多囊卵巢综合征胰岛素抵抗与瘦素关系的探讨

目的　探讨多囊卵巢综合征 (PCOS)妇女血清瘦素 (leptin)水平与胰岛素抵抗 (IR)的关系 ,为研究PCOS的发病机制和治疗新途径提供理论依据。方法　 5 1例PCOS患者及 2 3例正常妇女均测定体重指数(BMI)、腰臀比 (WHR)、血清生殖激素及leptin水平 ,同期行口服糖耐量 (OGTT)及胰岛素 (Ins)释放试验 ,OGTT示IR者给予二甲双胍 (1 5 g/d)治疗 3个月后复测上述指标。 结果　PCOS患者血清leptin水平高于相应对照组 ,且IR组显著高于NIR组 ;PCOS患者经二甲双胍治疗后血清Ins水平显著下降 ,胰岛素敏感指数 (ISI)显著上升 ,同时leptin水平下降。相关分析表明 ,PCOS患者血清leptin与BMI、WHR及T显著正相关 ,与ISI负相关 (r=0 6 7,P <0 0 1) ,多元回归显示leptin中有BMI、ISI引入。结论　PCOS患者血清leptin水平升高与胰岛素敏感性相关 ;二甲双胍治疗PCOS患者可提高其胰岛素敏感性 ,降低血清leptin水平。     

Prognostic factors for ovulatory response with clomiphene citrate in polycystic ovary syndrome

OBJECTIVE: To evaluate prospectively the prognostic factors for ovulatory responses following clomiphene citrate (CC) administration in polycystic ovary syndrome (PCOS). STUDY DESIGN: Fifty-nine infertile patients with a diagnosis of PCOS were recruited. Ovulation was induced using 100 mg/day CC administered daily from days 5 to 9 of the cycle. Endocrine and metabolic parameters between responder and non-responder groups were analyzed. RESULTS: For a 75-g fasting glucose load (75-g OGTT), blood glucose levels at 60 and 120 min, the area under the curve (AUC) and blood insulin levels at 120 min in the non-responder group (n=25) were significantly higher than those in the responder group (n=34), although the measurements of fasting blood glucose and insulin were not significantly different between the two groups. In the receiver operating characteristic curves, the most appropriate cutoff point was 120 mg/dl for the blood glucose level at 120 min and 9000 for the blood glucose x insulin level at 120 min. There were no significant differences in the clinical characteristics or in the endocrine and metabolic parameters between conceived (n=9) and non-conceived groups (n=21). CONCLUSION: The levels of blood glucose and blood glucose x insulin at 120 min after 75-g OGTT could be good biochemical markers of CC resistance in PCOS. No predictors of conception following CC therapy were identified by this study.     

Metabolic and endocrine effects of metformin and metformin plus cyclic medroxyprogesterone acetate in women with polycystic ovary syndrome

Objective

To evaluate the metabolic and endocrine effects of treatment with cyclic medroxyprogesterone acetate (MPA) plus metformin compared with metformin alone in women with PCOS.

Methods

In this prospective randomized study of women with PCOS, 20 women received 850 mg of metformin twice a day, and 20 women received 850 mg of metformin plus 5 mg of MPA twice a day. Body mass index, hormonal and lipid blood profiles, homocysteine blood level, and insulin sensitivities assessed by homeostasis model assessment (HOMA) were recorded at baseline and at 3 months.

Results

Total cholesterol levels decreased in the metformin plus MPA group (P = 0.002) but did not change significantly in the metformin group (P = 0.159). While homocysteine levels remained unchanged in the metformin plus MPA group, they increased significantly in the metformin group (P = 0.002).

Conclusion

There were no adverse effects of short-term cyclic MPA plus metformin treatment on metabolic parameters or insulin resistance in patients with PCOS over a 3-month treatment period.     

