脂联素在多囊卵巢综合征中作用机制的进展

多囊卵巢综合征(PCOS)是育龄期女性最常见的生殖内分泌疾病,主要特征为排卵功能障碍、卵巢多囊样改变、高雄激素血症。PCOS的临床特征具有复杂性和异质性,其发生发展与脂肪组织功能失常密切相关。脂联素是脂肪组织来源的脂肪因子,目前多项研究显示,在PCOS患者及DHEA诱导的PCOS大鼠模型中脂联素的水平显著降低,而脂联素水平与肥胖、胰岛素抵抗、炎症等密切相关。本文主要从激素合成、代谢、炎症等方面阐述脂联素在PCOS发生发展过程中的分子机制,以期为PCOS的诊断和治疗提供一定参考。     

腹型肥胖与多囊卵巢综合征

腹型肥胖、超重和肥胖是多囊卵巢综合征（PCOS）的常见症状。腹型肥胖和胰岛素抵抗可能引起卵巢和肾上腺分泌过多的雄激素,而雄激素过多分泌本身就可引起脂肪向腹部沉积。PCOS患者内脏脂肪的最新基因组学和蛋白组学研究发现其基因表达和蛋白质组成存在异常。本文综述了有关雄激素过多引起腹壁脂肪沉积,进一步促进PCOS患者卵巢和肾上腺雄激素的过多分泌的机制。     

减重手术在多囊卵巢综合征治疗中的作用

多囊卵巢综合征（polycystic ovarian syndrome,PCOS）是女性常见内分泌紊乱性疾病,其发生率近10%。表现为无排卵、高雄激素血症及超声显示卵巢的多囊改变。多数患者伴有代谢综合征（metabolic syndrome,MS）,表现为高血压、高血脂、肥胖、胰岛素抵抗及糖耐量异常。     

减重手术治疗多囊卵巢综合征的研究进展

多囊卵巢综合征（ polycystic ovary syndrome , PCOS）是育龄期妇女常见的一种内分泌代谢异常性疾病,以慢性无排卵、高雄激素血症和卵巢多囊样改变为主要特征。 PCOS 患病率为5％～10％［1］。PCOS存在胰岛素抵抗（ homeostatic model assessment for insulin resistance,HOMA-IR）、高雄激素血症、高泌乳素血症、肥胖等代谢异常。虽然目前有针对不同情况的PCOS的内分泌药物治疗方法,但药物治疗对PCOS的肥胖效果不佳［2］,且存在症状反复的可能性。同时肥胖的远期并发症也将严重威胁患者的健康,因此,减轻体重对PCOS患者的治疗十分重要。但实际上很多患者依靠运动、节食等方法减重效果十分有限,因此,探讨手术减重对PCOS具有十分重要的意义。本文对减重手术治疗PCOS的代谢效果及可能机制进行综述。     

胰岛素抵抗与多囊卵巢综合征

多囊卵巢综合征(PCOS)是妇科常见的内分泌疾病,其发病机理可能涉及下丘脑、垂体、肾上腺、胰岛素抵抗、肥胖等多种因素。国外对胰岛素抵抗的研究较多,现就胰岛素抵抗与PCOS进行综述。     

肠道菌群在多囊卵巢综合征中作用的研究进展

多囊卵巢综合征(PCOS)是育龄期女性最常见的生殖内分泌疾病,主要特征为排卵功能障碍、卵巢多囊样改变和高雄激素血症。此外,临床上PCOS还常伴随肥胖和胰岛素抵抗。PCOS的临床特征具有复杂性和异质性,其发病机制一直是该领域的研究热点。近年来多项研究发现,PCOS发生发展与肠道菌群密切相关。在PCOS患者以及多种PCOS动物模型中,肠道菌群均发生改变,而菌群的改变与雌、雄激素水平、免疫和代谢异常有一定相关性。因此,本文主要从性激素合成、免疫和代谢三个方面阐述肠道菌群参与PCOS发生发展过程的分子机制,以期为PCOS的诊断和治疗提供一定参考。     

减重手术治疗多囊卵巢综合征

正多囊卵巢综合征(polycystic ovarian syndrome,PCOS)是育龄女性常见的内分泌代谢紊乱性疾病,表现为无排卵、高雄激素血症及超声显示卵巢的多囊性改变,约60%的PCOS伴有肥胖。肥胖伴有的代谢综合征主要包括2型糖尿病、PCOS、高血压、睡眠呼吸暂停及高脂血症。减重手术治疗2型糖尿病已得到广泛认可,而对PCOS的作用文献报道尚少。PCOS能否与2型糖尿病一样,成为用代谢手术治疗     

腹腔镜治疗多囊卵巢综合征

1简介 多囊卵巢综合征（polycystic ovarian syndrome,PCOS）是一种常见的内分泌疾病,在育龄期女性中的发病率为6％～8％,是导致无排卵性不孕最常见的原因（约75％）。诊断依据临床表现（肥胖、月经稀发／闭经,多毛）,生化改变（血清黄体生成素及雄激素水平升高）及超声影像特点（卵巢多囊样增大）。PCOS患者还可能存在胰岛素抵抗及代偿性的高胰岛素血症。     

