PCOS与青春期胰岛素抵抗

多囊卵巢综合征(polycysticovariansyndrome,PCOS)的发病机制至今不清,近来留意到PCOS多起病于青春期初潮后,其病理生理与青春期的生理变化有一定联系,胰岛素抵抗既是青春期女性正常的生理变化,也是PCOS重要的病理生理改变。因此,了解多囊卵巢综合征与青春期胰岛素抵抗的联系,有助于研究PCOS的发病机制,有望指导早期预测和发现青春期PCOS患者以早期阻断和纠正其内分泌紊乱,同时还对防治与胰岛素抵抗密切相关的如糖尿病、高血压、冠心病等代谢综合征的发生发展具有重要的临床意义。1PCOS的青春期发育亢进学说PCOS的发病机制至今…     

青春期多囊卵巢综合征患者临床特征分析

目的探讨青春期多囊卵巢综合征（PCOS）患者的临床特征。方法回顾性分析2003年1月～2006年5月我院收治的青春期PCOS患者58例的临床资料。结果青春期PCOS患者中,超重者占39．7%,肥胖者占31．0％,月经异常、痤疮、多毛和黑棘皮症发生率分别为87．9％、65．5％、56．9％和6．9％,痤疮和多毛评分明显增高（分别为1．60±1．36和2．16±1．98）,胰岛素抵抗发生率为12．7％。青春中期组与晚期组各项指标比较,差异无显著性（P〉0．05）。结论肥胖、高雄激素血症和胰岛素抵抗是青春期PCOS患者的主要临床特征,应作为青春期PCOS的高危因素在临床上引起重视。     

青春期不同月经方式的多囊卵巢综合征120例育龄期内分泌状态的研究

目的　探讨青春期不同月经方式的多囊卵巢综合征 (PCOS)患者在育龄期内分泌状态。方法　选择12 0例PCOS育龄妇女 ,按青春期月经方式分为三组。测定其血清性激素、胰岛素、血糖 ,并进行分析对比。结果　原发不孕的PCOS患者青春期月经异常的发生率明显高于继发不孕的PCOS患者 (P <0 0 5 )。青春期月经稀发组T及E2 显著高于继发闭经组 ,A显著高于月经规律组 (P <0 0 5 )。继发闭经组胰岛素拮抗指数和BMI显著高于月经规律组 (P <0 0 5 )。结论　在青春期表现有月经稀发和继发闭经的PCOS患者在育龄期有更严重的分泌代谢失调、并伴有较低的妊娠率。     

青春期PCOS的临床与内分泌代谢特征及诊治

多囊卵巢综合征(polycysticovariansyndrome,PCOS)多起病于青春期,是青春期少女的常见疾病,以月经失调和高雄激素为基本特征。青春期PCOS的身体征象,包括高雄激素体征、肥胖甚至黑棘皮症等,不仅有损于少女的形象,而且成年后易发生2型糖尿病、心血管疾病及不孕症。青春期PCOS的早期诊断和治疗,对保证青春期少女的健康是十分必要的。1青春期PCOS的临床及内分泌代谢特征PCOS是一种异质性疾病,其临床表现和生化指标具有多样化特征。典型的临床特征与高雄激素血症和无排卵相关。1.1青春期PCOS的临床症状和体征多毛和痤疮是PCOS高雄激…     

青春期多囊卵巢综合征

主要讨论内容1.青春期PCOS的病理机制2.青春期PCOS病理与正常青春期生理改变的异同3.青春期PCOS与代谢异常4.青春期PCOS的诊断5.青春期PCOS的治疗杨冬梓教授青春期妇科学面对的人群是特定年龄段的女性,这一人群的妇科疾患因其生理特点而与成人不同。多囊卵巢综合征(polycystic     

青春期和育龄期多囊卵巢综合征的临床生化特征分析比较

目的:探讨青春期多囊卵巢综合征(PCOS)患者的临床生化特征.方法:收集2010年8月至2012年10月四川大学华西二院妇产科门诊收治的126例青春期PCOS患者(青春期组)和368例育龄期PCOS患者(育龄期组),分析和比较两组患者的临床及生化指标.结果:(1)青春期组患者的初潮年龄(12.59±1.39)显著低于育龄期组(13.28±5.36)(P＜0.05),但均在正常范围内;高雄症状的程度和发生率均显著高于育龄期组(P＜0.05),体重指数(BMI)、腰围、腰臀比(WHR)和平均舒张压均显著低于育龄期组(P＜0.05);(2)两组的平均血睾酮(T)、LH、FSH、LH/FSH及FINS、HOMA-IR、HDL无显著差异(P＞0.05).青春期组的平均空腹血糖(FPG)、胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白(LDL)、TC/HDL及LDL/HDL均显著低于育龄期组(P＜0.05);(3)青春期组的腰围≥80cm、收缩压≥130mmHg和FPG ≥5.6mmol/L的发生率显著低于育龄期组(P＜0.05).结论:青春期PCOS患者具有PCOS特征性的高雄、代谢障碍问题,需加以关注,并及早治疗.     