Effect of metformin on the clinical and metabolic assessment of women with polycystic ovary syndrome

A longitudinal prospective study was conducted in 21 women with polycistic ovary syndrome (PCOS), aged 27.20?±?5.02 years and treated with metformin (1500?mg/day) for 8 weeks. The patients were assessed for spontaneous menstruation, weight, body mass index (BMI), waist circumference, waist/hip ratio (WHR), glucose and insulin concentrations under fasting conditions and after a 75-g glucose tolerance test, lipid profile, testosterone, androstenedione, dehydroepiandrosterone sulfate, sex-hormone binding globulin (SHBG), and insulin-like growth factor (IGF)-I. Spontaneous menstruation was observed in 81% of the women treated with metformin, with no changes in weight or BMI. Waist measurement and the WHR were reduced. The quantitative insulin sensitivity check index (QUICKI) improved from 0.33?±?0.03 to 0.35?±?0.04 (p?<?0.005), and serum total cholesterol and low-density lipoprotein-cholesterol were reduced, while high-density lipoprotein-cholesterol was increased. Serum testosterone concentrations were also reduced. There were no differences in serum triglycerides, SHBG or IGF-I. The occurrence of spontaneous menstruation and changes in the pattern of body fat distribution, the reduction in serum testosterone concentrations, the improvement in lipid profile and the reduction of insulinemia with the use of metformin permit us to conclude that treatment with this drug is of benefit to women with PCOS.     

二甲双胍治疗耐克罗米芬的多囊卵巢综合征40例分析

目的：观察二甲双胍单用或联合高纯度卵泡刺激素（metrodin-HP即FSH－HP）治疗耐克罗米芬（CC)多囊卵巢综合征（PCOS）患者的疗效。方法：选择耐CC的PCOS患者40例，随机分成A组和B组。A组：20例患者从卵泡早期开始服二甲双胍，每天1500mg共12周，若未孕则加FSH－HP促排卵1个周期，B组；20例患者单独用FSH－HP促排卵1个周期。测定所有患者的性激素、空腹血糖（FG）及空腹胰岛素（FINS）。结果：服二甲双胍后，LH、T及FINS的水平明显下降（P＜0．05），A组有7例患者排卵且3例妊娠，妊娠率为15．0％，17例未孕者继续服二甲双胍联合FSH－HP促排卵，15例排卵和4例妊娠，妊娠率23．5％，B组单用FSH－HP促排卵，有14例排卵且3例妊娠，妊娠率15．0％，两者的妊娠率差异无显著性意义（P＞0．05）。A组的FSH－HP用量少于B组，差异有显著性意义（P＜0．05），中度以上OHSS发生率分别为0和10％，前者的发生率低于后者（P＜0．05）。结论：单用二甲双胍能使部分患者恢复排卵和妊娠。FSH－HP联合二甲双胍能减少FSH－HP的用量和OHSS的发生。二甲双胍单用或联合FSH－HP促排卵为耐CC的PCOS患者找到一种有效的治疗方法。     

Metformin versus laparoscopic ovarian drilling in clomiphene- and insulin-resistant women with polycystic ovary syndrome

Objective

To compare the hormonal-metabolic profiles and reproductive outcomes in clomiphene-resistant patients with polycystic ovary syndrome and insulin resistance between women receiving metformin and those undergoing laparoscopic ovarian drilling.

Methods

A total of 110 eligible participants were randomly allocated to diagnostic laparoscopy plus metformin therapy (group 1, n = 55) or laparoscopic ovarian drilling (group 2, n = 55). The t test was used for mean comparisons of hormonal-metabolic parameters and OGTT values before and after treatment. The χ² test was used for comparisons of ovulation, pregnancy, and abortion rates.

Results

Groups 1 and 2 showed a significant decline in testosterone, insulin-like growth factor-1 (P < 0.001 vs P < 0.001), and luteinizing hormone (P < 0.05 vs P < 0.001), while the glucose to insulin ratio was significantly increased (P < 0.001 vs P < 0.05) compared with baseline. Group 2 patients had more regular cycles and higher rates of ovulation and pregnancy compared with group 1: 76.4% [42/55] vs 58.2% [32/55], P < 0.04; 50.8% [131/258] vs 33.5% [94/281], P < 0.001; and 38.2% [21/55] vs 20.0% [11/55], P < 0.03, respectively. The difference in the early abortion rate between the groups was not statistically significant.

Conclusion

Although metformin results in a better attenuation of insulin resistance, laparoscopic ovarian drilling is associated with higher rates of ovulation and pregnancy.     

