中心型肥胖对多囊卵巢综合征不孕患者体外受精结局的影响

目的：探讨中心型肥胖对多囊卵巢综合征(PCOS)不孕患者体外受精(IVF)结局的影响。方法：回顾性分析2009-2010年中山大学孙逸仙纪念医院 PCOS不孕患者行IVF治疗的188个新鲜周期,按照是否为中心型肥胖分为腰围≥80 cm组(70个周期)和腰围<80 cm组(118个周期),比较两组基础内分泌代谢和IVF的临床及实验室参数。结果：腰围≥80 cm与腰围<80 cm组相比,体重指数(BMI)、腰臀比增加,血游离雄激素指数(FAI)高,性激素结合球蛋白(SHBG)低,空腹葡萄糖、空腹胰岛素、稳态胰岛素评价指数(HOMA-IR)、2 h口服葡萄糖耐量试验(OGTT2h)葡萄糖及胰岛素高,胰岛素抵抗、空腹血糖受损(IFG)、糖耐量异常(IGT)的发生率高,三酰甘油(TG)高、高密度脂蛋白(HDL)低,差异均有统计学意义(P<0.05)。校正BMI后,腰围与空腹胰岛素、HOMA-IR及FAI呈正相关(P<0.01);促性腺激素(Gn)用量[(2014.8±825.8)U vs.(1491.2±558.9)U ]及天数[(12.5±4.0)d vs.(10.7±3.0)d]增加(P<0.01),峰值雌二醇水平低[(8492.7±4771.2)pmol/L vs.(11918.1±5329.0)pmol/L,P<0.001],诱发卵子成熟的人绒毛膜促性腺激素(HCG)用量多(P=0.011)而成熟卵泡及获卵数少[(11.6±5.7)个vs.(13.8±7.3)个,P<0.05];胚胎种植率降低(24.3% vs.36.3%,P=0.019),早期流产率增加(38.5% vs.7.5%,P=0.002),临床妊娠率差异无统计学意义(40.6% vs.55.2%, P=0.07)。校正年龄及病因,Logistic回归分析显示HOMA-IR是PCOS患者IVF妊娠后早期流产的风险因素(OR=0.143,95%CI=0.026~0.768,P=0.023)。结论：中心型肥胖PCOS患者胰岛素抵抗和高雄激素血症更显著,糖脂代谢紊乱发生率高,负面影响PCOS患者IVF促排卵的反应,且胚胎种植率下降、早期流产率增加。     

不同体重管理方式对超重或肥胖型多囊卵巢综合征体外受精-胚胎移植助孕结局影响研究

目的 探讨不同体重管理方式对超重或肥胖型多囊卵巢综合征(PCOS)患者体外受精-胚胎移植(IVF-ET)助孕结局的影响.方法 选择2017年1月至2018年12月就诊于郑州大学第二附属医院拟行IVF-ET助孕治疗的超重或肥胖(BMI≥25)型PCOS患者254例,随机分为体重管理强化组(膳食干预80例,强化组)、体重管...     

肥胖与多囊卵巢综合征

多囊卵巢综合征(PCOS)临床表现为月经稀发、闭经、肥胖、多毛、不孕。其病理生理特征为长期慢性无排卵、高雄激素血症、胰岛素抵抗和高胰岛素血症。超声检查双侧卵巢为多囊卵巢。具有上述2项代谢紊乱的患者诊断为PCOS。PCOS在育龄妇女的发病率高达5％～10％。目前认为该病不是单一因素所致，而是遗传因素与环境因素共同作用的结果，其确切病因有待于进一步深入研究，PCOS的临床特征之一是肥胖。本文就肥胖与PCOS的相互关系作一阐述。     

降低体重对多囊卵巢综合征治疗的意义

肥胖 (ｏｂｅｓｉｔｙ)是指体内脂肪积聚过多和 (或 )分布异常。是一种多因素慢性代谢疾病。目前认为与遗传、中枢神经系统异常、内分泌功能紊乱、代谢因素和营养不平衡有关。肥胖者多有胰岛素抵抗 ,并且高血压、高血脂、糖尿病、冠心病和某些癌症发病率明显增高 ,相应生活质量下降 ,甚至预期寿命缩短。一般可通过身体外表特征测量值间接反映体内脂肪含量及分布的状况。临床测量肥胖的指标包括体重指数(ＢＭＩ)、腰围 (ＷＣ)和腰臀比 (ＷＨＲ)等。1　检测肥胖的指标[1～ 3 ]体重指数 (ＢＭＩ) :是与体内脂肪总量密切相关的指标。计算方法是…     

