二甲双胍对多囊卵巢综合征患者内分泌功能的影响

目的探讨二甲双胍对多囊卵巢综合征(PCOS)合并胰岛素抵抗(IR)患者内分泌的影响。方法 P-COS合并IR患者50例于自然月经或撤退性出血第2天开始服用二甲双胍12周,观察治疗前后血清促卵泡生成素(FSH)、黄体生成素(LH)、睾酮、雌二醇、雄烯二酮、性激素结合蛋白(SHBG)浓度、胰岛素(INS)水平以及血糖的变化。结果治疗后患者各时相INS水平显著下降,差异有统计学意义(P<0.01);患者血清LH、LH/FSH比值、睾酮和雄烯二酮水平均显著下降,差异有统计学意义(P<0.01);SHBG水平显著升高,差异也有统计学意义(P<0.01)。结论二甲双胍通过改善IR降低INS水平,改善患者临床症状和内分泌指标,使PCOS患者异常的血激素相得到明显改善。     

二甲双胍联合螺内酯治疗多囊卵巢综合征的疗效观察

目的本研究旨在观察对多囊卵巢综合征(PCOS)患者应用二甲双胍联合螺内酯治疗的疗效,包括患者体内代谢、内分泌相关指标改变。方法60例PCOS患者,随机分为A、B两组（各30例）。A组口服二甲双胍1 000 mg/d,B组口服二甲双胍1 000 mg/d联合螺内酯40 mg/d,随访3个月,比较各项指标水平差异。结果治疗后两组体质量、体质量指数（BMI）均降低,且差异有统计学意义（P<0.05）,B组腰臀比（WHR）以及多毛评分较治疗前均显著降低（P<0.05）。两组内分泌激素中黄体生成素(LH)、睾酮(T)值较治疗前均下降（P<0.05）,促卵泡生成素(FSH)较治疗前轻度变化,但差异无统计学意义（P>0.05）。A组经治疗后空腹胰岛素较前显著下降（P<0.05）,血糖水平则无改变（P>0.05）;B组治疗后血糖和胰岛素均较治疗前显著降低(P<0.01,P<0.05)。脂代谢方面,A组治疗后甘油三酯及低密度脂蛋白水平较治疗前显著降低（P<0.05）,B组治疗后甘油三酯（P<0.05）、低密度脂蛋白胆固醇（P<0.01）、总胆固醇（P<0.05）水平均较治疗均前显著降低。结论较二甲双胍单独应用,螺内酯和二甲双胍联合治疗具有更加显著的临床效果。     

达英-35联合二甲双胍对非胰岛素抵抗型多囊卵巢综合征患者的疗效观察

目的对比观察达英-35、二甲双胍2者联用与达英-35单用对多囊卵巢综合征（PCOS）非胰岛素抵抗型患者的疗效。方法选取PCOS非胰岛素抵抗型患者126例,随机分为2组,各63例,分别应用达英-35及达英-35、二甲双胍联用治疗,观察2组治疗3个疗程后体重指数（BMI）、空腹胰岛素（FINS）、黄体生成素（LH）、促卵泡素（FSH）及睾酮（T）的改善情况。结果单用达英-35组治疗后BMI、FINS、LH、FSH水平均稍有降低,但较治疗前无明显改善,T水平与治疗前比较有显著降低。联合用药组治疗后BMI、FINS、LH、FSH及T水平较治疗前均下降明显。结论达英-35、二甲双胍能明显改善非胰岛素抵抗型PCOS体重指数及雄激素水平,是一种有效治疗方法。     

Genetics of polycystic ovary syndrome

Introduction: Polycystic ovary syndrome (PCOS) is a hormonal and metabolic disorder affecting 5 to 20% of reproductive-aged women worldwide that results in androgen excess, menstrual dysfunction and oligo-ovulatory subfertility, with increased risks for type 2 diabetes, endometrial adenocarcinoma, and potentially vascular disease, among other morbidities. PCOS is a complex genetic trait with strong heritability accounting for as high as 70% of the development of the disorder.

Areas covered: The authors summarize the historical and recent findings of genetic studies of PCOS, such as familial studies, twin studies, and molecular genetic studies, including the results of recent genome wide associated studies. PubMed, Medline and Embase database were used to search relevant articles. Included studies were predominately conducted in Asia, North Africa, North America, and Europe.