糖尿病家族青春期多囊卵巢综合征胰岛素抵抗的临床特征和治疗

目的:探讨糖尿病(DM)家族青春期多囊卵巢综合征(PCOS)胰岛素抵抗(IR)的程度及应用二甲双胍治疗的效果。方法:选择父亲或母亲被确诊患DM的7例青春期PCOS患者为实验组,以无DM家族史的28例青春期PCOS患者为对照组。测体重指数(BM I)、基础体温(BBT),抽血测FSH、LH、PRL、T、E2、P,行75g葡萄糖耐量试验(OGTT)和胰岛素释放试验(IRT)。计算空腹血糖胰岛素比率(FGIR)、糖负荷120m in血糖胰岛素比率(G120/I120)及稳态模型的胰岛素抵抗指数(HOMA-IR)。确诊IR患者进行包括二甲双胍在内的综合治疗,每3月重复检测1次上述指标。结果:实验组7例均超重(BM I≥25),其比率明显高于对照组(7/7vs12/28,P<0.01);实验组IR患病率亦明显高于对照组(7/7vs 9/21,P<0.01),且IR程度明显高于对照组IR患者(HOMA-IR为14.35vs 6.02,P<0.01)。两组接受二甲双胍综合治疗的IR患者治疗6月后空腹胰岛素(I0)比治疗前明显降低(32.47vs 40.36,P<0.05),胰岛素敏感性(IS)明显提高(FGIR为3.42 vs2.99,P<0.05),T降低,并有3例卵巢恢复排卵。结论:DM家族青春期PCOS患者可能存在较重IR,坚持二甲双胍综合治疗可减轻IR程度并恢复卵巢排卵功能。     

The effect of metformin treatment on ovarian stromal blood flow in women with polycystic ovary syndrome

Objective  To evaluate the effects of metformin on the ovarian stromal blood perfusion in the patients with polycystic ovary syndrome (PCOS). Methods  Twenty-five women with PCOS who underwent a Doppler examination of the ovarian stroma was evaluated; hormonal, anthropometric, and biochemical parameters of patients were determined. After the patients were treated with 850 mg metformin twice a day for 6 months, the same parameters were evaluated in the same patients. Results  After metformin treatment, although pulsatility index (PI) was increased from 1.80 ± 1.23, 1.84 ± 1.28 to 2.20 ± 1.10, 2.19 ± 0.83 in the right and left ovary, respectively, and resistance index was increased from 0.84 ± 0.25, 0.83 ± 0.23 to 1.16 ± 0.37, 1.10 ± 0.26 in the right and left ovary respectively (P < 0.05), peak systolic velocity (PSV) was decreased from 12.30 ± 1.72, 12.34 ± 1.55 to 10.25 ± 0.97, 10.53 ± 1.33 in the right and left ovary respectively (P < 0.05). PI and RI did not show any difference between the homeostatic model assessment insulin resistance index (HOMA-IR) ≥ 2.38 and HOMA-IR < 2.38 groups before and after metformin treatment (P > 0.05). However, PSV was decreased significantly from 13.05 ± 1.35, 12.82 ± 2.02 to 11.03 ± 0.71, 10.25 ± 0.42 in HOMA-IR ≥ 2.38 group in the right and left ovary, respectively, and PSV was decreased from 11.50 ± 2.67, 11.28 ± 0.26 to 9.10 ± 0.58, 9.28 ± 0.25 in HOMA-IR < 2.38 group in the right and left ovary, respectively, before and after metformin treatment (P < 0.05). PSV for both ovaries were positively correlated with HOMA scores before and after metformin treatment [(r = 0.713, P = 0.000; r = 0.617, P = 0.04 and r = 0.635, P= 0.03; r = 0.483, P = 0.031 respectively]. Conclusion  Metformin treatment affected ovarian stromal blood flow in PCOS patients.     

An algorithm for treatment of infertile women with polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is a common condition with both a reproductive and metabolic phenotype. Women with PCOS often seek care because of infertility or menstrual cycle irregularities that result from chronic anovulation interspersed with occasional ovulatory cycles. Initially, it is important to delineate a differential diagnosis for oligo- or amenorrhea and to evaluate for disorders that may “masquerade” as PCOS. If fertility is a desired goal, then it is critical to optimize health conditions that impact fertility and gestation. Lifestyle modifications, including nutritional counseling and weight loss, should be a part of all treatment plans. Even minimal (5%) weight loss in obese women with PCOS improves both ovulation and pregnancy rates. The first line of treatment for ovulation induction remains the selective estrogen receptor modulator (SERM) clomiphene citrate. The role of insulin sensitizers, particularly metformin, remains unclear. A recent consensus panel recommended against its routine use in the absence of an elevated glucose or hemoglobin A1c. If a woman fails to achieve pregnancy after a trial of weight loss and six ovulatory cycles induced by clomiphene citrate, then ovulation induction with exogenous gonadotropin, with or without timed intrauterine insemination, or in vitro fertilitization, is a reasonable next step. Women with PCOS are particularly prone to excessive follicle development and are at increased risk for ovarian hyperstimulation syndrome (OHSS). Although limited data exist comparing approaches to ovulation induction or controlled ovarian stimulation in women with PCOS, the American Society for Reproductive Medicine recommends the use of “step-up” or “step-down” protocols in which a low dose of exogenous FSH or combined gonadotropins are employed in an attempt to constrain ovarian responsiveness. In vitro fertilization allows for the transfer of only one embryo or for cryopreservation of all embryos with subsequent transfer of a single embryo in a subsequent cycle without ovarian stimulation. Countless questions regarding pathogenesis and treatment of PCOS create opportunity for basic and clinical research and for refinement of existing therapeutic approaches.     