孕前超重和肥胖对妊娠结局的影响

目的:探讨孕前超重和肥胖对妊娠结局的影响.方法:收集2010年3月至2012年3月在我院产前检查并分娩的单胎初产妇2600例,根据孕前体重指数(BMI)分为正常组(BMI18.5～24.9 kg/m2)、超重组(BMI 25 ～28.0 kg/m2)和肥胖组(BMI≥28.0 kg/m2),统计学分析孕前超重、孕前肥胖妇女发生不良妊娠结局的风险.结果:2241例研究对象中,超重组523例(20.12％),肥胖组148例(5.69％).超重组和肥胖组增加了妊娠期高血压疾病(RR =3.99,RR=5.87)、妊娠期糖尿病(RR =2.29,RR =4.51)、胎膜早破(RR=1.60,RR =1.88)、剖宫产(RR =1.76,RR =2.67)、产后出血(RR =2.42,RR =3.79)和出生大于胎龄儿(RR=1.56,RR=1.71)的风险,孕前超重降低了小于胎龄儿的出生风险(RR =0.76),孕前超重组和肥胖组早产和胎儿窘迫发生率风险无增加.结论:孕前超重和肥胖发生不良妊娠结局的风险增高,应通过合理营养和运动锻炼将孕前体重控制在正常范围内,以降低不良妊娠结局的发生率.     

妊娠期糖尿病孕妇体重指数变化与围产结局的关系

目的探讨妊娠期糖尿病(GDM)孕妇妊娠前体重指数(BMI)及妊娠期体重指数增幅与围产结局的关系。方法2006年1月至2007年12月间在浙江大学医学院附属妇产科医院产科门诊行常规检查并确诊为GDM的238例患者,按妊娠前体重指数分为正常组(18.5≤BMI<23)、超重组(23≤BMI<25)、肥胖组(BMI≥25),按早孕至终止妊娠前BMI的总增幅,分为A组(BMI总增幅<4),B组(4≤BMI总增幅≤6),C组(BMI总增幅>6),比较分析各组间围产结局的差异。结果肥胖组子痫前期、早产发生率均(26.0%,32.7%)显著高于正常组(11.9%,8.3%)及超重组(10.8%,13.7%),差异均有统计学意义(P<0.05)。正常组孕妇胎儿窘迫发生率(8.3%)显著低于超重组(23.5%)和肥胖组(23.1%),差异有统计学意义(P<0.05)。B组子痫前期(10.4%)、羊水过多(10.4%)、胎膜早破(10.4%)、胎儿窘迫(11.3%)和早产(8.0%)的发生率均明显低于C组(22.2%,23.8%,25.3%,30.2%,30.2%),差异均有统计学意义(P均<0.05)。C组胎膜早破发生率明显高...     

体重超重对多囊卵巢综合征患者内分泌改变的影响

目的:探讨体重超重对多囊卵巢综合征患者的内分泌改变的影响。方法:检测31例体重超重和102例非超重多囊卵巢综合征患者的内分泌激素和胰岛素敏感性。结果:超重组的雄激素和空腹胰岛素水平显著升高(P<0.05,P<0.01),GIR显著下降(P<0.01),HOMAIR明显升高(P<0.01),超重组胰岛素抵抗的发生率明显高于非超重组,BMI与胰岛素敏感性呈负相关。结论:体重超重的PCOS患者高雄激素血症和胰岛素抵抗都更为严重,对超重PCOS患者的治疗应注重于纠正高雄激素血症和胰岛素抵抗状态。     

多囊卵巢综合征和肥胖及其治疗的研究进展

多囊卵巢综合征(PCOS)是一种异质性的内分泌紊乱疾病,在育龄妇女中高发.临床上发现PCOS和肥胖密切相关,PCOS患者中肥胖者居多,而肥胖的PCOS患者与非肥胖患者相比,有更加严重的内分泌代谢紊乱,肥胖在PCOS中可能起一定的病因作用.因此,需要更加重视肥胖PCOS患者的治疗,除常规PCOS的治疗外,肥胖患者还需纠正长期代谢紊乱导致的远期并发症.     

肥胖与青少年多囊卵巢综合征

多囊卵巢综合征（PCOS）是育龄妇女常见生殖内分泌疾病。近年发现,随着儿童肥胖患病率增加,青少年PCOS发病率也逐年提高。肥胖可通过增加外周循环胰岛素水平影响PCOS发病机制,PCOS患者高雄激素血症也会增加内脏脂肪沉积。肥胖会增加与PCOS相关的代谢和心血管方面的并发症的患病风险,如胰岛素抵抗（IR）、高脂血症、高血压以及临床症状不明显的动脉粥样硬化等。早期识别青春期PCOS,有利于及时纠正、阻断其内分泌紊乱,防止近期及远期并发症发生。     

