多囊卵巢综合征患者血清瘦素和胰岛素检测的临床意义

目的:检测多囊卵巢综合征(polycystic ovary syndrome, PCOS)患者血清瘦素(leptin)及胰岛素(insulin)含量,以探讨leptin与PCOS的关系.方法:采用放射免疫分析检测34例PCOS患者及30例健康对照组血清中的leptin和insulin浓度.结果:PCOS患者血清中的leptin及insulin含量均高于健康对照组,且有高度显著性差异(P＜0.01);同时,PCOS患者中的肥胖组与非肥胖组相比二者也有高度显著性差异(P＜0.01),肥胖组高于非肥胖组.结论:血清leptin和insulin与PCOS可能有较好的相关性,提示血清leptin含量可作为PCOS患者的一项辅助诊断指标.     

多囊卵巢综合征患者血清IGF-1水平与胰岛素抵抗

目的探讨血清胰岛素样生长因子1(IGF-1)、胰岛素敏感指数(ISI)与多囊卵巢综合征(PCOS)的关系。方法采集90例PCOS患者和41例正常对照组血清,应用电化学发光法检测胰岛素水平,葡萄糖氧化酶终点法检测空腹葡萄糖(FPG)水平,酶联免疫吸附试验(ELISA)检测IGF-1水平。结果 1.PCOS患者FPG、血清胰岛素、IGF-1水平明显高于正常对照组(t=16.72,2.24,4.51;P<0.01),且均与患者是否肥胖高度相关(t=5.08,2.07,3.30;P<0.01);2.PCOS患者胰岛素敏感性明显低于对照组,差别有显著性意义(t=3.12,P<0.05);3.PCOS患者血清IGF-1的含量与胰岛素敏感指数呈显著负相关,差别有显著性意义(r=-0.57,P<0.05);对照组血清IGF-1含量与胰岛素敏感指数无明显相关性(r=0.14,P>0.05)。结论多囊卵巢综合征患者存在不同程度的胰岛素抵抗(IR),IGF-1水平增高与PCOS患者发生IR有关,IGF-1可能与PCOS发生、发展有一定的内在联系并起协同作用。     

瘦素与多囊卵巢综合征的相关分析

目的探讨血清中瘦素（Leptin）水平与多囊卵巢综合征（PCOS）的关系。方法采用免疫化学发光法检测68例PCOS患者和32例正常妇女血清中的廋素、性激素水平,同时进行糖耐量及胰岛素释放试验。结果 PCOS组血清瘦素水平明显高于对照组（P〈0.05）;PCOS组与对照组相比,除E2水平无显著性差异（P〈0.05）外,其余各项LH、T、PRL、FSH、A4差异显著（P〈0.05）;PCOS组中非肥胖与肥胖组间,除了T、A4差异显著（P〈0.05）外,其余指标差异均无统计学意义（P〈0.05）;PCOS组中瘦素与FINS（r=0.726,P〈0.01）、IR（r=0.631,P〈0.01）、AUC（r=0.518,P〈0.01）、ISI（r=0.663,P〈0.05）均呈正相关关系。结论瘦素可能参与PCOS的发生、发展,并与胰岛素抵抗、高胰岛素血症密切相关。     

多囊卵巢综合征患者性激素水平与胰岛素抵抗相关性分析

目的探讨多囊卵巢综合征(PCOS)的病因、发病机理及寻找最佳的治疗方案提供依据。方法通过放射免疫(RIA)法测患者胰岛素释放试验,酶法测糖耐量试验,电化学发光免疫分析(ECLIA)法测血清LH、FSH、E2、P、T水平。结果表明28.2%患者有胰岛素抵抗(IR),13.1%有IR和糖耐量受损,5.5%糖耐量受损。单纯IR患者中,肥胖者占35.7%;单纯糖耐量受损者中,肥胖者占36.3%;IR伴糖耐量受损者中,肥胖者占34.6%;肥胖组LH、LH/FSH、E2、T水平与非肥胖组之间无显著性差异(P0.05);而肥胖组与非肥胖的空腹血糖及空腹胰岛素水平有显著性差异(P0.05);肥胖者与非肥胖者月经周期及卵泡数目两指标有显著性差异(P0.05)。结论有较多PCOS患者存在IR或糖耐量受损;在IR和糖耐量受损的患者中,肥胖者占有较高的比重,肥胖可促进IR形成;肥胖可加重IR和生殖功能障碍。     