Short-term metformin treatment for clomiphene citrate-resistant women with polycystic ovary syndrome

Objective

To evaluate the effect of a short-course pretreatment with metformin on hyperandrogenism, insulin resistance, cervical scores, and pregnancy rates in women with clomiphene citrate (CC)-resistant polycystic ovary syndrome (PCOS).

Methods

Thirty-seven women with CC-resistant PCOS were randomly assigned to be pretreated with 500 mg of metformin or placebo 3 times per day for 2 cycles, and 100 mg of CC was given on days 5 through 9 of the second cycle in both groups. Luteinizing hormone (LH), follicle stimulating hormone (FSH), dehydroepiandrostendione sulfate (DHEAS), total testosterone (T), glucose, and insulin levels were measured at baseline and after the first cycle, as well as body mass index (BMI), cervical score, and pregnancy rate.

Results

After 1 cycle, BMI, total T level, and percentage of participants with insulin resistance were significantly decreased in the metformin group, without any significant decrease in LH, FSH, and DHEAS levels; and in the second cycle, CC treatment resulted in a higher ovulation rate and a thicker endometrium in the metformin group. The pregnancy rate and cervical scores were also higher in that group.

Conclusion

The short-course pretreatment with metformin decreased hyperandrogenism and insulin resistance and improved cervical sores, ovulation rate, and pregnancy rate among women with CC-resistant PCOS.     

Nonobese women with polycystic ovary syndrome respond better than obese women to treatment with metformin

OBJECTIVE: To determine the clinical, hormonal, and biochemical effects of metformin therapy in obese and nonobese patients with polycystic ovary syndrome (PCOS). DESIGN: Controlled clinical study. SETTING: Department of Gynecology of Federal University of S?o Paulo, S?o Paulo, Brazil. PATIENT(S): Twenty-nine patients with PCOS. INTERVENTION(S): Patients were treated with 500 mg of p.o. metformin t.i.d. for 6 months. MAIN OUTCOME MEASURE(S): Clinical data as well as serum concentrations of sex steroids, sex hormone-binding globulin (SHBG), gonadotropins, leptin, GH, lipids, insulin, and glucose levels were assessed before and after treatment. RESULT(S): In the metformin group of nonobese patients, the mean fasting serum insulin concentration decreased from a pretreatment value of 12.1 +/- 2.4 to 6.3 +/- 0.6 microU/mL after treatment, and the area under the curve of insulin decreased from 5,189.1 +/- 517.4 to 3,035.6 +/- 208.9 microU/mL per minute. Also in the metformin group of nonobese patients, the mean basal serum total testosterone, free testosterone, and androstenedione concentrations decreased by 38%, 58%, and 30%, respectively. In the obese patients treated with metformin, only free testosterone showed a statistically significant decrease (1.7 +/- 0.2). CONCLUSION(S): Our data suggest that nonobese patients respond better than obese patients to a 1.5 g/day metformin regimen.     

Clinical, endocrine and metabolic effects of metformin vs N-acetyl-cysteine in women with polycystic ovary syndrome

Objective

To evaluate the clinical, endocrine and metabolic effects of metformin and N-acetyl-cysteine (NAC) in patients with polycystic ovary syndrome (PCOS).

Study design

In this prospective trial, 100 women with PCOS were randomly divided to receive metformin (500 mg p.o. three times daily) or NAC (600 mg p.o. three times daily) for 24 weeks. Hyperandrogenism, lipid profiles, hirsutism scores, menstrual irregularity, insulin sensitivity and tumour necrosis factor-α (TNF-α) levels were measured at baseline and after the treatment period.