Expert commentary: Current studies aim to establish the role and function of identified genes; such efforts could serve as potential platforms for novel diagnostic and treatments for PCOS patients. The etiology of PCOS will be better understood as more data is gathered systematically, subjects are better phenotyped larger populations are recruited, and a better understanding of the role of genetic architecture, genetic variation, epigenetics, and gene-gene, gene-environment, and gene-phenotype interaction is obtained.     

二甲双胍对多囊卵巢综合征患者血脂代谢及胰岛素抵抗状态的影响

目的 观察二甲双胍对多囊卵巢综合征（PCOS）患者血脂代谢及胰岛素抵抗状态的影响.方法 选取PCOS患者115例,随机分为二甲双胍组45例、联合组32例、对照组38例.二甲双胍组单用二甲双胍治疗,联合组给予二甲双胍联合炔雌醇环丙孕酮片治疗,对照组单用炔雌醇环丙孕酮片治疗,疗程均为3个月.观察3组治疗前后临床症状、血脂代谢指标、性激素指标及稳态评估模型的胰岛素抵抗指数（HOMA-IR）等变化.结果 治疗后3组临床症状均有改善,其中二甲双胍组的月经异常、多毛及单相基础体温发生率显著低于对照组（P＜0.05）;治疗后二甲双胍组、联合组的性激素指标、血脂代谢指标及HOMA-IR均较治疗前显著改善（P＜0.05或P＜0.01）;组间比较,治疗后二甲双胍组低密度脂蛋白胆固醇（LDL-C）、睾酮（T）及HOMA-IR改善程度最优（P＜0.05或P＜0.01）,联合组促黄体素（LH）、促卵泡素（FSH）及游离睾酮指数（FAI）改善程度最优（P＜0.05或P＜0.01）.结论 二甲双胍单用或与避孕药联合应用可显著改善PCOS患者的临床症状、血脂代谢及胰岛素抵抗状态.     

炔雌醇/环丙孕酮联合二甲双胍治疗多囊卵巢综合征疗效观察

目的探讨炔雌醇/环丙孕酮（达英-35）联合二甲双胍治疗多囊卵巢综合征（PCOS）的疗效。方法将PCOS患者80例随机分为联合治疗组（达英-35联合二甲双胍）和对照组（达英-35）,每组各40例,用药12周。观察治疗前后临床表现、性激素、空腹胰岛素及卵巢大小等变化。结果两组治疗后,月经恢复,血LH、T卵巢大小明显下降（P〈0.01）,联合治疗组体重指数、空腹胰岛素下降（P〈0.01）,而单用达英-35组体重指数和空腹胰岛素无明显变化（P〉0.05）。结论达英-35联合二甲双胍治疗PCOS,能有效降低雄激素水平,改善胰岛素抵抗,疗效优于单用达英-35。     

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.     

Genomic variants in polycystic ovary syndrome

The polycystic ovary syndrome (PCOS) is a common disorder in premenopausal women, characterized by the presence, among other traits, of hyperandrogenism, insulin resistance, and hyperinsulinism. The familial aggregation of PCOS lead the interest to the molecular genetic basis of this syndrome, especially to the genes encoding proteins involved in androgen synthesis and the regulation of insulin synthesis and action. Considering the relationship between insulin resistance and chronic inflammation, and the clustering of inflammatory markers in PCOS patients, recent studies focused on the involvement of proinflammatory genotypes on the pathogenesis of PCOS. Mounting evidence suggest at present a complex model of inheritance for PCOS, in which predisposing and protecting genomic variants interact with environmental factors such as obesity and a sedentary lifestyle, finally leading to the classic phenotype of this syndrome. Moreover, the association of hyperandrogenism, insulin resistance and chronic inflammation raised the possibility of an increase risk of cardiovascular disease in women suffering from PCOS. In the present review we will summarize the most important findings published to date regarding the molecular genetic mechanisms underlying the association of PCOS with insulin resistance and chronic inflammation, and the possible interaction of these mechanisms with environmental factors.     

