妊娠晚期妇女甲状腺疾病特点及甲状腺自身抗体变化的研究

目的 探讨妊娠晚期妇女甲状腺疾病的患病率、患病特点和甲状腺自身抗体的变化.方法 选择664例妊娠晚期妇女为妊娠组,276例非妊娠育龄妇女作为对照组.应用固相化学发光酶免疫法测定两组妇女的血清促甲状腺激素（TSH）和抗甲状腺过氧化物酶抗体（TPOAb）水平;TSH水平检测异常者加测游离甲状腺素（FT4）和游离三碘甲状腺原氨酸（FT3）,同时测定尿碘水平.按如下标准确定诊断：TSH＜0.3 mU/L,FT4和（或）FT3水平升高者诊断为临床甲状腺功能亢进症（甲亢）;TSH＜0.3 mU/L,而FT4和FT3水平正常者诊断为亚临床甲亢;TSH＞4.8 mU/L,FT4水平降低者诊断为临床甲状腺功能减退症（甲减）;TSH＞4.8 mU/L,而FT4和FT3水平正常者诊断为亚临床甲减.TPOAb＞5 kU/L为阳性.结果 （1）妊娠组妇女尿碘平均水平为201.5μg/L,对照组妇女尿碘平均水平为196.0μg/L,均为碘充足水平.两组比较,差异无统计学意义（P＞0.05）.（2）妊娠组妇女甲状腺疾病总患病率为7.8%（52/664）,对照组妇女甲状腺疾病总患病率为6.9%（19/276）.两组比较,差异无统计学意义（P＞0.05）.（3）两组妇女的甲状腺患病类型有明显不同,妊娠组妇女甲亢患病率为1.1%（7/664）,甲减患病率为6.8%（45/664）,妊娠组妇女甲亢患病率明显低于甲减,两者比较,差异有统计学意义（P＜0.01）;对照组甲亢患病率为4.7%（13/276）,甲减患病率为2.2%（6/276）,两者比较,差异无统计学意义（P＞0.05）.妊娠组与对照组妇女的甲亢或甲减患病率分别比较,差异均有统计学意义（P＜0.01）.（4）妊娠组非患病妇女的TSH水平显著高于对照组,分别为2.50 mU/L及1.54 mU/L,差异有统计学意义（P＜0.01）;妊娠组妇女TPOAb阳性率显著低于对照组,分别为3.3%（22/664）及9.4%（26/276）,差异有统计学意义（P＜0.01）.结论 妊娠晚期妇女甲状腺疾病的特点是甲减的患病率高,同时甲状腺自身免疫功能受到抑制.     

抗苗勒管激素及其Ⅱ型受体基因多态性在多囊卵巢综合征患者表达的研究

目的:研究抗苗勒管激素(AMH)及抗苗勒管激素Ⅱ型受体(AMHRⅡ)基因多态性在多囊卵巢综合征( PCOS)患者的表达情况;同时分析PCOS不同AMH基因型患者体重指数(BMI)、性激素水平之间是否存在差异,从基因水平探讨PCOS的发病机制.方法:采用聚合酶链反应(PCR)及DNA正、反向测序方法,检测94例PCOS患者(PCOS组)及94例正常排卵患者(对照组)AMH和AMHRⅡ基因型,同时将两组AMH、AMHRⅡ不同基因型患者的年龄、BMI及性激素水平分别进行比较.结果:①两组AMH基因型分布比较,差异有统计学意义(P＜0.05),而AMH等位基因频率、AMHRⅡ基因型分布及等位基因频率分布比较,差异均无统计学意义(P＞0.05).②在PCOS组不同AMH基因型患者中,BMI、LH、T间差异有统计学意义(P＜0.05),基因型分布类型与BMI、LH、T有关(P＜0.05),而与年龄、FSH、E2、PRL无关(P＞0.05);对照组年龄、BMI、性激素水平与AMH基因型分布无关(P＞0.05).③对照组和PCOS组年龄、BMI、性激素水平与AMHRⅡ基因型分布无关(P＞0.05).结论:AMH基因的多态性可能与PCOS的发病相关;PCOS患者AMH基因型中G/T表型可能是引起患者肥胖、高雄激素血症的原因.     

