减重手术对多囊卵巢综合征的治疗作用

多囊卵巢综合征(PCOS)是女性常见的内分泌疾病,PCOS容易合并肥胖和代谢综合征,但其代谢紊乱的危害容易被忽视.减重手术可以有效降低体重,恢复下丘脑-垂体轴正常功能,降低心血管风险、提高妊娠几率,预防或逆转代谢综合征.故减重手术可推荐作为PCOS女性尤其是合并代谢综合征患者的有效治疗手段.     

未发现多囊样卵巢的多囊卵巢综合征的临床特征

选择2004年9月至2006年10月在本中心就诊的多囊卵巢综合征(PCOS)患者876例,根据B超检查分为两组:多囊样卵巢组800例,无多囊样卵巢组76例.结果 发现无多囊样卵巢组多毛评分、睾酬、胆固醇和低密度脂蛋白明显高于多囊样卵巢组,差异有统计学意义.无多囊样卵巢组一级亲属中糖尿病、高血压病史的患病率明显增高.     

多囊卵巢综合征患者代谢综合征患病风险研究

目的 研究多囊卵巢综合征(PCOS)患者代谢综合征(MS)患病率,并探讨MS发生的危险因素.方法 比较348例年轻的PCOS患者及113名非PCOS正常女性的MS及其组分的患病率.结果 PCOS组MS的患病率为27.0%,明显高于正常对照组的10.6%(P<0.01),除甘油三酯外,其他MS组分在PCOS组均高于正常对照组(P<0.05或P<0.01),但校正年龄和体重指数(BMI)后,差异就不存在统计学意义(P=0.737).分层分析也显示PCOS非肥胖组和肥胖组的MS患病率与相应的正常对照组均无明显差异(均P>0.05).多元逐步回归分析显示稳态模型评估的胰岛素抵抗指数(HOMA-IR)和BMI是MS的独立预测因素(均P<0.01).结论 肥胖和胰岛素抵抗是MS的独立危险因素,PCOS单独并不增加MS的发生风险.     

多囊卵巢综合征患者血清瘦素水平测定的意义

为了探讨多囊卵巢综合征(PCOS)患者血清瘦素(Leptin)水平测定的临床意义,选择47例PCOS患者与34例体重相匹配的对照妇女,于卵泡期测定Leptin、体重指数(BMI)、腰围(WC)、腰臀比(WHR)、胰岛素(INS)、内分泌激素,并对其进行相关与回归分析。结果:PCOS组血清Leptin浓度(18.69±8.05)ng/ml,对照组(17.09±10.35)ng/ml,差异无显著性(P>0.05);PCOS组血清INS浓度(12.45±8.07)mU/L,对照组(5.95±1.19)mU/L,差异有显著性(P<0.01)。Leptin与BMI、WC、WHR、INS成正相关。认为PCOS患者血清Leptin水平并不高于对照组,Leptin水平与体脂分布、INS有关,可能间接参与PCOS的病变形成。     

急性冠状动脉综合征与炎症标志物

目的炎症在急性冠状动脉综合征(ACS)形成过程中起关键作用并影响其临床进展,ACS 患者炎症因子水平明显升高,这些炎症标志物对 ACS 的诊断、治疗、预后具有重要的指导意义。     

非酒精性脂肪性肝病和多囊卵巢综合征的关系

非酒精性脂肪性肝病(NAFLD)是一种与胰岛素抵抗(insulin resistance,IR)和遗传易感密切相关的代谢应激性肝脏损伤,其病理学改变与酒精性肝病相似,以肝细胞脂肪变性和脂肪贮存为特征,但患者无过量饮酒史的综合征.疾病谱包括非酒精性单纯性脂肪肝(nonalcoholic simply fatty liver,NAFL)、非酒精性脂肪性肝炎(nonalcoholic steatohepatitis,NASH)及其相关肝硬化和肝细胞癌[1-3].近年来,NAFLD发病率呈上升趋势,成为危害全球公共健康的重要疾病之一.目前我国NAFLD的发病呈现低龄化趋势,上海、广州、香港等发达地区成人NAFLD患病率在15%左右.NAFL患者10～20年肝硬化发生率为0.6%～3.0%,而NASH患者10～15年肝硬化发生率高达15%～25%[4].     