脂代谢异常与多囊卵巢综合征

多囊卵巢综合征(PCOS)是一种异质性内分泌紊乱,与生殖异常(高雄激素血症、月经过少/闭经、不孕症、妊娠并发症增加)及代谢异常(脂代谢异常、代谢综合征和冠心病)有关。PCOS与代谢紊乱的关系已有大量研究,且大多研究表明PCOS妇女中的血脂异常较非PCOS的同龄妇女中更普遍,与肥胖及胰岛素抵抗密切相关。本文就肥胖相关的脂代谢异常与PCOS的关系做一综述,以便为PCOS的筛查、诊断、治疗及预防远期并发症提供临床指导。     

多囊卵巢综合征患者胰岛素抵抗的研究进展

多囊卵巢综合征(PCOS)是一种常见的影响生育功能的妇科内分泌疾病,被认为与遗传、代谢、内分泌及环境等多因素相关。PCOS患者的胰岛素抵抗增加了2型糖尿病、高血压、脂质代谢异常等发生的风险,越来越多的研究开始关注PCOS患者的胰岛素抵抗,本文从胰岛素抵抗的发生机制、评估、治疗等方面阐述其在PCOS中的研究进展。     

同型半胱氨酸在多囊卵巢综合征中的研究进展

多囊卵巢综合征(PCOS)是女性常见的内分泌疾病,主要以排卵障碍、卵巢呈多囊样改变和高雄激素血症为特征。同型半胱氨酸(Hcy)是在蛋氨酸循环期间形成的含硫氨基酸,最新发现高同型半胱氨酸血症(HHcy)与PCOS密切相关,影响着PCOS的卵母细胞质量、高雄激素血症、胰岛素抵抗(IR)和高胰岛素血症,并且是其远期并发症如不良妊娠结局、心血管疾病、妊娠糖尿病的潜在危险因素。本文综述近年Hcy与PCOS的相关研究,旨在为PCOS临床诊断和治疗提供新的依据。     

Development of polycystic ovary syndrome: involvement of genetic and environmental factors

We have recently proposed that polycystic ovary syndrome (PCOS) has its origin in fetal life. This hypothesis is based on data from animal models (rhesus monkey or sheep that have been exposed prenatally to high doses of androgen) and is supported by clinical studies. It is suggested that, in human females, exposure to excess androgen, at any stage from fetal development of the ovary to the onset of puberty, leads to many of the characteristic features of PCOS, including abnormalities of luteinizing hormone secretion and insulin resistance. It is likely that, in humans with PCOS, the development of the PCOS phenotype results primarily from a genetic predisposition for the fetal ovary to hypersecrete androgen. At present, it is unclear whether the maternal environment directly influences the development of PCOS in the offspring. Maternal androgen excess is unlikely to affect the fetus, because the placenta presents an effective barrier, but metabolic disturbances during pregnancy could affect development of the syndrome in the fetus. In postnatal life, the natural history of PCOS can be further modified by factors affecting insulin secretion and/or action, most importantly, nutrition. We now have evidence for a disorder of early follicular development in the polycystic ovary that is consistent with an increased population of primordial follicles in the fetal ovary. It remains to be determined whether this phenomenon is the cause or the effect of increased exposure to androgen within the ovary. PCOS is the commonest endocrine disorder in women. It is not only a very prevalent cause of anovulatory infertility, menstrual disturbances and hirsutism, but it is also a major risk factor for the development of type 2 diabetes mellitus in later life. The aetiology of the syndrome remains uncertain but there is increasing evidence for a genetic basis. PCOS very often becomes clinically manifest during adolescence with maturation of the hypothalamic-pituitary-ovarian axis but the genesis of the syndrome may be during very early development - perhaps even in utero. In this review, this hypothesis is explored in the light of clinical, biochemical and genetic research.     

双酚A与多囊卵巢综合征相关性的研究进展

双酚A(BPA)是一种具有雌激素活性的内分泌干扰化学物,广泛用于塑料制品中。长期暴露于BPA可对机体内分泌产生不良影响,导致一些疾病的发生,其中BPA与多囊卵巢综合征(PCOS)的关系尤其受到关注。PCOS的病因至今不明,BPA作为环境干扰物可能参与了PCOS的发病,其作用机制可能与BPA结合雌激素受体、干扰非基因组细胞信号系统及调节卵巢内相关酶及因子等有关。现将BPA与PCOS的相关性及其可能的作用机制进行总结。     

Increased risk of psychiatric disorders in Chinese women with polycystic ovary syndrome

<正>Objective:To assess the psychological health status and quality of everyday life of women with polycystic ovary syndrome(PCOS). Methods:A total of 846 patients were assessed with Self-Rating Anxiety Scales(SAS) and Self-Rating Depression Scales(SDS)(292 of PCOS patients,294 of non-PCOS infertile patients and 260 of healthy control).Specific questionnaires were employed to rate the quality of everyday life and adverse effects of different psychiatric factors. Results:The scores of SDS and SAS of PCOS patients were higher than those of non-PCOS infertile patients and healthy control.In addition,the negative psychiatric and psychological impact of PCOS was severe.The quality of everyday life in PCOS patients was undermined to certain extents. Conclusions:The features of polycystic ovary syndrome bring stress to patients,causing psychological disorder. The quality of everyday life in affected women is impaired partly.These results implicate that psychological support should be considered in the treatment of PCOS-associated infertility.     

