中医中药治疗多囊卵巢临床研究

目的探讨中药补肾化瘀祛痰方治疗多囊卵巢的临床效果与潜在的作用机制。方法内服水煎补肾化瘀祛痰方,治疗54例多囊卵巢综合症,半年为1个疗程;观察患者服药前后的症状与体征(肥胖、多毛及痤疮)以及血清激素水平。结果患者在治疗后症状与体征的评分值与治疗前相比均有明显下降(P<0.01);血清睾酮水平与治疗前相比显著下降(P<0.05)。结论多囊卵巢综合征患者经过服用补肾化瘀祛痰方可以显著改善临床症状和体征,从而改善患者的卵巢功能。     

多囊卵巢综合征的病因及治疗进展

多囊卵巢综合征（PCOS）是一种生殖功能障碍与糖代谢异常并存的内分泌紊乱复杂的症候群[1],是生育期妇女常见的内分泌紊乱疾病之一,发病率为5%～10%[2],是以持续无排卵及高雄激素、胰岛素抵抗为主要临床特征。常见临床表现为月经稀发、闭经或月经不调、多毛、肥胖、不孕、痤疮、黑棘皮症、卵巢增大及多囊,以及一系列内分泌改变,其病因、发病机制尚未完全明确,     

炔雌醇环丙孕酮片联合二甲双胍治疗肥胖型多囊卵巢综合征80例

目的评价炔雌醇环丙孕酮片联合二甲双胍治疗肥胖型多囊卵巢综合征(PCOS)的疗效。方法随机选取80例肥胖型PCOS患者,应用炔雌醇环丙孕酮片(达英35)及二甲双胍连续治疗3个月,比较治疗前后的临床症状,体重指数(BMI),血清促黄体生成素(LH)、促卵泡素(FSH)、LH/FSH、睾酮(T),空腹血糖(FPG)及空腹胰岛素(FINS)。结果 80例肥胖型PCOS患者应用炔雌醇环丙孕酮片及二甲双胍联合治疗后,恢复规则月经44例,妊娠2例,多毛明显缓解14例,痤疮明显缓解40例;治疗后BMI,LH,T及FINS水平均明显下降(P<0.05);FSH及FPG治疗前后无明显差异(P>0.05)。结论炔雌醇环丙孕酮片联合二甲双胍可使部分患者恢复月经,改善多毛及痤疮症状,降低T及LH水平,提高胰岛素敏感性,可作为治疗肥胖型多囊卵巢综合征的有效方法。     

炔雌醇环丙孕酮合用二甲双胍治疗多囊卵巢综合征65例临床观察

目的 探讨炔雌醇环丙孕酮(商品名达因-35)合用二甲双胍治疗多囊卵巢综合征(PCOS)患者65例临床疗效.方法 将我院门诊65例PCOS患者随机分为观察组(炔雌醇环丙孕酮合用二甲双胍)和对照组(单用炔雌醇环丙孕酮),均治疗6个月,比较两组血中主要内分泌激素如黄体生成素(LH)、卵泡刺激素(FSH)、睾酮(T)、雌二醇(E2)、泌乳素(PRL)及空腹胰岛素(FINS),给予两组的临床症状体征进行评分(多毛评分、痤疮评分、卵巢体积评分),还比较了两组患者的体重指数(BMI)及腰臀比(WHR).结果 两组患者治疗后与治疗前比较,均可使PCOS患者LH、T、痤疮评分、多毛F-C评分及卵巢体积不同程度下降,差异有统计学意义(P＜0.05),但炔雌醇环丙孕酮合用二甲双胍组疗效更明显.治疗后LH、T、FINS、痤疮评分及卵巢体积评分在组间比较均分别有统计学意义(P＜0.05).结论 炔雌醇环丙孕酮合用二甲双胍治疗PCOS,能有效控制高雄激素血症,明显改善症状体征,疗效显著.炔雌醇环丙孕酮与二甲双胍两者具有协同作用,并能降低远期并发症的发生,两者合用对于PCOS的治疗效果优于单一使用炔雌醇环丙孕酮.     