左旋甲状腺素对亚临床甲状腺功能减退孕妇妊娠期糖尿病发生率的影响

目的：研究左旋甲状腺素（LT4）治疗对亚临床甲状腺功能减退（SCH）孕妇中妊娠期糖尿病（GDM）发生率的影响。方法：选取经甲状腺功能筛查诊断为SCH的妊娠妇女1 084例（SCH组）,正常妊娠妇女8 848例（对照组）。SCH组按患者是否愿意接受药物治疗分为SCH治疗组、SCH未治疗组,治疗组采用LT4治疗,未治疗组不用药。比较各组促甲状腺素（TSH）、游离甲状腺素（FT4）、甲状腺过氧化物酶抗体（TPOAb）情况,并根据口服糖耐量试验（OGTT）结果,比较各组GDM发生率。结果：SCH组TSH水平高于对照组,FT4低于对照组（均P=0.000）,治疗组与未治疗组的TSH水平高于对照组,FT4水平低于对照组（均P=0.000）。SCH治疗组的TSH水平与SCH未治疗组差异无统计学意义（P＞0.05）。SCH组TPOAb阳性率高于对照组（P=0.000）,SCH治疗组与未治疗组的TPOAb阳性率均高于对照组（P=0.000）,而SCH治疗组与未治疗组间差异无统计学意义（P＞0.05）。SCH组的GDM发生率高于对照组,差异有统计学意义（P=0.000）。SCH治疗组的GDM发生率低于未治疗组（P=0.035）。SCH治疗组的GDM发生率与对照组比较,差异无统计学意义（P＞0.05）,而SCH未治疗组的GDM发生率显著高于对照组,差异有统计学意义（P＜0.01）。结论：SCH会增加GDM的发病风险,尽早使用LT4正规治疗,可能对降低SCH孕妇的GDM发生率,减少SCH合并GDM对母儿的危害有积极作用。     

二甲双胍联合罗氟司特治疗多囊卵巢综合征的临床观察

目的：探究二甲双胍联合罗氟司特治疗多囊卵巢综合征（PCOS）的临床疗效。方法：选择2013年6月-2015年6月我院妇产科收治的53例肥胖型PCOS患者,按照患者先后治疗顺序将其分为对照组（仅给予二甲双胍治疗,前25例患者）和观察组（给予二甲双胍联合罗氟司特治疗,后28例患者）。2组患者均治疗3个月,测量治疗前后体质量、体质量指数（BMI）、腰围、血糖、胰岛素、胰岛素抵抗指数（HOMA-IR）、黄体生成激素、卵泡刺激素、雄烯二酮、总睾酮和游离睾酮。结果：2组患者在经过3个月的治疗后,观察组患者的体质量、BMI和腰围较治疗前显著下降（P＜0.05）,且观察组与对照组比较差异有统计学意义（P＜0.001）;观察组和对照组的血糖、HOMA-IR比较差异有统计学意义（P＜0.05）。此外,游离睾酮和雄烯二酮水平在组内治疗前后比较以及2组之间比较,差异均有统计学意义（P＜0.05）;2组患者治疗前血脂功能指标比较,差异均无统计学意义（P＞0.05）;治疗后观察组总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）以及低密度脂蛋白胆固醇（LDL-C）水平均较对照组改善,差异有统计学意义（P＜0.05）。结论：采用罗氟司特联合二甲双胍进一步减轻肥胖型PCOS患者的体质量,为PCOS的治疗提供了一个新的方案。     