青春期多囊卵巢综合征诊断与治疗中的过度与不足

现在的多囊卵巢综合征(PCOS)诊断标准都是针对成人而制定的,而青春期所表现出来的生理特点与PCOS的诊断标准有交叉,将针对成年人的PCOS诊断标准套用于青春期女性,势必造成过度诊断和过度治疗。建议对青春期女性暂不进行PCOS诊断,但不诊断并不意味着对她们不进行治疗,针对青春期出现的各种高雄、月经紊乱症状和代谢问题仍应积极进行相应的治疗。     

青春期多囊卵巢综合征的临床特征与诊断方法

由于青春期生理发育的特征，正常青春期少女也易表现为月经失调，出现雄激素增高体征，以往多被认为是短暂的生理过渡现象而未受到重视。但近年研究表明：多囊卵巢综合征（polycystic ovarian syndrome，PCOS）多起病于青春期，月经失调和高雄激素也是其基本特征。青春期PCOS的征象，包括高雄激素体征、肥胖甚至黑棘皮症等，不仅有损于少女的形象，而且其中25％-35％的PCOS患者到成年（30岁）出现糖耐量受损和糖尿病，[第一段]     

青春期多囊卵巢综合征治疗研究进展

多囊卵巢综合征(PCOS)是育龄期最常见的内分泌疾病,始于青春期。目前,青春期PCOS的诊断尚未明确,成人的诊断标准不完全适合于青春期,生活方式调整常为其一线干预措施,但有越来越多的研究显示胰岛素增敏剂、避孕药、抗雄激素药物及中医疗法对青春期PCOS亦有明显的改善作用。     

新疆维、汉族青春期多囊卵巢综合征特点及治疗探讨

目的:研究新疆维、汉族青春期多囊卵巢综合征(PCOS)的临床特点及复方醋酸环丙孕酮治疗的临床疗效和安全性。方法:调查新疆94例(维族39例,汉族55例)青春期PCOS患者的临床特征并随访观察复方醋酸环丙孕酮治疗6个周期前后的临床特征、血清性激素水平、卵巢超声相的变化以及副反应。结果:(1)临床特征:青春期PCOS患者的初潮年龄与正常女性相同。主要症状为闭经、月经稀发及月经不规律等月经异常。维族患者出现闭经者较汉族多(P<0.05);体检发现多毛,维族患者体毛普遍较汉族多(P<0.05),维族LH/FSH>2者较汉族多;痤疮则表现为汉族多于维族(P<0.05)。月经周期维族较汉族长(P<0.05);(2)治疗后,61例PCOS患者恢复自然月经。多毛和痤疮评分明显下降(P<0.05)。血清各性激素水平,如雌二醇(E2)、黄体生成素(LH)、促卵泡素(FSH)、LH/FSH、睾酮(T)、硫酸脱氢表雄酮(DHEAS)、游离睾酮指数(FAI)均下降,差异有统计学意义(P<0.05),性激素结合球蛋白(SHBG)增加(P<0.05)。双侧卵巢体积及双侧卵泡数量减少(P<0.05)。副反应轻微。复方醋酸环丙孕酮对维、汉族青春期PCOS患者治疗效果无统计学差异。结论:新疆维、汉族青春期PCOS患者的临床表现有一定差异。复方醋酸环丙孕酮可改善青春期多囊卵巢综合征患者的高雄激素症状及内分泌状况,对恢复排卵有一定的疗效。     