多囊卵巢综合征胰岛素抵抗相关基因研究

多囊卵巢综合征（PCOS）是常见的影响育龄期妇女的内分泌紊乱性疾病,临床表现各异,相关基因的研究显示可能为关键基因与环境作用所致,胰岛素抵抗是PCOS的重要病理生理变化,并与PCOS的代谢综合征密切相关,PCOS胰岛素抵抗相关基因是目前的基因研究重点。     

多囊卵巢综合征的胰岛素抵抗及与脂代谢的关联

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,占生育期妇女的5％～10％。由于PCOS临床表现的异质性,其诊断标准和定义仍存在争议。目前应用较广泛的是2003年鹿特丹诊断标准,即只要符合以下3项中的任意两项：①稀发排卵和／或无排卵;②有高雄激素血症的临床表现和／或生化改变;     

胰岛素抵抗对多囊卵巢综合征促排卵及妊娠结局的影响

目的探讨多囊卵巢综合征（PCOS）伴胰岛素抵抗（IR）以及高胰岛素血症对促排卵效果及妊娠结局的影响。方法将130例PCOS、伴/不伴有胰岛素抵抗的患者分为A、B两组,A组为非IR者或IR经治疗好转者;B组为IR未使用胰岛素增敏剂治疗者。比较两组患者体重、体重指数（BMI）的差异以及促排卵治疗后排卵率、妊娠率、流产率的差异。结果A组患者体重、BMI均低于B组,差异有显著性（P〈0.05）;A组患者排卵率,妊娠率高于B组患者,流产率低于B组患者,差异有显著性（P〈0.05）。结论改善PCOS患者的IR,降低体重,能增强患者对促排卵药物的敏感性,提高排卵率及妊娠率,降低流产率。     

卵巢局部IGF-I系统与多囊卵巢综合征胰岛素抵抗的相关性研究

目的：研究卵巢局部胰岛素样生长因子-I系统（IGF-I系统）在伴有胰岛素抵抗多囊卵巢综合征中的作用机制。方法选择30例合并胰岛素抵抗的PCOS（polycystic ovary syndrome）患者为试验组,30例患有卵巢良性肿瘤需手术探查的患者为对照组。检测并对比血清、小卵泡液中IGF-I、胰岛素样生长因子结合球蛋白-1（IGFBP-1）与各项性激素,FI,2hI,ISI,QUICK I,卵巢超声指标,研究其与各种指标间的相关性。结果试验组小卵泡液IGF-I高于对照组（P〈0.01）,小卵泡液及血清IGFBP-1低于对照组（P〈0.05,P〈0.01）。试验组小卵泡液IGF-I水平高于血清（P〈0.01）,小卵泡液IGFBP-1水平低于血清（P〈0.05）。试验组小卵泡液IGF-I与T0、E2及卵巢体积（OV）,卵巢总面积（TA）,卵泡数（FN）,空腹胰岛素（FI）,服糖后2h胰岛素（2hI）呈正相关（P〈0.05）;血清IGF-I与胰岛素敏感指数（ISI）,体重指数（BMI）,腰臀比（WHR）呈正相关（P〈0.05）,与定量胰岛素敏感指数（QUICK I）呈负相关（P〈0.05）;试验组小卵泡液及血清IGFBP-1与FI,2hI呈负相关（P〈0.05）。结论 IR可能通过影响卵巢局部IGF-I系统,刺激卵巢分泌雄激素,引发排卵障碍,在PCOS的发病机制中起到重要作用。     