Results

Both treatments resulted in a significant decrease in body mass index, hirsutism score, fasting insulin, HOMA index, free testosterone and menstrual irregularity compared with baseline values, and both treatments had equal efficacy. NAC led to a significant decrease in both total cholesterol and low-density lipoprotein levels, whereas metformin only led to a decrease in total cholesterol level. Although TNF-α levels increased following treatment for both groups, the difference from baseline was not significant.

Conclusions

Metformin and NAC appear to have comparable effects on hyperandrogenism, hyperinsulinaemia and menstrual irregularity in women with PCOS. The effects of metformin and NAC on insulin sensitivity are not associated with TNF-α.     

Metformin therapy in women with polycystic ovary syndrome.

OBJECTIVE: To determine the clinical, biochemical, hormonal, and ultrasonographic effects of 6 months of metformin therapy in women with polycystic ovary syndrome (PCOS) and compare with pretherapy parameters. METHOD: 50 Indian women with PCOS, 25 unmarried and 25 married, infertile women, were enrolled in this prospective clinical study. After a baseline workup, including body mass index (BMI), waist hip ratio (WHR), Ferriman Gallwey hirsutism scoring, menstrual pattern, levels of fasting insulin, lipids, oral glucose tolerance test (OGTT), serum gonadotropins, estradiol (E2), testosterone, androstenedione, sex hormone binding globulin (SHBG), and dehydroepiandrosterone sulphate (DHEAS), patients were given 1000 gm of metformin for 6 months and then reevaluated. RESULT: In 41 of 50 women who completed treatment, significant improvement in BMI, WHR, menstrual cyclicity (80.5%), ovulation rate (66%), and pregnancy rate (28%) was noted. Statistically significant decrease in lutenising hormone (LH) and LH/FSH ratio with an increase in follicle stimulating hormone (FSH) levels were seen. Levels of high-density lipoprotein (HDL) cholesterol (Chol) increased along with a decrease in total cholesterol. Improvement was noted in ovarian volume, stromal thickness, and number of follicles. There was no change in hirsutism, acne, levels of other sex steroid hormones, and lipids. CONCLUSION: A 6-month course of metformin therapy may improve menstrual cyclicity and fertility in women with PCOS.     

Insulin resistance, dyslipidemia, and metabolic syndrome in women with polycystic ovary syndrome

Objective

To investigate the association of insulin resistance with dyslipidemia and metabolic syndrome (MBS) in women with polycystic ovary syndrome (PCOS).

Methods

Fasting glucose (G), insulin (I), and lipid levels were measured in 50 infertile women with PCOS. A fasting G/I ratio of 4.5 or less (n = 29) defined insulin resistance (IR).

Results

The mean levels of total cholesterol (P < 0.001), low-density lipoprotein (P = 0.02), and triglycerides (P < 0.001) were significantly higher and the mean levels of high-density lipoprotein were significantly lower (P < 0.001) in the IR group. The prevalence of MBS (P = 0.02) and obesity (P = 0.04), hypertension (P = 0.02), fasting hyperglycemia (P = 0.03), low high-density lipoprotein levels (P = 0.02), and hypertriglyceridemia (P = 0.02) were also significantly higher in the IR group.

Conclusion

Insulin resistance is associated with dyslipidemia and MBS in women with PCOS. Lifestyle modification and insulin-sensitizing agents should be part of the management plan.     

罗格列酮联合二甲双胍治疗多囊卵巢综合征的临床疗效观察

目的 :探讨罗格列酮联合二甲双胍治疗多囊卵巢综合征 (PCOS)的临床疗效。方法 :10 0例临床上有PCOS表现的肥胖不育患者通过口服葡萄糖耐量试验 (OGTT)、胰岛素及C肽释放试验 ,检出胰岛素抵抗 (IR)患者 80例 ,随机分为A、B、C 3组 ,分别给予促排卵药 ,促排卵药加二甲双胍 ,促排卵药加二甲双胍加罗格列酮 ,共治疗 2个月经周期 ,比较 3组用药前后及 3组间体重指数 (BMI)、胰岛素抵抗指数 (HomaIR)、游离脂肪酸(FFA)、肿瘤坏死因子α(TNFα)、纤溶酶原激活抑制物 1(PAI 1)和排卵率的变化。结果 :C组患者治疗后的BMI、HomaIR、FFA、TNFα、PAI 1较治疗前明显下降 (P <0 .0 5 )。C组的排卵率明显优于A组 (P <0 .0 1)和B组 (P <0 .0 5 )。结论 :罗格列酮联合二甲双胍治疗PCOS效果显著。     