多囊卵巢综合征患者体外受精-胚胎移植后的妊娠结局

目的 分析多囊卵巢综合征(PCOS)患者体外受精-胚胎移植(IVF-ET)后的妊娠结局,及不同表型PCOS患者妊娠结局的差异.方法 选取2005年1月至2010年2月在山东大学附属省立医院生殖医学中心行IVF-ET治疗的PCOS患者631例(PCOS组),按照年龄与孕前体质指数( BMI)配对选择输卵管性不孕患者1423例作为对照组.对两组患者的临床资料进行回顾性分析,比较两组患者IVF-ET治疗后的流产率和单胎妊娠结局.结果 PCOS组和对照组患者IVF-ET后流产率分别为22.7％(143/631)和18.69％(266/1423),两组比较,差异有统计学意义(P＜0.05).PCOS组和对照组孕单胎例数分别为339例和794例,两组单胎妊娠结局为:PCOS组和对照组早产率分别为11.2％(38/339)和6.4％( 51/794),两组比较,差异有统计学意义(P＜0.05);妊娠期糖尿病发生率分别为1.5％(5/339)和0.6％ (5/794)、妊娠期高血压疾病发生率分别为4.7％( 16/339)和3.0％( 24/794)、妊娠天数分别为(272±13)d和(273±10)d、新生儿畸形率分别为0.6％(2/339)和0.8％ (6/794)、足月新生儿出生体质量均为(3.5±0.5) kg,以上各项两组比较,差异均无统计学意义(P＞0.05).PCOS组中规律排卵患者流产率及单胎早产率分别为18.6％(19/102)和8.2％(4/49),与对照组分别比较,差异均无统计学意义(P均＞0.05);稀发排卵患者流产率及单胎早产率分别为23.4％( 124/529)和11.7％ (34/290),与对照组比较,差异有统计学意义(P＜0.05).结论 PCOS患者行IVF-ET治疗后流产率、早产率增加,但PCOS患者中规律排卵型患者各种并发症发生率未升高.     

克罗米芬联合尿促性素对多囊卵巢综合征患者促排卵的临床效果

目的 探究多囊卵巢综合征（PCOS）患者采取克罗米芬联合尿促性素治疗对其促排卵的临床效果。方法 选取80例PCOS患者,采取随机数字表法分为对照组与试验组,每组40例。对照组采用克罗米芬治疗,试验组采用克罗米芬联合尿促性素治疗。比较两组促排卵效果、排卵率及妊娠率。结果 治疗前,两组患者排卵数、优势卵泡数、优势卵泡平均直径及卵泡成熟日比较,差异无统计学意义（P>0.05）。治疗后,两组患者排卵数、优势卵泡数均多于治疗前,卵泡成熟日短于治疗前,差异有统计学意义（P<0.05）,优势卵泡平均直径治疗前、治疗后比较,差异无统计学意义（P>0.05）。治疗后,试验组排卵数、优势卵泡数均多于对照组,差异有统计学意义（P<0.05）,试验组优势卵泡平均直径、卵泡成熟日与对照组比较,差异无统计学意义（P>0.05）。试验组患者排卵率82.50%、妊娠率55.00%均高于对照组的60.00%、32.50%,差异有统计学意义（P<0.05）。结论 克罗米芬联合尿促性素治疗PCOS患者可提高患者促排卵效果,提升排卵率及妊娠率,临床应用价值高。     

盐酸二甲双胍和马来酸罗格列酮治疗多囊卵巢综合征的临床研究

目的:探讨应用胰岛素增敏剂盐酸二甲双胍和马来酸罗格列酮治疗多囊卵巢综合征(PCOS)的临床效果.方法:选择在我院就诊的PCOS患者55例,随机分成盐酸二甲双胍组30例和马来酸罗格列酮组25例,治疗疗程12周.观察两组患者用药前后体重、血糖及胰岛素水平、生殖激素水平变化及排卵、月经改善和不良反应情况.结果:①盐酸二甲双胍治疗后患者的体重降低(P＜0.05),两组治疗后体重比较,差异有统计学意义(P＜0.05);②两药治疗后基础胰岛素值、胰岛素曲线下面积及胰岛素抵抗指数均降低,且马来酸罗格列酮组治疗后数值低于盐酸二甲双胍组(P＜0.05);③两药治疗后雄烯二酮、睾酮水平明显下降,与治疗前相比,差异有高度统计学意义(P＜0.01).④两药治疗后两组排卵率比较差异无统计学意义(P＞0.05).⑤盐酸二甲双胍组的不良反应有稀便、恶心,马来酸罗格列酮组有体重增加、水肿.结论:盐酸二甲双胍、马来酸罗格列酮均能改善PCOS患者的胰岛素抵抗.盐酸二甲双胍有轻微降低体重的作用,价格便宜;马来酸罗格列酮减轻胰岛素抵抗效果优于盐酸二甲双胍.     

