多囊卵巢综合征患者的雄激素水平与胰岛素抵抗

多囊卵巢综合征患者的雄激素水平与胰岛素抵抗吴效科顾秋善苏延华胰岛素抵抗和高胰岛素血症是多囊卵巢综合征（ＰＣＯＳ）的常见特征［１，２］，本研究通过葡萄糖耐量试验（ＯＧＴＴ），观察ＰＣＯＳ患者行双侧卵巢楔形切除术（楔切术）前后糖代谢的变化，以探讨ＩＲ与雄...     

多囊卵巢综合征的遗传研究进展

多囊卵巢综合征 (PCOS)的家族聚集现象提示遗传因素的重要作用 ,遗传方式尚不肯定 ,可能为常染色体显性遗传。目前认为 ,PCOS复杂的临床表现和生化特征是多个基因和环境因素共同作用的结果 ,其中CYP11α和雄激素受体 (AR)基因的变异与PCOS的高雄激素血症相关 ,胰岛素基因 5′端可变数串连重复序列 (VNTR)则是PCOS的易感位点 ,但这些都有争议和分歧 ,需要更多的研究进一步发现和证实     

多囊卵巢综合征伴肥胖者助孕前处理

多囊卵巢综合征（PCOS）是育龄期女性常见的内分泌紊乱综合征,通常表现为持续性无排卵、高雄激素血症、胰岛素抵抗等。内分泌紊乱状态使PCOS患者容易伴肥胖,肥胖又可与PCOS内分泌紊乱发生相互作用,共同增加患者不孕不育的风险,影响助孕结局,并增加妊娠合并症及远期并发症的风险。故对此类患者行助孕前需要详细评估身心健康状态,调整生活方式,必要时辅以药物甚至手术,以达到改善助孕结局、降低妊娠合并症及远期并发症风险的目的。     

多囊卵巢综合征临床治疗进展

多囊卵巢综合征 (PCOS)是育龄妇女内分泌紊乱中最常见的一种异质性疾病。确切病因不十分清楚 ,以高雄激素和持续无排卵为基本特征。近几年研究发现 ,PCOS患者也存在糖代谢异常 ,主要表现为胰岛素抵抗和高胰岛素血症。治疗上应根据不同病情选择不同的治疗方案 ,包括抗雄激素、调整月经周期、促排卵及应用胰岛素增敏剂改善代谢紊乱等。本文对近几年PCOS的治疗进展进行了阐述     

多囊卵巢综合征的胰岛素抵抗

胰岛素抵抗 (ｉｎｓｕｌｉｎｒｅｓｉｓｔｅｎｃｅ ,ＩＲ)是多囊卵巢综合征(ｐｏｌｙｃｙｓｔｉｃｏｖａｒｙｓｙｎｄｒｏｍｅ ,ＰＣＯＳ)患者主要和常见的代谢紊乱。多囊卵巢综合征和胰岛素抵抗是两种复杂的、牵涉广泛病理生理变化的病症。自 1980年 ,Ｂｕｒｇｈｅｎ[1] 等发现ＰＣＯＳ与高胰岛素血症相关后 ,对ＰＣＯＳ的胰岛素抵抗进行了广泛和深入的研究[2～ 4] ,本文对此进行简要的综述。1　胰岛素抵抗的概念1 1　胰岛素抵抗的定义胰岛素抵抗的定义目前仍不完全统一。根据美国糖尿病协会 (ＡｍｅｒｉｃａｎＤｉａｂｅｔｅｓＡｓｓｏｃ…     

多囊卵巢综合征患者的胰岛素抵抗

多囊卵巢综合征（peOS）是女性常见的生殖功能障碍性疾病,主要表现为卵巢的雄激素过多及无排卵,其发生率占生育年龄妇女的5％－10％卜］。此外,PCOS患者也存在糖代谢异常,主要表现为胰岛素抵抗（IR）及代偿性高胰岛素血症,其糖耐量低减的发生率也占生育年龄妇女的10％［'］。现就关于poOS的IR基础及临床方面研究进展作一综述。一、胰岛素作用及IR（一）胰岛素作用的细胞机理胰岛素是人体最重要的代谢激素,也是唯一降糖激素。胰岛素的生物学作用主要是调节糖代谢和脂代谢,还通过调控基因表达和蛋白质合成等进一步影响相应器官的…     