多囊卵巢综合征妊娠患者的产科结局

多囊卵巢综合征（PCOS）是生育期妇女最常见的生殖内分泌疾病,病因至今未明。高雄激素、胰岛素抵抗（IR）及高胰岛素血症是PCOS的病理生理基础。由于PCOS患者特殊的病理生理特点,妊娠后可能会并发流产、妊娠期糖尿病（GDM）、妊娠高血压疾病等合并症。充分认识PCOS患者的妊娠期并发症及新生儿结局．有针对性地预防和治疗母儿并发症,对保障母婴健康有重要意义。     

Associations between maternal BMI as well as glucose tolerance and adverse pregnancy outcomes in women with polycystic ovary syndrome

This retrospective, cohort study examined the association between maternal pre-pregnancy body mass index (BMI), independent of glucose tolerance and adverse pregnancy outcomes in women with polycystic ovary syndrome (PCOS), for which there are few previous studies. Medical records from 2012 to 2015 at Guangzhou Women and Children’s Medical Center, China were reviewed for women previously diagnosed with PCOS with normal 2-h 75-g oral glucose tolerance test (OGTT) results (n?=?1249). The separate and joint effects of maternal BMI and glucose levels on pregnancy outcomes were assessed. Maternal pre-pregnancy BMI was associated with hypertensive disorders of pregnancy (HDP) (OR: 1.22, 95% CI: 1.02–1.45), preterm birth (OR: 1.49, 95% CI: 1.08–2.17), and large for gestational age (LGA) (OR: 1.69, 95% CI: 1.16–2.20). Elevated fasting glucose and maternal pre-pregnancy BMI were jointly associated with increased risks of HDP, preterm birth, and LGA. Therefore, among women with PCOS and normal glucose tolerance, maternal pre-pregnancy BMI is an independent risk factor of adverse pregnancy outcomes.     

Platelet-derived microparticles in overweight/obese women with the polycystic ovary syndrome

A substantial proportion of women with the polycystic ovary syndrome (PCOS) are obese and obesity is considered as a prothrombotic state. Platelet-derived microparticles (PMPs) might be implicated in the activation of the coagulation cascade. We aimed to assess plasma PMPs in overweight/obese women with PCOS. We measured plasma PMPs and determined anthropometric, metabolic, hormonal and ultrasonographic features of PCOS in 67 overweight/obese women with PCOS (with body mass index [BMI] >25.0 kg/m²) and in 21 BMI-matched healthy women. Circulating androgens and markers of insulin resistance (IR) were higher in women with PCOS than in controls. Plasma PMPs were also higher in women with PCOS than in controls (p = 0.046). In women with PCOS, plasma PMPs correlated with the mean number of follicles in the ovaries (r = 0.343; p = 0.006). In controls, plasma PMPs did not correlate with any of the studied parameters. In conclusion, plasma PMPs are elevated in overweight/obese women with PCOS compared with BMI-matched controls. The cause of this increase is unclear but both IR and hyperandrogenemia might be implicated. More studies are required to elucidate the pathogenesis of the elevation of PMPs in PCOS and to assess its implications on the cardiovascular risk of these patients.     

Age- and body mass index-related differences in the prevalence of metabolic syndrome in women with polycystic ovary syndrome

Abstract

Aim: To compare the prevalence of metabolic syndrome (MetS) between women with polycystic ovary syndrome (PCOS) and controls across different age (≤20, 21–30 and 31–39 years old) and body mass index (BMI) (normal weight, overweight and obese) groups.

Methods: We studied 1223 women with PCOS and 277 BMI-matched controls. The prevalence of MetS in women with PCOS and controls was estimated according to four different MetS definitions.

Results: In subjects ≤20 and 21–30 years old, the prevalence of MetS did not differ between women with PCOS and controls regardless of the MetS definition, even though women with PCOS were more obese than controls in the ≤20 years old group. In subjects 31–39 years old, the prevalence of MetS was higher in women with PCOS than in controls but the former were more obese than controls. The prevalence of MetS did not differ significantly between women with PCOS and controls in any of the BMI groups (normal weight, overweight or obese) regardless of the MetS definition.

Conclusion: The prevalence of Mets appears to be primarily determined by obesity and age whereas PCOS per se appears to be a less important contributing factor.     

Morning plasma cortisol is low among obese women with polycystic ovary syndrome

Abstract

Polycystic ovary syndrome (PCOS) is the most common cause for androgen excess in women. It is associated with wide variety of metabolic disorders. The present study assessed morning plasma cortisol in women with PCOS. One hundred and ninety seven cases and 55 controls were enrolled for this study. The mean age of patients and controls were 23?±?5.6 years and 25?±?4.3 years. One hundred twelve (56%) women with PCOS had BMI >25. Serum cortisol levels were significantly higher in lean PCOS women compared to controls (13.4?±?5.1 versus 11.3?±?4.5, p?<?0.01) and over-weight PCOS women group (13.4?±?5.1 versus 9.3?±?3.2, p?<?0.01). There was a trend for less acne and hirsutism with increase in BMI. Morning plasma cortisol was lower among obese women with PCOS. Morning plasma cortisol correlated negatively with BMI in PCOS women with normal glucose tolerance.     