多囊卵巢综合征患者睡眠质量与代谢综合征的相关性分析

目的：探讨多囊卵巢综合征（polycystic ovary syndrome,PCOS）患者代谢综合征（metabolic syndrome,MS的发病与睡眠障碍的关系,为临床防治提供指导。方法：选取2021年4—10月黑龙江中医药大学附属第一医院妇科门诊就诊的PCOS患者170例,按是否合并MS分为PCOS合并MS组（A组,40例）、PCOS无MS组（B组,130例）,另选取同期非PCOS但存在MS的患者（C组,30例）作为对照,对3组患者的临床特征、睡眠质量、睡眠状况与MS标志物的相关性进行回顾性分析。结果：A、B、C组睡眠障碍者分别为18例（45.00%）、44例（33.84%）和4例（13.33%）,各组睡眠障碍程度的差异有统计学意义（P<0.05）。A组睡眠状况评分、体质量、体质量指数、收缩压、舒张压、腰臀比、空腹血糖、空腹胰岛素、胰岛素抵抗指数、总胆固醇、三酰甘油、低密度脂蛋白胆固醇、载脂蛋白B水平均高于B组（P<0.05）;A组黄体生成素、黄体生成素与卵泡刺激素比值、性激素结合球蛋白、高密度脂蛋白胆固醇水平低于B组（P<0.05）。A组在睡眠状况评分、黄...     

多囊卵巢综合征患者血清中一氧化氮水平及其相关因素的临床研究

目的探讨多囊卵巢综合征（PCOS）患者血清一氧化氮（NO）水平与其血管并发症的关系。方法采用硝酸还原酶法测定27例PCOS患者（PCOS组）,21例因男方因素或输卵管因素不孕患者（对照组）血清NO水平,测定并计算体重指数（BMI）、腰臀比（WHR）、收缩压（SBP）、舒张压（DBP）、体脂含量、胰岛素抵抗指数（HOMA-IR）、胰岛素敏感指数（IAI）、血清性激素、空腹血糖（FPG）和胰岛素（FINS）水平。结果非肥胖PCOS组的HOMA-IR高于非肥胖对照组,IAI、血清NO水平低于非肥胖对照组,差异均有显著性（P〈0.05）。非肥胖PCOS组IAI明显高于肥胖PCOS组,差异有显著性（P〈0.01）。血清NO水平在PCOS组和其对照组间差异无显著性（P〉0.05）。PCOS组中,血清NO水平与HOMA-IR（r=-0.317,P〈0.05）、体脂含量（r=-0.346,P〈0.05）呈负相关。结论PCOS患者血清NO水平降低,提示PCOS患者可能存在血管内皮功能受损。     

联合LC-MS和化学发光免疫法分析不同类型PCOS的雄激素水平

目的:利用液相色谱-质谱联用(LC-MS)方法和化学发光免疫分析法测定不同临床类型PCOS患者的血清雄激素水平,分析中国PCOS女性的高雄激素血症的生化特点。方法:纳入有排卵障碍和多囊卵巢的PCOS患者149例,根据血清睾酮(T)和硫酸脱氢表雄酮(DHEAS)值及F-G多毛评分情况分为两组:高雄组55例,非高雄组94例。同期选取输卵管性不孕患者82例作为对照组。化学发光法测定性激素结合球蛋白(SHBG)水平,计算游离雄激素指数(FTI)。LC-MS法测定各组血清睾酮、雄烯二酮(AD)和脱氢表雄酮(DHEA)。结果:高雄组的血清T水平及FTI值显著高于非高雄组及对照组(P0.05),非高雄组高于对照组(P0.05);高雄组、非高雄组的DHEAS及AD水平均高于对照组(P0.05);3组的DHEA水平比较,差异均无统计学意义。结论:血清T、AD、DHEAS及FTI均为诊断PCOS高雄激素血症的敏感指标;T及FTI是PCOS分型(高雄及非高雄)的主要依据;LC-MS和化学发光免疫分析法对PCOS高雄激素血症的诊断具有一致性。     

High prevalence of chronic thyroiditis in patients with polycystic ovary syndrome

Objective

A higher prevalence (26.9% versus 8.3% of controls) of autoimmune thyroiditis (AIT) in polycystic ovary syndrome (PCOS) has been reported in one study to date. We aimed to evaluate the prevalence of clinical, subclinical, potential thyroid autoimmune diseases and other organ-specific autoimmunity in a group of Italian patients with PCOS.