关于72例多囊卵巢综合征患者临床资料和胰岛素抵抗相关临床指标的观察分析

目的：分析多囊卵巢综合征(polycystic ovarian syndrome,PCOS)女性的临床特征与胰岛素抵抗(insulin resistance,IR)临床指标的关系。方法：选取2013年1月至2015年3月于本院内分泌科治疗的PCOS患者72例患者作为研究对象并根据是否合并有胰岛素抵抗分为两个亚组;同时,按随机表选取同期就诊于本院健康体检中心的55名育龄期女性作为对照组,收集比较各组一般临床资料、激素及生化指标、血糖及胰岛素,计算胰岛素抵抗、胰岛β细胞功能参数。结果：研究组较对照组BMI、SBP、血脂指标(TC、TG)、血尿酸(serum uric acid,SUA)显著升高,两组年龄、DBP相比差异无统计学意义(P>0.05);研究组IR发生率高于对照组(P<0.05);研究组非IR亚组患者激素水平与对照组相比,研究组血清促卵泡激素(follicle-stimulating hormone,FSH)、促黄体生成素(luteotropic hormone,LH)、睾酮(T)、雌二醇(E2)升高,LH/FSH比值增大,而研究组内两亚组比较,各项指标均无统计学意义(P>0.05);研究组中两亚组IR参数比较,合并有IR亚组的患者HOMA-IR、FPG/FINS较非IR亚组升高,差异有统计学意义(P<0.05),而HOMA-IAI、ISI comp、FPG/FINS较非IR亚组显著降低(P<0.05),SG/SI比值两亚组比较差异无统计学意义(P>0.05);两亚组胰岛β细胞功能参数比较,合并IR亚组患者HOMA-IS较非IR亚组降低,结果有统计学意义(P<0.05),两组ΔI30/ΔG30及DI值比较未见统计学差异(P>0.05)。结论：PCOS患者中胰岛素抵抗发生率高于正常人群,胰岛素抵抗通过多种途径提高了机体患多囊卵巢综合征的可能性,同时增加了患者发生糖脂代谢及内分泌紊乱的风险,对于患有PCOS的患者是否合并有胰岛素抵抗,对性激素水平干扰无差别。     

Prediction models for insulin resistance in the polycystic ovary syndrome

Women with the polycystic ovary syndrome (PCOS) have a high prevalence of insulin resistance, with consequent increased risk of metabolic diseases later in life. An early metabolic screening would therefore be of clinical relevance. By using stepwise regression analysis on several variables obtained in 72 women with PCOS, we constructed simple and reliable mathematical models predicting insulin sensitivity, as measured by the euglycaemic hyperinsulinaemic clamp. The normal ranges of insulin sensitivity were calculated from 81 non-hirsute, normally menstruating women with normal ovaries, and similar body mass index (BMI) and age as the women with PCOS. Measured variables included BMI, waist and hip circumferences, truncal-abdominal skin folds, circulating concentrations of gonadotrophins, androgens, sex hormone-binding globulin (SHBG), triglycerides, total cholesterol and cholesterol subfractions, fasting insulin, C-peptide and free fatty acids. The three best prediction models included waist circumference, together with insulin (model I: R(2) = 0.77), serum triglycerides (model II: R(2) = 0.65), and the subscapularis skin fold (model III: R(2) = 0. 64). Using reference limits for insulin sensitivity obtained in the 81 normal pre-menopausal women, the models identify insulin resistant women with PCOS. These simple and inexpensive models are potentially useful in clinical practice as an early screening in women with PCOS.     

复方环丙孕酮联合胰岛素增敏剂对非肥胖多囊卵巢综合征伴有胰岛素抵抗患者治疗效果的观察

目的探讨比较单独应用复方环丙孕酮（CPA）与CPA联合胰岛素增敏剂治疗非肥胖多囊卵巢综合征（P-COS）伴有胰岛素抵抗患者治疗效果的差异,以及二甲双胍和罗格列酮两种胰岛素增敏剂对于上述患者治疗效果的差异。方法68例非肥胖PCOS合并胰岛素抵抗（IR）患者随机分成3组,A组26例,单独应用CPA3个周期;B组23例。应用CPA＋MTE治疗3个周期;C组19例,应用CPA＋罗格列酮治疗3个周期。采取自身对照及组间对照法,比较用药前后血清胰岛素水平、IR指数、体重指数（BMI）、性激素等指标的差异。结果3组病人治疗后T及LH／FSH均较治疗前明显降低,B组、C组病人空腹胰岛素,IR指数等显著改善,B组、C组之间上述指标无显著差异。结论非肥胖型PCOS伴有IR患者应用胰岛素增敏剂,可以明显改善内分泌、代谢紊乱,二甲双胍与罗格列酮比较无显著差异。     