中西医治疗多囊卵巢综合征肥胖症40例分析

多囊卵巢综合征(PCOS)是患者神经、内分泌、代谢等方面的紊乱导致的闭经、不孕、多毛、肥胖等症。PCOS患者中，肥胖的发生率为41％～50％，多在青春期出现。降低体质量对多囊卵巢综合征的治疗意义重大。笔者采用中西医结合治疗多囊卵巢综合征肥胖患者40例，取得较好疗效。     

二甲双胍治疗多囊卵巢综合征的效果观察

目的：探讨二甲双胍治疗多囊卵巢综合征的效果。方法选取2012年1月~2013年12月在本院妇科门诊及病房收治的38例多囊卵巢综合征患者作为研究对象,在月经周期第3天或黄体撤退性出血的第3天,给予二甲双胍治疗,观察和对比治疗前后的体重指数（BMI）、腰臀比（WHR）、卵巢情况、雌二醇（E2）、睾丸酮（T）、促卵泡素（FSH）、促黄体生成素（LH）、空腹血糖（FSG）、空腹胰岛素（FINS）。结果治疗后的BMI、WHR较治疗前显著下降,痤疮、多毛、多囊样卵巢、卵巢体积增大、月经稀少、继发性闭经等症状也显著改善,差异有统计学意义（P〈0.01）;治疗后的T、FSH、LH、FSG、FINS等检验结果较治疗前明显下降,差异有统计学意义（P〈0.05）;患者的不良反应发生率为5.26%。结论采用二甲双胍治疗多囊卵巢综合征能迅速改善患者症状,临床效果显著,值得推广应用。     

达英_(-35)治疗多囊卵巢综合征的临床分析

多囊卵巢综合征(PCOS)是由多种神经内分泌和代谢性疾病引起的卵巢终期病变。近期引起慢性无排卵、月经失调、不孕、多毛、痤疮、肥胖和黑棘皮症等,B超见卵巢体积增大,卵泡数目增多,激素水平异常。远期引起子宫内膜癌、糖尿病和心血管疾病。PCOS的治疗原则是促进排卵,恢复正常月     

多囊卵巢,谁的罪过

女人都希望自己的皮肤光滑,身材苗条,婀娜性感,但是有一种病会让你的美丽大打折扣,那就是多囊卵巢综合征(PCOS)。为什么这么说呢?因为患有多囊卵巢综合征,月经失调、多毛、痤疮、肥胖、黑棘皮症、不孕等美丽杀手就会环绕在你的周围,让你欲哭无泪,万箭穿心。     

复方醋酸环丙孕酮联合二甲双胍治疗青春期多囊卵巢综合征临床观察

目的观察青春期多囊卵巢综合征(PCOS)患者联合应用二甲双胍、复方醋酸环丙孕酮(达英-35)治疗前后激素水平的变化分析。方法将36例PCOS患者随机分成两组,对照组18例单独应用复方醋酸环丙孕酮治疗,观察组18例应用复方醋酸环丙孕酮联合二甲双胍治疗。比较两组患者用药前后血性激素水平、空腹血糖、空腹胰岛素、胰岛素抵抗指标、BMI、F-G评分、痤疮及卵巢多囊样改变等。结果两组患者治疗后血清雄激素水平、LH水平、LH/FSH比值较治疗前明显降低,多毛、痤疮症状及卵巢多囊样改变明显改善,差异有统计学意义(P<0.05或P<0.01),观察组患者空腹血糖、空腹胰岛素、胰岛素抵抗指标降低明显,同对照组比较,差异有统计学意义(P<0.01)。结论青春期PCOS患者使用复方醋酸环丙孕酮联合二甲双胍治疗,可明显改善内分泌失控状态。     

二甲双胍联合去氧孕烯炔雌醇治疗青春期多囊卵巢综合征的疗效观察

目的观察二甲双胍联合去氧孕烯炔雌醇（妈富隆）治疗青春期多囊卵巢综合征（PCOS）的疗效。方法 40例青春期PCOS患者,采用二甲双胍联合妈富隆治疗。观察治疗后月经恢复情况、肥胖及多毛、痤疮的改善情况,并记录治疗前后卵泡刺激素（FSH）、促黄体生成素（LH）、LH/FSH、空腹血糖（FBG）、空腹胰岛素（FIN）水平。结果治疗后36例患者月经恢复正常,肥胖无明显改善,多毛、痤疮症状明显改善;LH、LH/FSH及FIN水平均低于治疗前,差异均有统计学意义（P〈0.05或P〈0.01）。结论二甲双胍联合妈富隆治疗青春期PCOS,能明显改善临床症状,促使月经规律化,降低LH水平及LH/FSH比值,有效改善胰岛素抵抗,值得临床推广应用。     