Study design

113 consecutive patients referred to our endocrinology unit as outpatients over 18 months, and diagnosed with PCOS according to the Rotterdam criteria, were included in the study, and 100 age-matched healthy women were enrolled as controls. Each patient was evaluated for family and personal history of autoimmune and non-autoimmune diseases and tested for autoantibodies against thyroperoxidase, thyroglobulin, parietal cells, intrinsic factor, adrenal-cortex, 21-hydroxylase, steroid-producing cells, 17-alpha-hydroxylase, side-chain cleavage enzyme, islet-cells, glutamic-acid decarboxylase, nuclei and mitochondria. All patients had serum TSH, FT4 and FT3 tested and patients with thyroid autoantibodies and/or abnormal TSH levels had an ultrasound thyroid scan. An oral glucose tolerance test and measurements of serum anti-Mullerian hormone (AMH) and inhibin B levels were carried out.

Results

AIT was present in 30/113 (27%) patients compared with 8% of controls (p < 0.001). Subclinical hypothyroidism was detected in 13/30 (43%) patients with AIT; the remaining patients had normal thyroid function. The prevalence of non-thyroid autoantibodies in PCOS patients was not different from controls. AMH concentration was higher in PCOS patients compared to controls, but there was no difference between AIT and non-AIT groups.

Conclusions

The prevalence of AIT in patients with PCOS was significantly higher than in controls. No other autoimmune diseases were associated with PCOS. This observation suggests that PCOS patients should be screened for AIT.     

Polycystic ovaries as a relative protective factor for bone mineral loss in young women with amenorrhea.

OBJECTIVE: To examine the impact of polycystic ovaries (PCO) on bone mineral density in amenorrheic women of reproductive age. DESIGN: A retrospective analysis and comparison of polycystic ovarian syndrome (PCOS) with non-PCOS amenorrheic women. A subgroup of patients with ultrasound (US)-diagnosed PCO was also investigated. SETTING: Specialist clinic in reproductive endocrinology. PATIENTS, PARTICIPANTS: Six hundred ten consecutive cases, mean age of 29.8 +/- 7.5 years, with current history of amenorrhea of various causes. MAIN OUTCOME MEASURE: Bone mineral density in the lumbar spine (L1 to L4) as measured by dual energy x ray absorptiometry, in relation to PCOS, US-diagnosed PCO, and US findings of normal ovaries. RESULTS: Amenorrheic patients with PCOS were found to be younger (P less than 0.001), with higher body mass index (P less than 0.001), were more estrogenized, as measured by endometrial thickness and uterine cross-sectional area (P less than 0.001), and had higher bone mineral density (P less than 0.001) compared with non-PCOS amenorrheic patients. CONCLUSIONS: Patients with amenorrhea because of PCOS and those with US-diagnosed PCO have a higher bone density compared with amenorrheic patients with normal ovaries as detected by US scan.     

Do polycystic-appearing ovaries affect the risk of cardiovascular disease among women with polycystic ovary syndrome?