多囊卵巢综合征患者组织胰岛素抵抗

多囊卵巢综合征（PCOS）是一种发病多因性、临床表现呈多态性的内分泌综合征。其发病原因至今尚未阐明，近年大量研究表明胰岛素抵抗（IR）与PCOS之间关系密切，胰岛素抵抗可能是PCOS发生发展的主要因素之一。胰岛素作用的经典靶器官是肝脏、脂肪及肌肉。目前，对PCOS患者组织胰岛素抵抗的研究主要有脂肪、肌肉、卵巢及子宫内膜．对其作一综述。     

多囊卵巢综合征临床特征分析

<正>多囊卵巢综合征(PCOS)发病率占育龄女性的6%～8%。PCOS不仅严重干扰女性生殖功能,而且代谢异常影响了女性健康,因此越来越受到国内外学者的重视。现将我院门诊诊治的110例P- COS的临床表现和特征进行分析并与53例正常月经女性进行比较,报告如下。     

多囊卵巢综合征的分型探讨

目的探讨不同分型方法用于多囊卵巢综合征(PCOS)分型时,其临床、内分泌、糖和脂代谢紊乱的特征,以指导临床治疗。方法将192例PCOS患者按鹿特丹修订的分型标准分为A组110例[长期无排卵;具有雄激素水平升高的临床和(或)生化依据;卵巢增大,单侧卵巢体积大于10ml或超声下至少有直径2~9mm的小卵泡≥12个;并排除其他疾病所致的雄激素增多症];B组46例[长期无排卵;具有雄激素水平升高的临床和(或)生化依据,并排除其他疾病所致的雄激素增多症];C组36例(长期无排卵;卵巢增大,单侧卵巢体积>10ml或超声下至少有直径2~9mm的小卵泡≥12个;并排除其他疾病所致的雄激素增多症)。又按肥胖与否将192例患者分为肥胖型PCOS70例(OB-PCOS组)和非肥胖型PCOS122例(NOB-PCOS组)。以同期就诊、年龄及体重匹配、基础体温(BBT)双相的输卵管因素不孕症患者104例为对照组。采用多毛评分及痤疮评分法对192例患者进行评分并测定其血清生殖激素、胰岛素、血脂及血糖的水平。采用空腹胰岛素(FINS)及胰岛素曲线下面积(IAUC)评估高胰岛素血症;采用稳态模型的胰岛素抵抗指数(HOMA-IR)评估胰岛素抵抗;糖耐量试验(OGTT)及葡萄糖曲线下面积(GAUC)评估糖代谢状态。采用游离雄激素指数(FAI)评估雄激素增多症及雄激素生物学活性。结果(1)评分:多毛评分A组为(7·1±1·8)分,B组为(6·9±1·9)分,均明显高于C组的(3·9±1·5)分,差异有统计学意义(P<0·01);痤疮评分A组为(0·9±1·1)分,B组为(0·7±1·1)分,均高于C组的(0·2±0·4)分,差异也有统计学意义(P<0·01);OB-PCOS组与NOB-PCOS组多毛评分及痤疮评分比较,差异均无统计学意义(P>0·05)。(2)黑棘皮症:A组的发生率为21·8%(20/110),B组的发生率为19·6%(9/46),C组的发生率为0(0/36),A、B组黑棘皮症的发生率均明显高于C组,差异有统计学意义(P<0·01);OB-PCOS组黑棘皮症的发生率为35·0%(25/70),NOB-PCOS组为6·0%(8/122),两组比较,差异有统计学意义(P<0·01)。(3)生殖激素:①FAI:A组为2·6±1·8,B组为2·2±1·4,均明显高于C组的1·2±0·6,差异有统计学意义(P<0·01);OB-PCOS组FAI为3·4±1·8,NOB-PCOS组为1·8±1·2,两组比较,差异也有统计学意义(P<0·01)。②黄体生成素(LH)与卵泡刺激素(FSH)的比值:NOB-PCOS组LH/FSH为2·4±1·1,明显高于OB-PCOS组的1·5±0·8,差异有统计学意义(P<0·01),A、B、C3组比较,差异无统计学意义(P>0·05)。(4)生化指标:OB-PCOS组FINS、HOMA-IR、IAUC、GAUC、甘油三酯(TG)分别为(17±11)mIU/L、1·0±0·6、(249±128)mIU·h·L-1、(19·6±7·8)mmol·h·L-1和(1·9±1·0)mmol/L,均明显高于NOB-PCOS组的(8±10)mIU/L、0·1±0·8、(132±81)mIU·h·L-1、(16·7±3·4)mmol·h·L-1和(1·1±0·7)mmol/L,分别比较,差异均有统计学意义(P均<0·01);A、B、C3组间上述生化指标比较,差异均无统计学意义(P>0·05)。结论鹿特丹修订的PCOS分型方法可反映疾病的基本特征;而肥胖分型不仅能反映病情的基本特征和严重程度,而且对代谢并发症的风险评估具有重要意义。     