单侧多囊卵巢与多囊卵巢综合征的比较研究

目的:探讨单侧多囊卵巢的临床病理特点及病因。方法:收集单侧多囊卵巢12例,与8例典型多囊卵巢综合征对照比较,分析其临床表现、生化参数、卵泡液中相关激素水平以及卵巢间质细胞超微结构。结果:单侧PCO患者临床表现多样,和典型PCOS比较,单侧PCO出现月经改变和不孕显著减少。单侧PCO组血清PRL和T水平显著高于正常对照组,P<0.05;LH水平显著低于PCOS组,P<0.01。单侧PCO卵泡液中T和INS的水平比正常侧卵巢组显著升高,P<0.01;LH水平显著低于PCOS组,P<0.05。单侧PCO间质细胞粗面内质网、光面内质网不同程度出现扩张,部分粗面内质网有脱粒现象;线粒体出现扩张。结论:单侧PCO是一种不同于PCOS的特殊疾病类型,其临床表现多样,对卵巢生殖和内分泌功能的损害比PCOS轻。单侧PCO与PRL和卵巢局部T异常分泌均有关。单侧PCO间质细胞超微结构改变介乎正常卵巢和典型PC0S之间。     

Polycystic ovary syndrome in adolescence and early adulthood

Polycystic ovaries and the associated syndrome are recognized as the most common cause of endocrine disturbances in adult women, but much less research has been performed to examine how polycystic ovary syndrome (PCOS) presents in girls and young women. Polycystic ovaries have been demonstrated in childhood, and there is evidence to show that even very young women may show symptoms and signs of the associated syndrome. Closer examination of younger populations (ˇ- 25 years of age), and in particular, studies of girls during the transition from puberty into early adulthood (adolescence), may provide new insights into the pathogenesis and natural history of polycystic ovaries and PCOS, and may indicate whether polycystic ovaries could potentially be considered as a marker for health screening. Consideration should be given to the management of girls and young women with polycystic ovaries and PCOS as this group may have different needs and health risks compared with older women.     

Polycystic ovary syndrome in adolescence and early adulthood

Polycystic ovaries and the associated syndrome are recognized as the most common cause of endocrine disturbances in adult women, but much less research has been performed to examine how polycystic ovary syndrome (PCOS) presents in girls and young women. Polycystic ovaries have been demonstrated in childhood, and there is evidence to show that even very young women may show symptoms and signs of the associated syndrome. Closer examination of younger populations (less-than-or-eq, slant 25 years of age), and in particular, studies of girls during the transition from puberty into early adulthood (adolescence), may provide new insights into the pathogenesis and natural history of polycystic ovaries and PCOS, and may indicate whether polycystic ovaries could potentially be considered as a marker for health screening. Consideration should be given to the management of girls and young women with polycystic ovaries and PCOS as this group may have different needs and health risks compared with older women.     

Increased risk for polycystic ovary syndrome associated with human leukocyte antigen DQA1*0501.

OBJECTIVE: The objective of this investigation was to identify genes that confer susceptibility to polycystic ovary syndrome. STUDY DESIGN: Nineteen subjects with polycystic ovary syndrome, hirsutism, and elevated plasma androgen levels and 46 fertile, female control subjects were studied. Alleles at the human leukocyte antigen DQA1 locus were identified with dot-blot hybridizations with allele-specific oligonucleotide probes. Associations between human leukocyte antigen DQA1 alleles and polycystic ovary syndrome were examined with logistic regression analysis. RESULTS: The frequency of the human leukocyte antigen DQA1*0501 was 0.50 and 0.26 in subjects with polycystic ovary syndrome and control subjects, respectively (corrected for multiple comparisons, p = 0.067). Homozygosity for this allele was also increased among subjects with polycystic ovary syndrome (p = 0.054). The odds ratios for having polycystic ovary syndrome associated with the *0501 allele and the *0501/*0501 homozygous genotype were 2.8 and 5.8, respectively. CONCLUSION: These data suggest that a polycystic ovary syndrome susceptibility allele is linked to human leukocyte antigen and that the susceptibility allele is recessive.     

The role of metformin in the management of polycystic ovary syndrome

PURPOSE OF REVIEW: The purpose of this review is to provide a critical summary of recent studies on the clinical effects of metformin in polycystic ovary syndrome. RECENT FINDINGS: After the recognition that hyperinsulinaemia is a fundamental disturbance in polycystic ovary syndrome, a novel and promising form of therapy in the form of insulin-sensitizing drugs has been introduced. Among these, metformin is the most widely used. This therapeutic intervention has been shown to exert beneficial effects on the endocrine and metabolic disturbances that characterize the syndrome and, more recently, to improve the reproductive outcome in women with polycystic ovary syndrome. With rapid progress in this area, metformin use has also been extended to the management of lean polycystic ovary syndrome patients. SUMMARY: Although most studies are nonrandomized trials, current data provide a rationale for metformin as first-line management for women with polycystic ovary syndrome, alone or in combination with conventional treatments. Controversy still exists, however, regarding the mechanisms by which metformin exerts its beneficial effects in polycystic ovary syndrome.     