多囊卵巢综合征患者肥胖和高雄激素血症与胰岛素抵抗的相关性

收集多囊卵巢综合征(PCOS)患者101例,招募30名正常健康志愿者。根据血清雄激素水平及稳态模型评估的胰岛素抵抗指数(HOMA-IR)水平分层分析肥胖、高雄激素和胰岛素抵抗的关系。结果显示,101例PCOS患者中39.8％患者体重正常,24.5％超重,35.7％肥胖。将PCOS患者分为正常雄激素组(睾酮＜0.51 μg/L)和高雄激素组(睾酮≥0.51 μg/L),两组体重指数(BMI)、空腹血糖(FPG)、甘油三酯(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)及HOMA-IR均无统计学差异。将PCOS患者分为非胰岛素抵抗组(HOMA-IR＜2.29)和胰岛素抵抗组(HOMA-IR≥2.29),两组血清睾酮水平无统计学差异,胰岛素抵抗组的BMI、FPG、TG、TC、LDL-C明显高于非胰岛素抵抗组(P＜0.05或P＜0.01),HDL-C明显低于非胰岛素抵抗组(P＜0.01)。HOMA-IR与BMI显著相关(P＜0.01),而与血清睾酮水平无显著相关性,提示PCOS患者体重增加与HOMA-IR的相关性独立于血清睾酮水平。     

二甲双胍在多囊卵巢综合征患者妊娠期的应用

二甲双胍通过改善胰岛素抵抗（IR）、降低雄激素水平、调节脂代谢等作用,调节多囊卵巢综合征（PCOS）患者月经周期、促进排卵、减轻体重,从而增加妊娠率,在临床治疗中广泛应用.PCOS患者妊娠后由于IR加重,面临妊娠早期流产、妊娠糖尿病（GDM）、妊娠高血压及子痫前期等不良并发症,二甲双胍能减少PCOS患者妊娠早期流产、延缓GDM的发生,且对胎儿结局及出生后生长发育无明显影响.     

The prevalence of metabolic syndrome in patients with polycystic ovary syndrome: A systematic review and meta-analysis

IntroductionPolycystic ovary syndrome (PCOS) is an endocrinopathy with unknown pathophysiology among women of reproductive age. Several studies have been conducted to determine the prevalence of metabolic syndrome (MetS) among PCOS patients. However, the results were contradictory. The present study was conducted to evaluate the prevalence of MetS in PCOS patients using the related published data.MethodThe present systematic review was perfumed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search was done using MeSH keywords in databases of PubMed, Scopus, Embase, CINAHL, Web of Science, Cochrane Library, EBSCO, and Google scholar search engine as well as the reference list of the retrieved papers without time limit until October 2018. We used Cochran's Q test and I² Index to evaluate the heterogeneity among the studies and the random effects model was used to combine the results. Data analysis was performed using Stata ver. 11.1.ResultsForty six studies including 8946 patients with PCOS were included in the final analysis. Total heterogeneity was high (I²: 91.43%, P < 0.001). The prevalence of MetS in PCOS patients was estimated to be 30% (95%CI: 27–33). Subgroup analysis based on MetS diagnostic criteria showed an estimated prevalence of 0.27% (95%CI: 0.18–0.37), 0.30% (95%CI: 0.27–0.34), 0.32 (95%CI: 0.25–0.39), 0.32 (95%CI: 0.27–0.37) and 0.24 (95%CI: 0.14–0.34) for IDF, NECP-ATPIII, AHA NHLBI, CDS, and unknown criteria, respectively.ConclusionConsidering the prevalence of MetS in PCOS patients, diagnosis of MetS in PCOS patients is necessary to reduce the mortality and morbidity rates.     

超声引导下IMFP技术治疗多囊卵巢综合征无排卵性不孕的临床研究

目的研究超声引导下未成熟卵泡穿刺(IMFP)技术对多囊卵巢综合征(PCOs)无排卵性不孕患者内分泌及基础窦卵泡计数的作用,并观察其在治疗后用人类尿促性腺激素(HMG)促排卵的反应性及妊娠情况.方法对37例PCOs患者用少量HMG后,在超声引导下进行IMFP,检查穿刺后患者的内分泌、卵巢基础窦卵泡计数和诱导排卵反应的变化,并随访其有无妊娠.结果对37例PCOs患者进行88个周期的穿刺治疗,经过2～3次穿刺后,患者睾酮(T0)和促黄体生成素/促卵泡激素(LH/FSH)比值转为正常,其中33例(89.2%)基础窦卵泡计数降到10个/卵巢以下.之后用HMG诱发排卵,在注射绒毛膜促性腺激素(HCG)后都出现排卵,仅1例发生轻度卵巢过度刺激综合征(OHSS).随访6个月,此33例患者均妊娠.结论对PCOs患者用超声引导下IMFP技术可改善其内分泌异常,减少基础窦卵泡计数,使其在促排卵周期中不发生OHSS而妊娠.     