OBJECTIVE: To determine if polycystic-appearing ovaries (PAO) are associated with differences in risk factors for cardiovascular disease among women with polycystic ovary syndrome (PCOS). DESIGN: Case-control sub-study. SETTING: Division of Reproductive Endocrinology, Magee-Womens Hospital. PATIENT(S): Women with PCOS (n = 63) and non-PCOS controls (n = 56). INTERVENTION: Transvaginal ultrasonography and single sample venipuncture. MAIN OUTCOME MEASURE(S): Ultrasound ovarian appearance, fasting insulin, lipoproteins, androgens, LH/FSH ratio, anthropomorphic measurements, and blood pressure. RESULT(S): Women with PCOS had higher androgen and fasting insulin levels, a more adverse lipid profile, greater waist-hip and LH/FSH ratios, and a larger ovarian volume than controls. Thirty-three percent of the cases with PCOS, but only 5% of controls, showed PAO on ultrasound study (P<.01). PCOS cases with and without PAO had comparable levels of fasting insulin, lipids, and blood pressures. PCOS cases with PAO had a higher LH/FSH ratio (P=.028), increased levels of serum androstenedione (P=.029) and testosterone (P=.055), and greater ovarian volume (P=.024) compared to non-PAO patients. CONCLUSION: Women with PCOS have greater cardiovascular risk than controls. Within PCOS cases, however, the ultrasound appearance of polycystic ovaries does not appear to further intensify the cardiovascular disease risk profile of these women.     

Comparison of clinical and laboratory characteristics of cases with polycystic ovarian syndrome based on Rotterdam’s criteria and women whose only clinical signs are oligo/anovulation or hirsutism

This study was an attempt to determine whether the hormonal and clinical profiles of polycystic ovarian syndrome (PCOS) or non-PCOS cases whose only admission signs were oligo/anovulation or hirsutism. This retrospective study comprised a total number of 118, age-matched, young Turkish women with initial admission signs and symptoms of menstrual disorders (MD) like oligo/anovulation or hirsutism. Of these, 66 cases were diagnosed as PCOS, based on 2003 Rotterdam criteria [presence of two of first three criteria such as oligo- and/or anovulation, signs of clinical hyperandrogenism (HA-c) and/or biochemical signs of hyperandrogenism (HA-b) and polycystic ovaries on ultrasonography after exclusion of specific identifiable disorders]. Fifty-two women were diagnosed as cases of oligo/anovulation or hirsutism before the era of PCOS Rotterdam’s consensus criteria. These two PCOS and non-PCOS cases were evaluated in terms of body mass index (BMI), waist-to-hip ratio, serum FSH, LH, estradiol (E2), dehydroepiandrosterone sulphate (DHEAS), androstendione (A) 17 hydroxyprogesterone (17-HP), fasting insulin, C-peptide levels, sex hormone-binding globulin (SHBG) and finally, ultrasonographic ovarian morphology. PCOS cases with unilateral and bilateral polycystic ovarian morphology on ultrasound scan were analyzed based on Rotterdam criteria. No statistically significant difference was detected among two groups, in terms of BMI, waist-to-hip ratio, serum FSH, LH, E2, fasting insulin, C-peptide levels (P > 0.05). However, blood levels of DHEAS, A and 17-HP were higher, whilst SHBG levels were remarkably lower (P = 0.008) in PCOS cases. Among PCOS group, hormonal and clinical characteristics did not differ, irrespective or uni- or bilaterality of ovarian morphology on ultrasonographic scan. Percentages of cases with androgenic alopecia, oily skin/acnea and increased ovarian volume were higher in PCOS group; whereas Ferriman–Gallwey score ≥ 8 were similar between two groups. Total but not free testosterone remained high in PCOS group (P < 0.01). In both PCOS and non-PCOS cases, a linear correlation was apparent between BMI and insulin levels (r _s = 0.69 and 0.32, P < 0.05, respectively). Among PCOS group, MD + HA-b + HA-c (n = 40) was present in 60.6% of subjects, MD + HA-b (n = 12) in 18.2%, and MD + HA-c (n = 14) in 21.2%. The three phenotypes did not differ in mean BMI, waist-to-hip ratio and biochemical characteristics. To conclude, non-PCOS women with only sign or symptom of oligo/anovulation or hirsutism had a more favorable endocrine milieu. These cases should be followed in vigilance in an aim to confront the development of short- and long-term adverse effects of impending PCOS in the future. Furthermore, different phenotypes of PCOS cases were clinically or biochemically similar in characteristics.     