Glucose intolerance, insulin resistance and cardiovascular risk factors in first degree relatives of women with polycystic ovary syndrome

BACKGROUND: The aim of the present study was to evaluate insulin resistance (IR), glucose tolerance status and cardiovascular risk factors in first degree relatives of patients with polycystic ovary syndrome (PCOS). METHODS: A total of 120 family members [Mothers(PCOS) (n = 40), Fathers(PCOS) (n = 38), Sisters(PCOS) (n = 25) and Brothers(PCOS) (n = 17)] of 55 patients with PCOS and 75 unrelated healthy control subjects without a family history of diabetes or PCOS (four age- and weight-matched subgroups, i.e. Control(Mothers), Control(Fathers), Control(Sisters) and Control(Brothers)) were studied. IR was assessed by homeostatic model assessment (HOMA IR), log HOMA, insulin sensivity index (ISI), the quantitative insulin sensitivity check index (QUICKI) and area under the curve for insulin during the oral glucose tolerance test (AUCI, AUCG) in with normal glucose tolerance (NGT) subjects and controls. Serum adiponectin, resistin, homocysteine and lipid levels were measured. RESULTS: The prevalence of any degree of glucose intolerance was 40% in Mothers(PCOS) and 52% in Fathers(PCOS). In total, six (15%) glucose tolerance disorders were identified in the Control(Mothers) and Control(Fathers) in first degree relatives of control subjects. The first degree relatives of PCOS patients had significantly higher serum fasting insulin, HOMA-IR, Log HOMA and AUCI levels in all subgroups than the control subjects. The control subjects had significantly elevated QUCKI, ISI levels and serum adiponectin levels compared to the first degree relatives of PCOS subjects in all subgroups. The serum Hcy and resistin levels increased significantly in both Fathers(PCOS) and Mothers(PCOS) groups but not Brothers(PCOS) and Sister(PCOS). CONCLUSION: The results of the present study support the finding that the first degree relatives of PCOS patients carry an increased risk of cardiovascular disease, as do PCOS patients.     

Serum and adipocyte resistin in polycystic ovary syndrome with insulin resistance

BACKGROUND: The aim of this study was to investigate the relationship between resistin and insulin resistance in patients with polycystic ovary syndrome (PCOS). METHODS: We compared serum resistin levels in 17 PCOS women and 10 lean, healthy, age-matched non-PCOS women and also compared levels of insulin receptor (IR), phosphatidylinositol-3 kinase (PI3-kinase), glucose transporter 4 (GLUT4) protein and resistin mRNA in adipocytes isolated from the omental adipose tissue of five of the PCOS patients and five age- and weight-matched, non-PCOS controls, to look for local defects in insulin action in PCOS. RESULTS: The PCOS group was hyperinsulinaemic and displayed an impaired insulin response in a 75 g oral glucose tolerance test and an abnormal homeostasis model insulin resistance index. Serum resistin levels were similar in PCOS patients and controls; however, resistin mRNA levels were 2-fold higher in adipocytes from PCOS patients. No correlation was found between serum resistin levels and either the BMI or testosterone levels. Western blot analysis showed that adipocyte levels of insulin receptor, PI3-kinase, and GLUT4 were respectively decreased by 56, 39.4 and 54% in PCOS patients compared with controls. CONCLUSIONS: These results suggest that overexpression of the resistin gene in adipocytes may be a local determinant factor in the pathogenesis of PCOS.     