经阴道超声对多囊卵巢综合征诊断价值的研究

目的观察B超测量值对多囊卵巢综合征(PCOS)的诊断价值。方法对26例确诊为PCOS合并胰岛素抵抗患者、31例单纯PCOS患者及30例正常育龄妇女进行经阴道B超测量卵巢,共5个参数,分别为卵巢总体积(OV)、卵泡数(FN)、卵巢总面积(TA)、间质面积(SA)、间质面积和总面积比值(SA/TA)。结果OV、TA、SA/TA在PCOS合并胰岛素抵抗组、单纯PCOS组及正常对照组之间有显著性差异,FN在单纯PCOS组与正常对照组之间、PCOS合并胰岛素抵抗组与正常对照组之间有显著性差异,SA在正常对照组与PCOS合并胰岛素抵抗之间、单纯PCOS组与PCOS合并胰岛素抵抗组之间有显著性差异。结论在PCOS诊断中,经阴道B超测量FN、OV、TA、SA/TA可考虑作为PCOS的常规诊断指标。OV、TA、SA/TA的增大,尤其是SA的增大可提示诊断PCOS合并胰岛素抵抗。     

The role of proprotein convertase subtilisin/kexin type-9 concentration and paraoxonase 1 activities in the blood of women with polycystic ovary syndrome

This study aimed to evaluate the concentration of proprotein convertase subtilisin/kexin type-9 (PCSK9) and the activities of paraoxonase 1 in women with and without polycystic ovary syndrome (PCOS). We found significant higher PCSK9, whereas lower high-density lipoprotein concentration in the serum of women with PCOS when compared to the group without PCOS. Also paraoxonase 1 activities were significantly different between women with PCOS than without PCOS. In addition, the women with PCOS and insulin resistance had higher concentrations of PCSK9 than women with PCOS and insulin sensitivity. Higher PCSK9 concentration in the group with PCOS could be also associated with hormones concentrations.Changes in paraoxonase 1 activities and lipid profile parameters as well as higher concentration of PCSK9 in the group of women with PCOS could be associated with metabolism disorders, but due to the small clinical sample size, the study should be continued.     

多囊卵巢综合征影响因素分析

目的 寻找与多囊卵巢综合征发病有关的因素.方法 采用病例对照研究,调查2005年2月～2006年4月南京医科大学第一、第二附属医院不孕症门诊患者105例及同期非多囊卵巢综合征的就诊患者210例资料,进行单因素分析.结果 多囊卵巢综合征发病的单因素和多因素分析结果:家族遗传史、初潮月经紊乱、失眠、打鼾、职业、室内装潢史,两组比较差异有显著性.结论 家族遗传史、初潮月经紊乱、失眠、打鼾、职业、室内装潢史是多囊卵巢综合征的高危因素.     

The role of obesity in the development of polycystic ovary syndrome

Polycystic Ovary Syndrome (PCOS) is one of the common endocrine diseases that affects women in their reproductive age. PCOS has diverse clinical implications that include reproductive (infertility, hyperandrogenism, hirsutism), metabolic (insulin resistance, impaired glucose tolerance, type 2 diabetes mellitus, cardiovascular diseases) and psychological features (increased anxiety, depression and worsened quality of life). The exact patho-physiology of PCOS is complex and remains largely unclear. The prevalence of PCOS is estimated at 4-18%, depending on diverse factors discussed ahead. The phenotype varies widely depending on life stage, genotype, ethnicity and environmental factors including lifestyle and body weight. During the last decades, obesity and excess weight are major chronic diseases all around the word. Obesity increases some features of PCOS such as hyperandrogenism, hirsutism, infertility and pregnancy complications. Both obesity and insulin resistance increase diabetes mellitus type 2 and cardiovascular diseases. Moreover, obesity impairs insulin resistance and exacerbates reproductive and metabolic features of PCOS. It is well known that obesity is associated with anovulation, pregnancy loss and late pregnancy complications (pre-eclampsia, gestational diabetes). Obesity in PCOS is also linked to failure or delayed response to the various treatments including clomiphene citrate, gonadotropins and laparoscopic ovarian diathermy. It has been reported that, after losing as little as 5 % of initial body weight obese women with PCOS improved spontaneous ovulation rates and spontaneous pregnancy. Therefore, the weight loss prior to conception improves live birth rate in obese women with or without PCOS. The treatment of obesity may include lifestyle therapy (diet and exercise), pharmacological treatment and bariatric surgery. In summary, weight loss is considered the first-line therapy in obese women with PCOS. In the present review, the consequence and treatment of obesity in women with PCOS are discussed.     