Perspectives on the International Recommendations for the Diagnosis and Treatment of Polycystic Ovary Syndrome in Adolescence

Recommendations have been provided for the diagnosis and therapy of polycystic ovary syndrome in adolescence from 3 international expert conferences 2015-2018. Despite agreement about essentials, differences among details of these recommendations have engendered confusion. This commentary provides perspective about the agreements and disagreements among these recommendations and how these recommendations relate to other guidance. It concludes with practice suggestions that align with these recommendations.     

Induction of ovulation in infertile women with hyperandrogenism and insulin resistance

The polycystic ovary syndrome is a common cause of anovulatory infertility. Women with severe insulin resistance are a unique subset of polycystic ovary syndrome. The syndrome of hyperandrogenism, insulin resistance, and acanthosis nigricans (HAIR-AN syndrome) is one presentation of the insulin-resistant subset of polycystic ovary syndrome. Insulin resistance and hyperandrogenism are caused by genetic and environmental factors. In women with anovulatory infertility caused by hyperandrogenism and insulin resistance, clomiphene citrate treatment often fails to result in pregnancy. For these women, weight loss and insulin sensitizers can be effective methods of inducing ovulation and pregnancy and may reduce the number of clomiphene-resistant women with polycystic ovary syndrome who are treated with gonadotropins, ovarian surgery, or in vitro fertilization-embryo transfer.     

多囊卵巢综合征流行病学特点

多囊卵巢综合征（PCOS）是一种常见的生殖内分泌紊乱性疾病,不同国家和地区对PCOS患病率及临床特点的相关流行病学报道均存在差异,文章对PCOS的相关流行病学特点进行总结并阐述。     

Steroidogenic acute regulatory protein (StAR) in the ovaries of healthy women and those with polycystic ovary syndrome

OBJECTIVE: Polycystic ovary syndrome is the most common cause of oligo-ovulation, affecting approximately 4% of women. A primary defect of steroidogenesis resulting in increased ovarian and adrenal androgen production may be responsible for polycystic ovary syndrome, at least in some patients. Because the action of the steroidogenic acute regulatory protein (StAR) initiates the process of steroidogenesis, we proceeded to test the hypothesis that increased production or concentration of StAR may result in the abnormality of steroidogenesis found in polycystic ovary syndrome. STUDY DESIGN: We examined the ovaries from 10 healthy women and 7 women with polycystic ovary syndrome, determining the relative concentration of StAR in total protein extracts by use of Western blotting, and the overall distribution and staining intensity of StAR in prepared tissue sections. RESULTS: Overall the ovaries of healthy women and women with polycystic ovary syndrome demonstrated a similar prevalence and size of follicular cysts, although the ovaries of women with polycystic ovary syndrome had a greater mean number of follicular cysts. In general, the distribution of StAR immunoreactivity within most of the ovarian structures was not different in the ovaries of women with polycystic ovary syndrome compared to those of the healthy ovaries. However, the ovaries from the cases demonstrated a significantly greater number of follicular cysts with staining for StAR immunoreactivity in the thecal cells than did the ovaries from healthy women (100% vs 38%, P <.05). CONCLUSION: These data suggest that the exaggeration in androgen biosynthesis in the ovaries of patients with polycystic ovary syndrome may be occurring at its earliest step (ie, that involving StAR), such that an increased amount of cholesterol is made available for androgen biosynthesis in the polycystic ovary.     

Further evidence concerning catecholamine metabolism in polycystic ovary syndrome following Gn-RH administration.

The role of catecholamine activity in the GnRH-LH system among cases of polycystic ovary syndrome was investigated by high-performance liquid chromatography using an electrochemical detector. We measured plasma levels of catecholamine metabolites, 3-methoxy-4-hydroxyphenylglycol (MHPG) and 3,4-dihydroxyphenylacetic acid (DOPAC), in relation to LH-RH administration in 23 women with polycystic ovary syndrome. MHPG concentrations were significantly higher in polycystic ovary syndrome patients than in ten control subjects in early follicular phase. The peak values of LH after LH-RH administration were significantly correlated with plasma MHPG concentrations. These data suggest that an excess of norepinephrine is present in polycystic ovary syndrome and that the hypophyseal response to LH-RH administration is correlated with catecholamine, especially norepinephrine activity.