肥胖与非肥胖多囊卵巢综合征患者血清肿瘤坏死因子-α(TNF-α)水平的比较

目的:比较肥胖与非肥胖多囊卵巢综合征(PCOS)患者血清肿瘤坏死因子-α(TNF-α)水平的差异。方法:55例PCOS患者,根据体质量指数(BMI)分为肥胖组(BMI>25,n=31)和非肥胖组(BMI≤25,n=24);同期选择50例非PCOS育龄妇女,分为肥胖对照组(BMI>25,n=25)和非肥胖对照组(BMI≤25,n=25)。应用酶联免疫吸附法(ELISA)测定血清TNF-α的含量,分析TNF-α与胰岛素抵抗指数(HOMA-IR)的相关性。结果:PCOS肥胖组与PCOS非肥胖组的TNF-α水平分别显著高于其相应的对照组(P<0.01),PCOS非肥胖组的TNF-α水平也显著高于肥胖对照组(P<0.05)。PCOS肥胖组与PCOS非肥胖组之间的TNF-α水平无显著差异(P>0.05)。PCOS组TNF-α与HOMA-IR呈显著正相关(P<0.05)。结论:肥胖与非肥胖PCOS患者的血清TNF-α水平均升高,可能存在肥胖以外升高TNF-α的途径;TNF-α与PCOS的IR发生有密切联系。     

Paternal history of diabetes mellitus and hypertension affects the prevalence and phenotype of PCOS

PurposeThe purpose of the present study is to determine if paternal or maternal history of diabetes mellitus (DM) and hypertension (HT) contributes to the prevalence and phenotype of polycystic ovary syndrome (PCOS).MethodsWe performed an epidemiologic study about PCOS from four districts in Beijing, China, between 2008 and 2009. Parental histories of DM and HT were collected, and the basic characteristics and serum indices of 123 PCOS patients and 718 non-PCOS controls were tested.ResultsThe prevalence of a parental history of DM and HT was significantly higher in PCOS patients than non-PCOS women (17.1 % vs. 9.2 % and 42.3 % vs. 26.0 %, P < 0.05, respectively). When paternal history was separated from maternal history, only a paternal history of DM and HT reached statistical significance between PCOS and non-PCOS patients (odds ratio (OR) = 3.42, 95 % confidence interval (CI) = 1.69–6.91; OR = 2.50, 95 % CI = 1.58–3.93, respectively). A paternal history of both DM and HT was significantly associated with sex hormone-binding globulin, fasting plasma glucose, and fasting insulin levels, the free androgen index, and the homeostatic model assessment-insulin resistance in PCOS patients (P < 0.05 for all). There was no independent association between maternal history and the clinical or biochemical phenotype of PCOS.ConclusionsPCOS patients with a positive paternal history of both DM and HT have an adverse endocrine and metabolic profile. A paternal history of DM and HT poses a risk to PCOS.

Electronic supplementary material

The online version of this article (doi:10.1007/s10815-015-0587-y) contains supplementary material, which is available to authorized users.     

我院育龄妇女血清睾酮水平正常值范围的修正及其对PCOS诊断的影响

目的:修正高雄激素血症的诊断标准,并分析其对PCOS诊断标准的影响。方法:以3 545例无排卵障碍和无内分泌疾病的育龄妇女为正常排卵组,测定其睾酮(T)水平,并根据测定值修正T水平的正常值范围,按修正的正常值范围通过1 248例PCOS患者分析其对PCOS诊断标准及分型的影响。结果:①正常排卵组和PCOS组的年龄、FSH、E2组间比较差异无统计学意义(P0.05),而BMI、LH、T组间比较差异有统计学意义(P0.05)。根据正常排卵组的T水平确定其正常值范围为0.27±0.23(0.04~0.50)ng/ml,修正后T0.65 ng/ml即可诊断为生化高雄激素血症。②修正雄激素的正常值范围后,PCOS组高雄激素血症的比例有明显提高,PCOS 4个亚型构成比有变化,有359例Ⅱ型PCOS患者转为Ⅰ型PCOS。结论:我院育龄女性雄激素水平的正常值范围需要修正,修正的雄激素正常值范围对PCOS的诊断及分型有影响。     

Assessment of glucose tolerance and pregnancy outcome of polycystic ovary patients.