多囊卵巢综合征患者抗苗勒氏管激素与相关临床指标的关系

【摘要】目的 探讨多囊卵巢综合征（PCOS）患者抗苗勒氏管激素（AMH）水平与体质指数（BMI）、激素及代谢指标的关系。方法 将60例PCOS患者和30例不孕患者分为PCOS组1（BMI≥25 kg/m2）、PCOS组2（BMI<25 kg/m2）,每组30例;对照组1（BMI≥25 kg/m2）、对照组2（BMI<25 kg/m2）,每组15例。空腹采血并测定血清卵泡刺激素（FSH）、黄体生成素（LH）、雌二醇、睾酮、血清AMH、空腹血糖和空腹血清胰岛素,计算稳态模型胰岛素抵抗指数（HOMA-IR）,比较4 组的上述指标并进行相关性分析。结果 PCOS 组AMH、LH、LH/FSH、睾酮、空腹胰岛素及 HOMA-IR均高于对照组,PCOS组1和PCOS组2 AMH差异无统计学意义,PCOS组1 LH、LH/FSH低于PCOS组2,空腹胰岛素、HOMA-IR高于PCOS组2。PCOS组AMH与BMI无相关性。PCOS组1 AMH与睾酮、空腹血糖、空腹胰岛素、 HOMA-IR呈正相关,与雌二醇、FSH呈负相关;PCOS组2 AMH与LH、LH/FSH、睾酮呈正相关（均P < 0.05）。结论 PCOS患者血清AMH显著升高,其升高与体质量无关,可能与激素紊乱和糖代谢紊乱有关。     

多囊卵巢综合征合并高胰岛素血症患者的内分泌特征及治疗探讨

目的研究多囊卵巢综合征(PCOS)合并高胰岛素血症(HI)患者的内分泌特征,探讨盐酸二甲双胍治疗的机制及效果。方法测定21例HI和15例非HI的PCOS患者血清瘦素(Leptin)、胰岛素样生长因子1(IGF-1)、IGF结合蛋白1(IGFBP-1)、空腹胰岛素(FINS)、黄体生成素(LH)及睾酮(T)水平,并进行比较。PCOS合并HI者应用盐酸二甲双胍500mg,3次/d,治疗8周,比较治疗前后各指标的变化。结果HI组血清Leptin、FINS水平高于非HI组,血清IGFBP-1低于非HI组。盐酸二甲双胍治疗HI组后,血清Leptin、FINS及T水平降低,血清IGFBP-1增高。结论PCOS是否合并HI其内分泌特征不同,盐酸二甲双胍可以改善PCOS合并HI者的内分泌紊乱。     