二甲双胍在多囊卵巢综合征促排卵治疗中的作用

目的　评估二甲双胍在多囊卵巢综合征 (PCOS)患者促排卵治疗中的作用。方法　以40例PCOS患者 (PCOS组 )为研究对象 ,其中 2 0例口服二甲双胍治疗 12周 ,治疗后 17例未孕者加用高纯度促卵泡激素 (FSH HP)治疗 1个周期 (A组 ) ,另 2 0例单用FSH HP治疗 1个周期 (B组 ) ;同时 ,以体重和月经周期均正常的 2 0例门诊患者为对照组。观察各组及A组患者口服二甲双胍前后血清FSH、黄体生成激素 (LH)、睾酮、瘦素、空腹血糖及空腹胰岛素水平 ;比较A、B两组促排卵治疗结果。结果　空腹胰岛素和瘦素水平 ,PCOS组显著高于对照组 (P <0 .0 5) ,PCOS肥胖者高于PCOS非肥胖者(P <0 .0 5) ,但PCOS非肥胖者与对照组相比 ,差异无显著性 (P >0 .0 5)。二甲双胍治疗后 ,LH、空腹胰岛素、睾酮及瘦素水平明显下降 (P <0 .0 5～ 0 .0 1)。PCOS组患者中有 3例服二甲双胍治疗期间妊娠 ,另外 3 7例行FSH HP促排卵治疗后有 7例妊娠 (A组 4例 ,B组 3例 ) ,总妊娠率为 19% ( 7 3 7) ;A组的排卵率 ( 88% ,15 17)和妊娠率 ( 2 4% ,4 17)虽高于B组 ( 70 % ,14 2 0 ;15% ,3 2 0 ) ,但差异无显著性 (P >0 .0 5)。结论　二甲双胍能降低胰岛素和瘦素水平 ,逆转PCOS患者性激素异常 ,使部分患者恢复排卵和妊娠 ,可增强PCOS患者对促性腺素的敏感     

Alterations in low-density lipoprotein and high-density lipoprotein subclasses among Hispanic women with polycystic ovary syndrome: influence of insulin and genetic factors

Objective: To examine the influence of hyperandrogenism on low-density lipoprotein (LDL) and high-density lipoprotein (HDL) subclass levels as well as lipoprotein (a) levels in hyperandrogenic women compared with a control group.

Design: Case-control study.

Setting: University-based outpatient clinic.

Patient(s): Sixteen Hispanic women with polycystic ovary syndrome were compared with 21 controls matched for age, weight, and ethnicity.

Intervention(s): None.

Main Outcome Measure(s): Fasting serum levels of testosterone, insulin, and lipoproteins.

Result(s): Compared with controls, women with polycystic ovary syndrome had significantly lower levels of apolipoprotein A-I (95 ± 28 mg/dL versus 144 ± 42 mg/dL) and HDL_2a (30.9% ± 4.4% versus 36.6% ± 5.4%) but significantly higher levels of HDL_3c (5.1% ± 2.2% versus 2.4% ± 1.5%). There were no statistically significant differences in LDL subclasses between groups, but there was a high incidence (54%) of the atherogenic lipoprotein phenotype B in this Hispanic population. As a group, Hispanic women with the abnormal B phenotype had significantly higher levels of insulin, HDL, HDL_2b, and triglycerides.

Conclusion(s): Hyperandrogenemia may have an adverse effect on serum lipoproteins through effects on HDL subclasses. Hispanic women may have a higher incidence of the atherogenic lipoprotein phenotype B, which may increase their risk for atherosclerosis.     