OBJECTIVES: To determine the impact of polycystic ovary syndrome (PCOS) on glucose tolerance during pregnancy and perinatal outcome. METHODS: Pregnancy records of 38 PCOS patients were compared retrospectively with 136 non-PCOS patients randomly. Patients with glucose challenge tests values of >130 mg/dl were referred for the 3-h, 100-g oral glucose tolerance test (OGTT). RESULTS: A family history of diabetes mellitus, pre-pregnancy body mass index (BMI), gestational weight gain was significantly higher in PCOS patients than controls. The prevalence of gestational diabetes mellitus (GDM) was similar in both groups. Impaired glucose tolerance (IGT) was observed in 18.4% of PCOS patients vs. 5.1% of controls. The main predictor of GDM was found pre-pregnancy BMI >25 while main predictor of IGT was found as PCOS. Mean gestational age at delivery, prevalence of preterm labor, modes of delivery, mean birthweight, mean Apgar score at 5 min, proportion of babies admitted to the neonatal intensive care unit (NICU) were similar in both groups. CONCLUSIONS: Higher IGT prevalence in PCOS patients might be related to maternal obesity and excess gestational weight gain and does not affect perinatal outcome.     

生长激素在多囊卵巢综合征促排卵中的作用

目的　探讨生长激素(GH)在多囊卵巢综合征(PCOS)患者促排卵中的作用。方法　测定130例PCOS患者(PCOS组)及107例正常妇女(对照组)的血中生殖激素及GH和胰岛素样生长因子Ⅱ(IGF-Ⅱ)的基础水平,并应用GH辅助促排卵方案治疗7例对人绝经期促性腺激素(hMG)反应不良的PCOS患者,观察疗效。结果　PCOS患者血中GH水平明显降低,肥胖者更为明显,非肥胖与肥胖者分别为(2.50±1.33)μg/L及(1.04±0.47)μg/L,而对照组肥胖与非肥胖者分别为(2.95±1.49)μg/L、（5.30±2.26）μg/L（P均<0.05）;PCOS组肥胖者IGF-Ⅱ水平为（136±27）nmol/L,高于非肥胖者的（123±20）nmol/L,两者比较,差异有显著性（P<0.05）。应用GH辅助促排卵治疗,可以明显减少hMG用量1～12支,缩短hMG刺激时间3～12d,增加优势卵泡的数量。结论　PCOS患者存在GH分泌障碍,应用GH辅助促排卵可以提高排卵率。     

Autoantibody studies of female patients with reproductive failure.

The aim of this study was to investigate the prevalence and character of autoimmune derangements in women with reproductive failure. A total of 108 females (age range 17-43, mean 27.5 years), including 16 with primary menstrual cycle disturbances and polycystic ovaries (PCO), 20 with polycystic ovary syndrome (PCOS), 38 with endometriosis (E), and 34 with chronic anovulation, luteal phase insufficiency, subfertility or unexplained infertility (INF) were investigated. A control group of 392 women was formed from an unselected population sample (age range 17-43, mean 31.0 years). All sera were tested by indirect immunofluorescence method to assess common autoantibodies: nuclear (ANA), smooth muscle (SMA), parietal cell (PCA), thyroid microsomal (TMA), reticulin (ARA), mitochondrial (AMA) and liver/kidney microsomal autoantibodies (LKMA). Enzyme-linked immunosorbent assay was used to detect antibodies against beta2-glycoprotein I (anti-beta 2GPI) and carbonic anhydrase (anti-CA). Our results showed that 40.7% of patients' sera and 14.8% of control sera contained one or more common autoantibodies, ANA and SMA were most frequently detected (difference between two groups P<0.005). Anti-beta 2GPI were found in eight cases (7.4%), including two patients with INF but without other autoantibodies. Anti-CA were revealed in nine cases (8.3%) including patients' PCOS, E and INF. A comparison of patients' clinical data with antibody assay results did not reveal any significant associations. Our results indicate a high prevalence of autoimmune reactions in women with reproductive failure due to the most common causes PCO, PCOS and E as well as in unexplained infertility. This might reflect the propensity to develop autoimmune reactions in such patients, including pathogenic autoimmune reactions to specific target antigens.