MenSCs移植对大鼠多囊卵巢综合征的影响及其机制

目的 探讨经血来源干细胞（MenSCs）移植对多囊卵巢综合征（PCOS）大鼠模型的治疗效果。方法 成年雌性 SD大鼠 45只均分为 3组（n=15）：对照组不作处理；PCOS组肌内注射脱氢表雄酮（DHEA，60 mg/kg）诱导 PCOS；移植组肌内注射 DHEA，饲养 3周后后经尾静脉注射 MenSCs悬液。各组饲养 5周后处死，取静脉血，酶联免疫吸附试验（ELISA）检测促卵泡激素（FSH）、黄体生成素（LH）、雌二醇（E2）、孕激素（P）、睾酮（T）、泌乳素（PRL）水平。取卵巢组织进行 HE染色观察卵巢形态。实时荧光定量检测卵巢组织 miRNA-135表达。Western blot检测卵巢组织 Bax和Bcl-2蛋白表达。结果 相对于对照组，PCOS组的 FSH降低，LH和 T均升高（P＜0.05）；相对于 PCOS组，移植组的FSH升高，LH和 T均降低（P＜0.05）。对照组卵泡形态正常，PCOS组卵巢可见较多囊状扩张的卵泡，移植组多囊状扩张的卵泡较 PCOS组减少。与对照组比较，PCOS组 miRNA-135和 Bcl-2蛋白相对表达水平降低，而 Bax蛋白相对表达水平升高（P＜0.05）；与 PCOS组比较，移植组 miRNA-135和 Bcl-2蛋白相对表达水平升高，Bax蛋白相对表达水平降低（P＜0.05）。结论 经血来源干细胞移植对大鼠 PCOS有明显的改善作用，其机制可能通过上调 miRNA-135的表达，进而调控 Bax/Bcl-2途径来实现。     

Genetic Basis of Metabolic Abnormalities in Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is a common heterogeneous disorder characterized by hyperandrogenism and chronic anovulation. The syndrome is frequently associated with an increased risk for insulin resistance and type 2 diabetes mellitus; obesity exacerbates insulin resistance and favors the progression from impaired glucose tolerance to diabetes in these patients. In young women, precocious pubarche and hyperinsulinemia are early manifestations of PCOS. The familial clustering of women with PCOS suggests that heredity is implicated in the origin of the syndrome. However, genetic approaches to its pathogenesis have been hampered by the heterogeneity of phenotypic features within families, and the lack of uniform criteria for diagnosis. Currently, PCOS is considered a polygenic trait that might result from the interaction of susceptibility and protective genomic variants under the influence of environmental factors. Both linkage analysis and association studies are valid tools for the study of the genetics of PCOS. Candidate genes for PCOS include those related to androgenic pathways and metabolic associations of the syndrome. More recently, genes encoding inflammatory cytokines have been identified as target genes for PCOS, as proinflammatory genotypes and phenotypes are also associated with obesity, insulin resistance, type 2 diabetes, PCOS, and increased cardiovascular risk. This paper reviews the candidate genes involved in the metabolic pathways that are altered in patients with PCOS. Despite a significant amount of research in this area, none of the genes studied so far has been identified as the PCOS susceptibility gene for the majority of cases. PCOS is the first component of the metabolic syndrome to be detected in many women, so the identification and correct diagnosis of PCOS has important preventive and therapeutic implications for the affected women and their families. In the future, new therapeutic approaches to PCOS will rely on knowing the genes, environmental influences, and etiologic mechanisms associated with the disorder.     

雄激素受体在多囊卵巢综合征患者子宫内膜的表达

目的观察多囊卵巢综合征患者子宫内膜雄激素受体表达的改变。方法采用免疫组化法对40例多囊卵巢综合征患者和40例对照子宫内膜雄激素受体表达进行检测。结果 PCOS患者子宫内膜雄激素受体表达较对照组增多,主要表现在腺上皮(P<0.05﹚。结论多囊卵巢综合征患者子宫内膜雄激素受体表达增多,影响子宫内膜容受性,是导致多囊卵巢综合征不育患者促排卵治疗后低妊娠率的原因之一。     

Insulin-sensitisers in the treatment of polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is a common endocrine condition with reproductive and metabolic implications. In the current setting there is an evolving, yet inadequate, understanding of the pathophysiology, long-term health implications and ideal therapies for women with PCOS. Insulin resistance, secondary to both genetic and lifestyle factors, is integrally involved in the pathogenesis, the metabolic and clinical features and the long-term sequelae of PCOS in a majority of patients. Therapeutic strategies targeting insulin resistance ameliorate clinical features and may reduce long-term sequelae of PCOS, including diabetes. The main benefit of improved insulin resistance is to improve fertility and potentially to improve clinical features of hyperandrogenism and lower androgen levels. Insulin sensitisers also have the potential to delay the development of diabetes and cardiovascular disease in PCOS. Lifestyle therapy is indicated as the first intervention; however, metformin as an insulin sensitising agent has a role in first-line medical therapy in women with PCOS. Further research is needed to define the role of insulin sensitisers in PCOS and to determine the long-term risks and benefits of these therapies.