多囊卵巢综合征胰岛素抵抗的发生机制

多囊卵巢综合征（PCOS）是一种发病多因性、临床表现多态性的综合征，以慢性持续的无排卵和高雄激素血症为基本病理生理改变。研究证实胰岛素抵抗（IR）可能是PCOS发生发展的主要因素之一，本文就PCOS-IR发生机制的研究进展作一综述。     

胰高血糖素样肽-1对多囊卵巢综合征的影响

多囊卵巢综合征（PCOS）是女性最常见的内分泌紊乱疾病,发病率为6％～10％.发病机制主要包括胰岛素抵抗、高胰岛素血症、糖耐量减低、肥胖以及慢性炎性反应状态等.胰高血糖素样肽／鄄1（GLP-1）及其受体激动剂通过与GLP-1受体特异性结合而发挥作用,能够改善PCOS患者胰岛素抵抗、降低体重、降低炎性反应因子的表达等,增加患者受孕几率,因此在治疗PCOS中有着广阔的应用前景.     

Review of nonalcoholic fatty liver disease in women with polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in reproductive-aged women. Women with PCOS frequently have metabolic complications including insulin resistance (IR), early diabetes, hypertension and dyslipidemia. Recent studies have demonstrated an association between PCOS and another metabolic complication: nonalcoholic fatty liver disease (NAFLD). NAFLD occurs as a result of abnormal lipid handling by the liver, which sensitizes the liver to injury and inflammation. It can progress to nonalcoholic steatohepatitis (NASH), which is characterized by hepatocyte injury and apoptosis. With time and further inflammation, NASH can progress to cirrhosis. Thus, given the young age at which NAFLD may occur in PCOS, these women may be at significant risk for progressive hepatic injury over the course of their lives. Many potential links between PCOS and NAFLD have been proposed, most notably IR and hyperandrogenemia. Further studies are needed to clarify the association between PCOS and NAFLD. In the interim, clinicians should be aware of this connection and consider screening for NAFLD in PCOS patients who have other metabolic risk factors. The optimal method of screening is unknown. However, measuring alanine aminotransferase and/or obtaining ultrasound on high-risk patients can be considered. First line treatment consists of lifestyle interventions and weight loss, with possible pharmacologic interventions in some cases.     

Prevalence of metabolic syndrome in women with polycystic ovary syndrome and the factors associated: A cross sectional study at a tertiary care center in Hyderabad,south-eastern India

Background and aimsMetabolic syndrome (MetS) and polycystic ovary syndrome (PCOS) are two interrelated but distinct endocrine problems with several health consequences secondary to insulin resistance. This study aimed to determine the prevalence of MetS in women with PCOS.MethodsThis was a cross sectional study carried out from May 2017 to October 2017 at the gynecology outpatient clinic of a tertiary care private hospital in Hyderabad, India. Eligible women diagnosed with PCOS according to Rotterdam criteria were enrolled. The primary outcome was the prevalence of MetS diagnosed by the modified NCEP ATP III criteria.ResultsThe study comprised 382 patients with a mean age of 26.8 ± 5.3 years. MetS was present in 147 (38.5%) women with PCOS. The most frequently observed individual components of MetS were increased waist circumference and decreased HDL cholesterol. When predictors for MetS were analyzed by multivariate regression, BMI (aOR 1.14; 1.06–1.23; p ≪0.001) and age (aOR 1.12; 1.06–1.17; p ≪0.001) were significantly associated with MetS; however, the effect size was modest.ConclusionA high prevalence of MetS was observed in women with PCOS at this tertiary center in Hyderabad, with abdominal obesity and low HDL cholesterol as predominant components. We believe that universal screening of all PCOS women is a reasonable option.     

The association between metabolic syndrome and polycystic ovary syndrome: A systematic review and meta-analysis

BackgroundOne of the most frequently encountered endocrinopathy in women of reproductive age is polycystic ovary syndrome (PCOS). Recent studies have reported varied prevalence of metabolic syndrome (MetS) in women with PCOS. The aim of this study is to determine if the women with PCOS are at a higher risk of MetS.MethodThe present systematic review and meta-analysis was conducted according to the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. To collect articles, we searched online databases of PubMed/Medline, Scopus, Web of Science, Science Direct, Embase, CINAHL, Cochrane Library, EBSCO and Google scholar search engine and the reference list of the retrieved articles using MeSH keywords of “metabolic syndrome”, “woman” and “polycystic ovary syndrome” without time limit until October 2018. Cochran's Q test and I² Index were used to evaluate the heterogeneity among studies and the random effects model was used for combining the results. Data analysis was performed in STATA software version 11.1.ResultFinally, 72 studies involving 10075 PCOS patients with an average age of 26.2 ± 5.01 years were included in the meta-analysis. The heterogeneity rate was high (I² = 76.5%; p < 0.001) and the pooled estimate of the association between MetS and PCOS was significant (OR = 2.57, 95% CI: 2.18–3.02; P < 0.001).ConclusionAccording to the results, there is higher risk of MetS in women with PCOS. Therefore, diagnosis and treatment of MetS in women with PCOS may have a significant impact on this patients health and reduce the rate of mortality and morbidity.     