未成熟卵母细胞体外培养在助孕中的应用

多囊卵巢综合征是生育期妇女不孕的最常见的内分泌代谢紊乱性疾病。本研究以多囊卵巢综合征患者作为研究对象 ,探讨未成熟卵母细胞体外培养的可行性及实验条件。一、资料与方法1 研究对象 :选择 2 0 0 0年 10月至 2 0 0 1年 10月 ,于本中心就诊的多囊卵巢综合征不孕患者 2 2例 ,年龄 2 6～ 37岁 ,平均 (2 9 6± 2 6 )岁 ,其中 5例既往有中度或重度卵巢过度刺激综合征病史 ;5例曾行控制性超排卵 ,为卵巢反应不良。2 方法 :(1)促卵泡激素 (ＦＳＨ)刺激 :于使用促性腺激素释放激素激动剂后 15ｄ或撤退性出血后第 5天开始 ,给予ＦＳＨ(瑞士雪…     

Assisted reproduction in the treatment of polycystic ovarian syndrome

Treatment of patients with polycystic ovary syndrome (PCOS) with assisted reproductive techniques is a great challenge for the infertility specialist. Patients with PCOS demonstrate many problems, such as excessive body weight and hyperinsulinaemia, that render management more complex. Prior to treatment with IVF, the PCOS patient should be thoroughly evaluated for disclosure of endometrial neoplasia, hyperinsulinaemia, and other general health related problems. Ovarian stimulation for IVF carries the risks of overstimulation and severe hyperstimulation, which should be avoidable in most cases with preventive measures. The outcome in terms of pregnancy and implantation rates is similar for patients with PCOS when compared with patients undergoing IVF for other indications. There are some questions regarding oocyte and embryo quality in women with PCOS. This manifests itself in lower fertilization rate and decreased embryo quality in some studies. However, increased numbers of oocytes available for insemination or ICSI compensate for decreased fertilization rates and embryo quality. More recent studies suggest higher cumulative conception rates in women with PCOS when compared with controls. In-vitro maturation (IVM) of oocytes retrieved from non-stimulated or minimally stimulated cycles represents a viable option that should be considered seriously when assisted conception is attempted. Results of IVM, however, should be improved further and generalized before the technique can be advocated as the initial treatment approach in these patients.     

Assisted reproduction in patients with early-stage ovarian malignancies

OBJECTIVE: To determine the outcome of women with early-stage ovarian malignancies who subsequently underwent assisted reproductive technologies (ART). DESIGN: Retrospective study. SETTING: Academic assisted reproductive technology program. PATIENT(S): Four infertile women who were previously diagnosed with early-stage ovarian malignancies. INTERVENTION(S): Controlled ovulation hyperstimulation, IVF, and/or gamete intrafallopian transfer treatments using clomiphene citrate and/or gonadotropins. MAIN OUTCOME MEASURE(S): Development of tumor recurrence and disease-free interval. RESULT(S): All four women remain free of disease for up to 15 years after treatment. Three of the four women achieved pregnancy. CONCLUSION(S): In patients with early-stage ovarian malignancies, conservative therapy followed by ovarian stimulation for assisted reproduction is an acceptable strategy.     

Genetics of polycystic ovarian syndrome

Polycystic ovarian syndrome (PCOS) is a reproductive system disorder characterized by irregular menses, anovulation, clinical and/or biochemical signs of hyperandrogenism (hirsutism and/or acne), ovarian micropolycystic appearance and metabolic abnormalities, such as hyperinsulinaemia and obesity. The aetiopathogenesis of this syndrome is not well known. Several pathogenetic hypotheses have been proposed to explain the full array of symptoms and signs, but with elusive results. A genetic abnormality causing PCOS is supported by the observation that different members of the same family are often affected, and about half of the sisters of PCOS women have elevated serum testosterone concentrations. Therefore, the presence of gene abnormalities in women with PCOS has been widely explored in the attempt to establish whether their mutations or polymorphisms may cause PCOS. The main genes evaluated are those involved in steroidogenesis, steroid hormone effects, gonadotrophin release regulation and action, insulin secretion and action, and adipose tissue metabolism. Despite the vast body of literature produced, none of the genes evaluated seems to play a key role in PCOS pathogenesis. It is likely that PCOS may represent the final outcome of different, deeply inter-related genetic abnormalities that influence each other and perpetuate the syndrome.     

