfate, and estradiol were determined. Student's t test and Spearman correlations were computed after adjustment for body mass index (BMI) and age. Homocysteine was significantly higher in polycystic ovary syndrome patients than in the control group (10.3 +/- 2.87 vs. 8.78 +/- 2.75 micromol/l; p < 0.05). In women with polycystic ovary syndrome, there were significant positive correlations between homocysteine and androstenedione (r = 0.329; p < 0.05) and glutathione and dehydroepiandrosterone sulfate (DHEA-S) (r = 0.469; p < 0.05). We conclude that homocysteine is increased in women with polycystic ovary syndrome and is probably linked to androgen levels but not to markers of insulin resistance or with lipid metabolism.     

Understanding the causes and management of hirsutism

Female hirsutism is an embarrassing condition that threatens both a woman's perception of her femininity and her self-esteem. There are various causes of excessive facial hair in women, the most common being polycystic ovary syndrome. Periods of hormonal flux such as pregnancy and the menopause can exacerbate the condition.     

论多囊卵巢综合征患者高雄激素血症的发生机制

多囊卵巢综合征(polycystic ovary syndrome,PCOS)是年轻妇女最常见的内分泌疾病,也是引起妇女体内雄激素过多的常见原因,发生率约占生育年龄妇女的5%~10%,其临床表现和生化特征多样化,主要是由于雄激素过多引起的一系列严重内分泌、代谢、生殖和心血管系统紊乱症状。众所周知,高雄激素血症是PCOS的主要生化特征,且PCOS患者雄激素的发生机制复杂,正确认识并防治高雄激素血症成为治疗PCOS的关键。下面就PCOS雄激素的形成机制有关研究进行综述。     

2013年内分泌代谢领域进展

2013年内分泌代谢领域发展迅速,主要进展包括一系列临床指南、专家共识以及大型临床研究、新的治疗理念.本研究主要介绍了糖尿病(DM)方面的重要进展,另外还包括甲状腺、高尿酸血症、肢端肥大症、骨质疏松以及多囊卵巢综合征方面的进展,希望会对以后的临床工作有所帮助.     

Polycystic ovary syndrome: it is always bilateral?

OBJECTIVE: To evaluate whether patients with unilateral polycystic ovary showed different ovarian and uterine blood flow from those with bilateral polycystic ovaries, and to investigate whether there was a correlation between the ultrasonographic aspect and different hormonal parameters. DESIGN: An observational study. SUBJECTS: Sixteen patients with unilateral polycystic ovary and twenty patients with bilateral polycystic ovaries underwent clinical, biochemical, gray-scale and color Doppler ultrasonographic evaluation. METHODS: The following parameters were evaluated: hormonal (luteinizing hormone (LH), follicle stimulating hormone (FSH), LH/FSH concentration ratio, estradiol, prolactin, androstenedione, testosterone), clinical (body mass index, Ferriman-Gallwey score), ultrasonographic (ovarian volume, number and distribution of subcapsular follicles, stromal score) and Doppler (uterine artery and intraparenchymal vessel pulsatility index, ovarian stromal vascularization), in oligomenorrheic patients in the early follicular phase (cycle days 3-5) or in amenorrheic patients at random. RESULTS: Significantly higher androstenedione plasma levels and LH/FSH concentration ratios were observed in bilateral polycystic ovaries. In unilateral polycystic ovaries, gray-scale and color Doppler ultrasonography showed different features in the affected and the unaffected ovary, similar to the appearance of a polycystic and normal ovary, respectively. CONCLUSION: Polycystic ovary syndrome does not predetermine a single ultrasonographic and Doppler pattern.     

Effect of yoga on polycystic ovarian syndrome: A systematic review

Polycystic Ovarian Syndrome (PCOS) is not a disease but a mere syndrome. Many researchers have studied polycystic ovarian syndrome and found that there is no proper cause of that, it may occur due to hormonal imbalance or stress, or due to a sedentary lifestyle. The rate of polycystic ovarian syndrome in Indian women has been increasing rapidly. The symptoms include acne, weight gain, hirsutism, difficulties in fertility, irregular or infrequent periods, immature ovarian eggs that do not ovulate, multiple cysts in the ovary. If left untreated, it may become the cause for heart diseases, diabetes, hypertension, infertility, and even cancer. There are varieties of medical treatments available to treat polycystic ovarian syndrome but they have a temporary effect and if taken for a long time then it may lead to serious side effects. Yoga has proven effects in reducing and managing the symptoms of polycystic ovarian syndrome more effectively along with medicine. This review work has been designed to consider the available literature concerning the effectiveness of yoga in the management of the polycystic ovarian syndrome. It includes some research papers published between 2012 and 2019. By providing yogic treatment effect on several parameters (such as blood lipid level, glucose metabolism, endocrine parameters, quality of life, resting cardiovascular parameters, level of anxiety, depression) on the woman with polycystic ovarian syndrome were measured. After thoroughly studying about 74 research papers, 16 are found most relevant to be reviewed. The studies of these papers concluded the successful use of different yogic limbs for the management of polycystic ovarian syndrome with or without medications.