Relationships between circulating leptin concentrations and other hormonal parameters in obese and non-obese women with polycystic ovary syndrome

Aim: To clarify the role of leptin in women with polycystic ovary syndrome (PCOS), we analyzed whether serum leptin levels correlate with other hormonal parameters in obese and non-obese women with PCOS.
Methods: We studied 20 obese (body mass index, BM ≥25 kg/m²) and 20 non-obese (BMI <25 kg/m²) women with PCOS diagnosed by the existence of menstrual disturbance, elevated serum level of luteinizing hormone (LH) with normal follicle-stimulating hormone (FSH) and the characteristic polycystic appearance of the ovaries on transvaginal ultrasound images. Blood samples for LH, FSH, estradiol, testosterone (T), androstenedione (Δ₄) and leptin were obtained, and the relationships between variables were examined by calculating Spearman correlation coefficients.
Results: Mean levels of leptin, T and Δ₄ in obese PCOS women were significantly higher than those in non-obese PCOS women, but this was not the case for BMI, bodyweight and waist to hip ratio. In all the 40 PCOS women considered together, there were significant positive correlations of leptin with BMI, waist to hip ratio, and Δ₄ levels. However, in each group separately, serum leptin levels in obese PCOS women correlated only with BMI and bodyweight, whereas serum leptin levels in non-obese PCOS women correlated with serum A4 levels.
Conclusion: Although further study is needed to assess the role of leptin on ovarian function in non-obese women with PCOS, present findings do not support the fact that leptin is involved in the development of hormonal abnormalities in obese women with PCOS. (Reprod Med Biol 2002; 1 : 49–54)     

Effects of ovarian drilling in middle Black Sea region Turkish women with polycystic ovary syndrome having normal and high body mass indices

AIM: To assess the effectiveness of laparoscopic ovarian drilling (LOD) in women with polycystic ovary syndrome (PCOS) with normal and high body mass indices (BMIs). METHODS: We investigated the effects of LOD process on two different groups of Turkish women with normal (n = 13) and high (n = 12) body mass indices. Three-puncture laparoscopy was performed under general anesthesia. Luteinizing hormone (LH), follicle-stimulating hormone (FSH), dehydroepiandrosterone-sulfate (DHEAS) and total testosterone (total T) levels were measured one menstrual cycle before the operation (in early follicular phase defined as day 3 of the menstrual cycle) and one menstrual cycle after the operation (in early follicular phase defined as day 3 of the menstrual cycle). RESULTS: Ovarian drilling had a positive effect on FSH increase and DHEAS, total testosterone and LH/FSH ratio decrease; but BMI levels had no effect on these hormonal changes, respectively (F = 0.343, P = 0564) (F = 0.790, P = 0383) (F = 0.083, P = 0776) and (F = 0.816, P = 0376). Ovarian drilling had a positive effect on LH decrease and BMIs were effective on this change (F = 6.946, P < 0.05). LH decrease in the group with normal BMI was significantly higher than the obese group with high BMI. Ten of 13 women with normal BMI (76.9%) and eight of 12 women with high BMI (66.6%) started to see regular menses 2 to 3 months after the procedure. CONCLUSION: Ovarian drilling is an effective procedure on PCOS. Women with lower BMI may benefit more from the procedure.     

Effect of orlistat or metformin in overweight and obese polycystic ovary syndrome patients with insulin resistance

The aim of this study was to evaluate the effect of orlistat or metformin combined with Diane-35 on anthropometric, hormonal and metabolic parameters in overweight and obese polycystic ovary syndrome (PCOS) patients with insulin resistance (fasting insulin?>?10?mIU/L). A total of 240 PCOS women were randomly allocated to orlistat plus Diane-35(OD group), metformin plus Diane-35(MD group), orlistat plus metformin plus Diane-35(OMD group) or Diane-35 (D group). Body weight, BMI, waist and hip circumference, blood pressure, endocrine profile, lipid profile and insulin resistance were assessed at baseline and after 3 months. Significant reductions in waist and hip circumference, serum LH, total testosterone and uric acid were observed in all groups compared with baseline. TG and TC significantly decreased in the OD group. Homeostasis model assessment insulin resistance (HOMA-IR) index was reduced in the OD (p?=?.015), MD (p?=?.001) and OMD (p?=?.004) groups. Body weight, BMI, systolic BP and HDL-C significantly changed in the OD and OMD group compared with the D group (p?相似文献