Genetics of polycystic ovarian syndrome

Polycystic ovarian syndrome is a complex disorder with multiple factors affecting its etiology. Elucidation of specific genes and mode of inheritance remains a significant challenge. Linkage and association studies have resulted in over 50 candidate genes as a source of heritable predisposition; however, small sample sizes and failure to reproduce results have hindered efforts. In addition, low fecundity, lack of a male phenotype, and variation of diagnostic criteria represent unique challenges to discovery of polycystic ovarian syndrome genes. A concerted effort will be necessary to conclusively rule in or rule out candidate genes.     

Surgical management of polycystic ovarian syndrome

The objective of this chapter is to review the role of surgical management of polycystic ovarian syndrome in infertile women. Pertinent studies and their references were identified through computer medline search. To date there is no standardization of the technique of laparoscopic ovarian drilling. However, it appears that the results are promising, with a high ovulation rate ranging between 70% and 90% and a pregnancy rate of 70%. Clomiphene citrate remains the first line of treatment to induce ovulation in infertile women with polycystic ovarian syndrome. Laparoscopic ovarian drilling can be offered to clomiphene-resistant women, especially to those who have also failed to respond to gonadotrophin treatment or who have experienced ovarian hyperstimulation syndrome. It appears that the pregnancy rate after ovarian drilling is comparable with that for gonadotrophin therapy. However, until more complete and long-term data are available, caution must be exercised when offering this type of treatment.     

Genetic approaches to polycystic ovarian syndrome

PURPOSE OF REVIEW: This review clarifies the challenges facing investigators in the search for polycystic ovarian syndrome candidate genes. RECENT FINDINGS: Evidence for fibillin 3 has emerged as a polycystic ovarian syndrome candidate gene. The sex hormone binding gene also shows promise, as does evidence for fetal programming and X-chromosome inactivation. SUMMARY: As with many complex disorders, the heritability of polycystic ovarian syndrome has eluded investigators. Although familial aggregation studies have demonstrated clearly a genetic component to the syndrome, simple Mendelian models do not characterize its mode of inheritance. Instead, multiple loci and epigenetic modification may play a role in the phenotype. The candidate gene approach relies upon improved statistical and technological methods to analyze potential genes based on biologic plausibility. Pathways that affect steroidogenesis, insulin resistance, gonadotropin function, and obesity provide potential genes for investigation. Obstacles such as phenotypic variability, lack of a male phenotype, multiple attempts at analysis, and small sample sizes hamper these efforts. Nevertheless, great care must be taken to apply rigorous standards as we proceed with genetic studies. In addition to increasing our knowledge of common disorders, potential benefits include personalized medicine, with pharmacogenetics allowing therapies tailored to the individual.     

多囊卵巢综合征的表观遗传学研究

多囊卵巢综合征(PCOS)是关乎女性一生的疾病,在其病因学、诊断标准和最佳治疗方案上尚有许多争论和悬而未决的问题。遗传和环境因素共同导致了PCOS的发生,但至今仍未发现与PCOS确切相关的特异基因。而环境因素通过何种介导机制影响PCOS的发生,依然不明确。表观遗传学将环境因素和遗传因素很好地联系起来,PCOS的发生也许与表观遗传学的异常机制有关。     

Long-term consequence of polycystic ovarian syndrome

Polycystic ovarian syndrome (PCOS) is one of the most common hormonal disorders affecting women, although the true incidence and pathophysiology have yet to be determined. A diagnosis of PCOS is likely to be associated with an increased long-term risk of developing cardiovascular disease and type 2 diabetes, especially in obese women. The evidence base for a causal relationship between cancer risk and PCOS is weak. Lifestyle changes leading to weight loss is the most effective treatment in these patients. There is insufficient evidence for the use of metformin or surgical interventions such as ovarian drilling in preventing the long-term effects of PCOS.