多囊卵巢综合征患者血清脂联素水平及与胰岛素抵抗相关性的研究

目的:检测多囊卵巢综合征(PCOS)患者血清脂联素(APN)水平,探讨APN与胰岛素抵抗(IR)的相关性。方法:研究对象于月经周期第3~5天行75g糖耐量实验(OGTT实验),分别测定0h、1h、2h的血糖(FPG、PG1h、PG2h)、胰岛素(FINS、INS1h、INS2h)和脂联素(FAPN、APN1h、APN2h)。PCOS患者给予达英-353个周期联合二甲双胍治疗3个月后复查上述指标,比较治疗前后的变化。结果:(1)PCOS组与对照组均表现为肥胖组APN水平低于非肥胖组,且PCOS组中肥胖组与非肥胖组的APN水平均低于对照组(P<0.05);(2)PCOS组中肥胖组与非肥胖组的FINS、INS1h、INS2h、AUCins及HOMA-IR均高于对照组,且肥胖PCOS组高于非肥胖PCOS组(P<0.05);(3)PCOS组经二甲双胍联合达英-35治疗后FINS、INS1h、INS2h、AUCins、HOMA-IR均降低(P<0.05),而APN水平明显升高;(4)相关性分析表明,PCOS患者APN水平与FINS、INS1h、INS2h、FPG、AUCins、HOMA-IR和BMI均呈负相关。多元逐步回归分析显示,APN与FINS、HOMA-IR的相关性最显著。结论:PCOS患者APN水平显著降低与IR密切相关。     

多囊卵巢综合征无排卵患者子宫内膜超声形态学及组织学变化

目的探讨多囊卵巢综合征(PCOS)无排卵患者子宫内膜超声形态学的变化特点,及组织学变化与激素水平的关系。方法采用B超观察76例PCOS无排卵患者(PCOS组)及32例排卵正常的不孕患者(对照组)的子宫内膜;按照Gonen等的分型方法,将子宫内膜分为A型(即低回声三线型)、B型(即均质中等回声)、C型(即强回声)3型;采用免疫组化技术,检测子宫内膜腺上皮细胞增殖相关核抗原Ki67及降钙素的表达;采用透射电镜观察子宫内膜超微结构;采用酶联免疫发光法,检测血清中黄体生成激素及孕酮等的水平。结果PCOS组子宫内膜为A型者23例,B型者34例、C型者17例,另2例患者因内膜厚度<5mm,未进行分型。A型患者的内膜间质发育异常比率为9%(2/23),B型和C型为43%(22/51)两者比较,差异有统计学意义(P<0·05)。PCOS组分泌期内膜腺上皮细胞Ki67表达为(14±6)%,对照组为(9±7)%,两组比较,差异有统计学意义(P<0·05)。PCOS组增生期子宫内膜腺上皮细胞中细胞器增多;分泌期显示分泌反应不良。结论PCOS无排卵患者子宫内膜呈现增生和分泌表现异常,其内膜超声形态学的强回声表现,可能与局灶性内膜间质发生异常组织学改变有关。     

生活方式调整及药物治疗多囊卵巢综合征的临床研究

目的探讨生活方式调整、二甲双胍及罗格列酮治疗多囊卵巢综合征（PCOS）的临床疗效。方法将106例PCOS患者随机分为单纯生活方式调整（锻炼及饮食控制）、生活方式调整＋二甲双胍与生活方式调整＋罗格列酮治疗3组,分别为43、36、27例,共有60例（分别为22、21、17例）患者完成治疗,观察3组患者治疗前、后排卵情况,比较体重指数（BMI）、腰围、腰围与臀围比值（WHR）、血清睾酮、空腹真胰岛素水平、血脂、稳态模型法测定的胰岛素抵抗指数（HOMA-IR）、空腹血糖与胰岛素比值（GIR）、定量胰岛素敏感检测指数（QUICKI）的变化。结果治疗前3组患者年龄、BMI、腰围、WHR、睾酮水平、空腹真胰岛素水平、总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白．胆固醇（HDL-C）、低密度脂蛋白-胆固醇（LDL-C）比较,差异均无统计学意义（P〉0．05）。单纯生活方式调整组的43例患者中22例完成治疗,23％（5／22）恢复排卵;生活方式调整＋二甲双胍组的36例患者中21例完成治疗,43％（9／21）恢复排卵;生活方式调整＋罗格列酮组的27例患者中17例完成治疗,59％（10／17）恢复排卵。3组患者的恢复排卵率比较,差异无统计学意义（P〉0．05）;但生活方式调整＋罗格列酮组较单纯生活方式调整组恢复排卵率高,且差异有统计学意义（P〈0．05）。治疗后3组患者的BMI、腰围、WHR、睾酮、TC、TG、LDL-C、HDL-C比较,差异均无统计学意义（P〉0．05）。结论生活方式调整、二甲双胍、罗格列酮对PCOS患者均有恢复排卵作用。