吡格列酮和二甲双胍联合治疗肥胖型多囊卵巢综合征临床研究

目的观察吡格列酮和二甲双胍联合治疗肥胖型多囊卵巢综合征(polycystic ovary syndrome,PCOS)后,体重、胰岛素敏感性和排卵情况的变化.方法7例年龄在19～29周岁的初诊PCOS患者给予吡格列酮15mg/d和二甲双胍(格华止)1000mg/d,治疗3个月,比较治疗前后体重、简化葡萄糖耐量试验、胰岛素水平(空腹和服糖后2h)、性激素、泌乳素和卵巢超声检查、基础体温曲线、体重指数和胰岛素敏感指数的变化.结果治疗后7例患者均出现月经来潮,体重减轻,血胰岛素、睾酮、黄体生成素水平降低,卵泡刺激素升高,基础体温曲线呈双相曲线.卵巢超声检查无显著变化.结论吡格列酮和二甲双胍联合治疗肥胖型多囊卵巢综合征疗效可靠.     

益气活血汤加减联合二甲双胍治疗多囊卵巢综合征的临床效果

目的探讨益气活血汤加减联合二甲双胍治疗多囊卵巢综合征(PCOS)的临床效果。方法选取140例PCOS患者作为研究对象,按数字表法将其分为对照组和观察组,各70例。对照组接受二甲双胍药物治疗,观察组在对照组基础上增加益气活血汤加减治疗。比较两组的临床疗效、排卵率和妊娠率;比较两组治疗前、后的性激素水平、分泌代谢指标水平及胰岛素抵抗指数。结果观察组的治疗总有效率为94.29%,明显高于对照组的78.57%,差异有统计学意义(P<0.05)。治疗后,两组LH、PRL及T水平均降低,E2水平均升高,且观察组优于对照组,差异有统计学意义(P<0.05)。治疗后,观察组的TC、TG、FPG水平及HOMA-IR均低于对照组及治疗前,差异具有统计学意义(P<0.05);但对照组治疗前、后,TC、TG、FPG水平及HOMA-IR比较,差异无统计学意义(P>0.05)。治疗后随访半年,观察组的排卵率和妊娠率分别为84.29%和45.71%,均高于对照组的64.29%和22.86%,差异具有统计学意义(P<0.05)。结论益气活血汤加减联合二甲双胍治疗PCOS可有效调节患者的激素水平,改善糖代谢、脂代谢及胰岛素抵抗,提高排卵率及妊娠率。     

多囊卵巢综合征的研究现状

多囊卵巢综合征(polycystic ovarian syndrome,PCOS)是一种生殖功能障碍与糖代谢异常并存的内分泌紊乱综合征,临床表现为持续性无排卵、卵巢多囊样改变(polycystic ovary,PCO)、雄激素过多和胰岛素抵抗(insulin resistance,IR)等,是生育期妇女月经紊乱、导致不孕的最常见的原因,其病因至今尚未阐明。近年来,国内外对该病的研究均有一定进展,现将     

口服避孕药联合二甲双胍治疗多囊卵巢综合征的对照研究

目的探讨口服避孕药(达因-35)联合二甲双胍治疗多囊卵巢综合征(PCOS)的临床疗效。方法 2010年1月至2012年1月在阜阳市人民医院就诊的PCOS患者120例,随机分为A、B两组。A组62例,应用达因-35联合二甲双胍治疗;B组58例,单用达因-35治疗,疗程均为3个月。结果 A、B两组临床症状改善情况比较差异无统计学意义(P>0.05)。A组治疗后睾酮(T)、黄体生成素(LH)、LH/卵泡刺激素(FSH)明显下降(P<0.05);B组治疗后T、LH、LH/FSH明显下降(P<0.05),腰臀比和体质量指数明显增加(P<0.05)。结论口服避孕药联合二甲双胍是治疗PCOS的最佳选择。     

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.     

Spironolactone for hirsutism in polycystic ovary syndrome

OBJECTIVE: To evaluate the level of evidence for treatment of hirsutism associated with polycystic ovary syndrome (PCOS) with spironolactone. DATA SOURCES: Studies and reports were located in MEDLINE (1966-January 2005), EMBASE, and International Pharmaceutical Abstracts through the second week of January 2005. DATA SYNTHESIS: Hirsutism is a common clinical problem and is often associated with PCOS. Research has been performed to assess the efficacy of spironolactone therapy in patients with hirsute characteristics. Five studies that evaluated the effectiveness of spironolactone for hirsutism in PCOS were identified and reviewed. CONCLUSIONS: The effects of multiple treatment options on the subjective and objective measures of hirsutism have displayed varying results. The outcomes reported to date have shown a positive trend toward using spironolactone in women with PCOS and hirsutism.