B超引导下小卵泡穿刺术联合二甲双胍治疗多囊卵巢综合征的临床研究

目的探讨B超引导下经阴道卵泡穿刺术联合二甲双胍治疗多囊卵巢综合征（PCOS）临床效果。方法46例PCOS不育患者分为两组,A组（n=21）行B超引导卵泡穿刺术,B组（n=25）卵泡穿刺术联合二甲双胍治疗,观察穿刺术前后血内分泌水平和卵巢窦卵泡数变化及比较术后3个月两组内分泌水平和妊娠率。结果穿刺术前后比较,两组两侧卵巢的窦卵泡数均显著减少（P〈0．01）;A组血黄体生成素（LH）和睾酮（T）水平有所下降,B组LH和T水平则显著降低（P〈0．05）;穿刺术后3个月,两组空腹胰岛素（FINS）、LH和T水平比较有显著性差异（P〈0．05）,妊娠率两组比较无显著差异。结论B超引导下经阴道卵泡穿刺术联合二甲双胍治疗PCOS,能更有效改善PCOS患者内分泌异常。     

Is polycystic ovarian syndrome a risk factor for urolithiasis?

Urinary stone disease is a complex multifactorial disorder influenced by both intrinsic and environmental factors. It is generally known that age and sex are risk factors for urinary stone disease. Also men have higher mean urinary oxalate concentrations than women. In addition, in animal and human studies, testosterone has been shown to increase the formation of urinary stones. This suggests that sex hormones are considered to be involved in the pathogenesis of stone disease. Polycystic ovary syndrome (PCOS) is one of the most frequent endocrine disorders of women in the reproductive age, affecting 5–10 % of women in this life span. It is characterized with chronic anovulation\oligo-ovulation, clinical or biochemical evidence of hyperandrogenism and polycystic ovaries on ultrasound examination. Hyperandrogenism, the main feature of PCOS, may trigger the urinary stone formation besides hirsutism, alopecia and acne. Therefore, we hypothesize that PCOS accompanied by hyperandrogenism may be a risk factor in the formation of urinary stone disease.     

达英-35联合二甲双胍治疗克罗米芬不敏感型多囊卵巢综合征的疗效观察

目的观察达英-35、二甲双胍及两者联合应用对克罗米芬(CC)不敏感型多囊卵巢综合征(PCOS)患者内分泌指标及临床结局的影响。方法将90例对CC不敏感的PCOS患者随机分为3组。A组(达英-35)30例,B组(二甲双胍组)30例,C组(达英-35与二甲双胍联合组)30例。服用3个月后,再用CC促排卵,观察各组内分泌指标的变化及排卵率、妊娠率。结果 A组治疗后LH、T水平较治疗前显著下降(P0.01);B组治疗后LH、T、BMI水平较治疗前下降(P0.05),治疗后FINS水平较治疗前显著下降(P0.01);C组治疗后LH、T、FINS及BMI水平较治疗前均有显著下降(P0.01);C组的排卵率及妊娠率显著高于A组和B组。结论达英-35与二甲双胍联合应用对PCOS患者进行预治疗,可有效改善PCOS患者内分泌紊乱,增强对CC的敏感性,提高排卵率及妊娠率,是治疗CC不敏感型PCOS患者的理想方案。     

维生素D与多囊卵巢综合征相关性的研究进展

维生素D缺乏在多囊卵巢综合征(PCOS)妇女中常见,它与PCOS妇女的胰岛素抵抗、高雄激素表现、心血管疾病危险及生育功能下降有关。适当补充维生素D可减轻PCOS的危险因素,改善PCOS妇女的健康。     

The etiopathogenetic hypotheses in polycystic ovary

First described in 1935, polycystic ovary syndrome (PCOS) is a frequent endocrine disease (6% in female population). However its pathogenicity is not yet completely understood. The possible etio-pathogenic mechanisms include: neuroendocrine disorders (hypothalamic, as a result of congenital androgenism or of disorders of neurotransmitters or pituitary, with excess of LH), ovarian disorders (enhanced sensibility at LH, local growth factors, hyperactivity of Cit P450cl7 alpha enzymes), adrenal disorders, insulin resistance, genetic determinism, puberty onset. The authors discuss in detail this hypothesis and these possible importance.