多囊卵巢综合征合并胰岛素抵抗对体外受精-胚胎移植临床结局的影响

目的分析多囊卵巢综合征(PCOS)患者进行体外受精-胚胎移植(IVF-ET)时,胰岛素抵抗与临床结局的关系。方法选择PCOS患者181例为实验组(A组),将合并胰岛素抵抗的分为A1组,不合并胰岛素抵抗的分为A2组;月经周期规则且无胰岛素抵抗的输卵管性不孕(均为双侧输卵管梗阻)患者138例作为对照组(B组)。三组患者均采用经典长方案进行体外受精-胚胎移植(IVF-ET),比较各组间年龄、体重指数、AMH、性激素水平、Gn天数、Gn用量、HCG日内膜厚度、HCG日E2值、HCG日P值、获卵数、优质胚胎数、ET数、妊娠率、着床率、流产率与PCOS胰岛素抵抗的关系。结果三组间基本情况、Gn天数、HCG日内膜厚度、HCG日E2、HCG日P值优质胚胎个数、HCG日内膜厚度、ET个数差异无统计学意义(P>0.05);B组与A组比较妊娠率、着床率、流产率差异无统计学意义(P>0.05),但妊娠率、着床率呈递减趋势,流产率呈增高趋势;A1组与A2组妊娠率、着床率、流产率差异无统计学意义(P>0.05),A1组与B组比较妊娠率,着床率减低,差异有统计学意义(P<0.05),两组流产率差异无统计学意义(P>0.05),但呈增高趋势。结论PCOS人群IVF-ET的临床结局偏差,合并胰岛素抵抗成为降低辅助生殖助孕结局的重要影响因素。     

小檗碱联合达英-35治疗多囊卵巢综合征的疗效观察

目的观察小檗碱（BBR）联合达英-35（CPA）对多囊卵巢综合征（PCOS）合并胰岛素抵抗（IR）患者治疗效果。方法将89例PCOS合并IR的不孕症患者随机分成3组,连续用药3个月经周期。采取自身对照及组间对照的方法比较用药前后临床表现、糖代谢和性激素等指标的变化。结果 3组患者经过治疗后体重、BMI、总睾酮较治疗前明显降低;小檗碱组患者空腹血清胰岛素水平、空腹血糖、IR指数、腰臀比、T、LH等指标与二甲双胍组组比较有统计学意义（P〈0.05）。结论 PCOS合并IR的患者应用BBR或MET均可明显改善内分泌代谢紊乱。在改善糖代谢方面,二者效果相当,但在改善中心性肥胖和高雄等方面,BBR更具优势。     

Serum visfatin in relation to insulin resistance and markers of hyperandrogenism in lean and obese women with polycystic ovary syndrome

BACKGROUND: Visfatin, a protein secreted by adipose tissue, is suggested to play a role in pathogenesis of insulin resistance. In polycystic ovary syndrome (PCOS), insulin resistance might be involved in the development of endocrine and metabolic abnormalities. The aim of the study was to asses the relation between serum visfatin concentration and insulin sensitivity and markers of hyperandrogenism in lean and obese PCOS patients. METHODS: The study group consisted of 70 women with PCOS (23 lean and 47 obese) and 45 healthy women (25 lean and 20 obese). Euglycemic hyperinsulinemic clamp and the measurements of serum visfatin, sex hormones were performed. RESULTS: The PCOS group had lower insulin sensitivity (P=0.00049) and higher serum visfatin (P=0.047) in comparison to the control group. The decrease in insulin sensitivity was present in both the lean (P=0.019) and obese (P=0.0077) PCOS subjects, whereas increase in serum visfatin was observed only in lean PCOS subjects (P=0.012). In the whole group, serum visfatin was negatively correlated with insulin sensitivity (r=-0.27, P=0.004). This relationship was also observed in the subgroup of lean (r=-0.30, P=0.038), but not obese women. Additionally, in lean women, visfatin was associated with serum testosterone (r=0.47, P=0.002) and free androgen index (r=0.48, P=0.002), independently of other potential confounding factors. CONCLUSIONS: Visfatin is associated with insulin resistance and markers of hyperandrogenism in lean PCOS patients.     

Leptin, polycystic ovaries and polycystic ovary syndrome.

As soon as leptin was discovered four years ago, its potential as a player in the polycystic ovary syndrome (PCOS) was explored in a primitive way, though little light was shed on the enigma that is PCOS. As a second wave of leptin research is now available, we review how the expanded role of the cytokine in reproduction might yet impact upon our understanding of PCOS.