多囊卵巢综合征相关基因研究进展

多囊卵巢综合征是生育期女性最常见的内分泌紊乱,以无排卵性不孕、高雄激素血症、胰岛素抵抗为特征,与2型糖尿病、血脂异常、心血管疾病、子宫内膜癌相关.国外报道发病率约6.6%,但病因和具体机制还不清楚.目前的观点倾向于多个微效基因与环境因素共同作用引起.其中最为密切的是D19S884,已在3项独立研究中得到证实.其他如钙蛋白酶(CAPN)-10、17α-羟化酶(CYP17)、雄激素受体(AR)、性激素结合球蛋白基因也是潜在的位点.     

Androgen receptor gene CAG(n) trinucleotide repeats polymorphism in Chinese women with polycystic ovary syndrome

Trinucleotide repeats CAG(n) in androgen receptor gene is thought to be a potential site of genetic susceptibility to polycystic ovary syndrome (PCOS). However, previous studies of PCOS have shown variable association of CAG(n )polymorphism with PCOS. In order to evaluate CAG(n )polymorphism in Chinese women with PCOS, we have genotyped CAG(n) repeat numbers in female Chinese subjects (148 PCOS patients and 104 control subjects). The mean CAG(n) repeat lengths of PCOS patients and control subjects were similar (22.88 +/- 1.76 vs. 22.85 +/- 1.60; P = NS). No difference in the mean CAG(n) repeat lengths of hyperandrogenic and nonhyperandrogenic subgroups of PCOS patients was found (22.86 +/- 1.68 vs. 22.91 +/- 1.84; P = NS). Moreover, no difference was found in the term of mean CAG(n) repeat lengths in the nonhyperandrogenic subgroup and the control subjects (22.86 +/- 1.68 vs. 22.85 +/- 1.60; P = NS). However, mean CAG(n) repeat lengths were negatively correlated with serum total cholesterol and low-density lipoprotein-cholesterol concentration in PCOS patients (r = -0.182, P < 0.05 and r = -0.210, P < 0.05, respectively), but not with total testosterone, body mass index, waist and hip circumferences. The CAG(n) repeat length polymorphism may not be a major determinant of PCOS, but it may influence the lipid metabolism of PCOS patients.     

多囊卵巢综合征的诊治进展

多囊卵巢综合征(PCOS)病因不明,与胰岛素抵抗和高胰岛素血症密切相关。因不同人群临床表现存在高度异质性,故PCOS诊断标准尚存在争议,因而PCOS生物标志物成为研究热点。PCOS治疗包括调节生活方式,改善代谢紊乱、高雄激素血症以及生殖异常。本文综述了PCOS发病特点、诊断标准及治疗方式的最新进展。     

多囊卵巢综合征的药物治疗

多囊卵巢综合征是一种涉及多系统的内分泌疾病,常伴有代谢紊乱和心血管疾患.传统的治疗药物包括口服避孕药、促排卵药、抗雄激素药等,新的治疗药物包括双胍类、噻唑烷二酮类、他汀类、芳香化酶抑制剂等.本文就多囊卵巢综合征药物治疗的研究进展作一综述.     

Ovarian morphology and prevalence of polycystic ovary syndrome in Japanese women with type 1 diabetes mellitus

Aims/Introduction

Polycystic ovary syndrome (PCOS) is a heterogeneous disorder including polycystic ovary morphology (PCOM), ovulatory dysfunction and hyperandrogenism. PCOS is frequently associated with type 2 diabetes mellitus; however, it is unknown whether PCOM and PCOS are prevalent in Japanese patients with type 1 diabetes mellitus. The purpose of our study was to determine the frequency of PCOM and PCOS in women with type 1 diabetes mellitus.

Materials and Methods

We evaluated clinical, hormonal and ovarian ultrasound data from 21 type 1 diabetes mellitus patients whose average glycated hemoglobin levels were 7.9 ± 1.5%.

Results

Ultrasound identified PCOM in 11 patients (52.4%) and these patients also had higher levels of the androgen dehydroepiandrosterone sulfate (DHEA‐S) than those without PCOM (P < 0.05). Of the patients with PCOM, five presented menstrual irregularities (45.5%) and three met the Japanese criteria for PCOS (27.2%); whereas all patients without PCOM had a normal menstrual cycle (P < 0.05).

Conclusions

Japanese premenopausal women with type 1 diabetes mellitus had a high frequency of PCOM as well as PCOS. This is the first research of this area carried out in an Asian population.