多囊卵巢综合征诊断及分型的研究与进展

多囊卵巢综合征（polycystic ovary syndrome,PCOS）是青春期及育龄期妇女最常见的一种内分泌紊乱性疾病,以月经稀发或闭经、临床上高雄表现或高雄激素血症和多囊卵巢作为特征,经常伴有胰岛素抵抗（IR）、代偿性高胰岛素血症和肥胖。临床表现有月经紊乱、稀发或闭经、多毛、黑棘皮现象、肥胖、不孕、双侧卵巢多囊样改变（PCO）等,     

多囊卵巢综合征IGF-Ⅰ、IGFBP-1相关因素探讨

目的探讨多囊卵巢综合征(PCOS)患者胰岛素生长因子-Ⅰ(IGF-Ⅰ)、胰岛素生长因子结合球蛋白-1(IGFBP-1)水平与肥胖、性激素、糖代谢各项指标之间的关系。方法测定31例PCOS研究组和29例健康对照组IGF-Ⅰ、IGFBP-1水平及肥胖、性激素、糖代谢各项指标,比较两组间差异;分析研究组IGF-Ⅰ、IGFBP-1水平与其他各项指标之间相关性。结果研究组IGFBP-1,性激素结合球蛋白(SHBG)低于对照组,体重指数(BMI),臀围比值(WHR),多毛评分(F-G评分),黄体生成素(LH),黄体生成素/卵泡刺激素(LH/FSH),总睾酮(T),游离睾酮(FT),雄烯二酮(A2),硫酸脱氢表雄酮(DHEAS),空腹胰岛素(FINS),胰岛素抵抗指数(HomaIR)高于对照组,差异均有显著性(P0.001～0.05),IGF-Ⅰ,FSH,雌二醇(E2),17羟孕酮(17-OHP),泌乳素(PRL),空腹血糖(FBG)差别无显著性(P0.05)。研究组中IGFBP-1与BMI呈负相关(r=-0.372,P0.05),与FINS呈负相关(r=-0.481,P0.01),与SHBG呈正相关(r=0.504,P0.01),IGF-Ⅰ与各指标之间无明显相关性。结论 IGFBP-1与PCOS患者肥胖、空腹胰岛素水平密切相关。     

异常月经周期与多囊卵巢综合征的相关性分析

目的分析异常月经周期与多囊卵巢综合征的相关性。方法调查2009年10月-2010年1月期间,在北京妇产医院和北医三院生殖中心的门诊病人810例并采用2003年鹿特丹标准诊断多囊卵巢综合征,分析两者间的关系。结果 1.810名妇女中月经周期异常占68.9%(558/810)。月经稀发和闭经占异常月经周期的99.1%(553/558),月经稀发所占比例最高(65.6%,366/558),月经频发比例最小(0.9%,5/558)。2.随着年龄的增加,月经稀发与闭经的发生率呈逐渐降低的趋势,而正常月经周期所占的比例则逐渐增加(P=0.000)。3.多囊卵巢综合征有523例。在月经稀发患者中多囊卵巢(PCO)占83.3%(305/366);高雄激素血症(HA)占52.7%(193/366)。闭经患者中多囊卵巢占90.4%(169/187);高雄激素血症占61.5%(115/187)。月经稀发和闭经PCOS患者中,均以月经稀发/闭经(O)+多囊卵巢(P)+高雄(H)最多见。O+H亚型与O+P+H比较,O+H主要以月经稀发为主,而O+P+H的闭经率则显著高于经典型O+H。结论月经稀发与PCOS关系密切,可以作为PCOS的第一步筛查指标。要重视月经周期超过35天的妇女。     

Clinical Observation of Acupoint Catgut-embedding Therapy in Treating Obesity-type Polycystic Ovarian Syndrome

[目的]观察定位埋线治疗肥胖型多囊卵巢综合征(PCOS)患者的临床疗效.[方法]14例肥胖型PCOS患者均采用穴位埋线治疗3个月,治疗前后检测患者的体质量指数( BMI),检测黄体生成素(LH)、睾酮(T)、空腹血糖、空腹胰岛素、餐后2h血糖、餐后2h胰岛素水平及计算胰岛素抵抗指数(HOMA-IR),对各观察指标分别进行治疗前后比较.[结果](1) 14例患者治疗前均有月经稀发或闭经表现,经过穴位埋线治疗后有8例恢复周期在45 d内自行月经来潮,超过45 d仍未来经者予口服孕酮使之撤药性出血.其中合并不孕者10例,有2例分别在治疗第3个月和第4个月时成功宫内妊娠.(2)体质量、血睾酮和LH水平、BMI、空腹胰岛素和餐后2h胰岛素水平及HOMA-IR值治疗前后比较,差异均有统计学意义(P＜0.05或P＜0.01),空腹血糖、餐后2h血糖治疗前后比较,差异无统计学意义(P＞0.05).[结论]穴位埋线可有效控制肥胖型PCOS患者的体质量,并能有效调节患者的内分泌激素水平,值得临床推广应用.     

多囊卵巢综合征合并甲状腺功能减退的相关性研究

目的 探讨多囊卵巢综合征(PCOS)合并甲状腺功能减退与高雄激素血症和高胰岛素血症及月经紊乱的相关性.方法 270例育龄期多囊卵巢综合征患者作为观察组,225例月经规律的不孕患者(非多囊卵巢综合征患者)作为对照组,比较两组患者的甲状腺激素(TSH、FT3、FT4),根据有无甲状腺功能异常将观察组分为甲减组和非甲减组,比较两组患者多囊卵巢综合征(PCOS)主要症状的发生概率.结果 观察组中17.41％(47/270)的患者伴有甲状腺功能减退,对照组中8.00％(18/225)的患者伴有甲状腺功能减退,TSH与FT3差异有统计学意义,与FT4差异无统计学意义.伴甲减的PCOS患者中伴高雄激素血症、高胰岛素血症、肥胖、月经紊乱的发生比例分别是38.28％、46.81％、31.91％、44.68％,高于对照组,除肥胖外,其余差异均有统计学意义.结论 PCOS患者中有大多数患者伴有甲状腺激素分泌异常,甲状腺功能减退与多囊卵巢综合征之间有密切联系,且高雄激素血症、高胰岛素血症、月经紊乱的发生概率均较高.     

miRNA-21在多囊卵巢综合征患者中的临床诊疗意义

目的探究mi RNA-21在PCOS患者中的临床诊疗意义。方法选择在我院妇产科检查的PCOS患者24例,其中合并肥胖患者13例。随机选取26例经诊断无雄激素过多或排卵功能异常的健康对照女性,其中有一半人群肥胖。本次研究将分为PCOS患者的观察组、女性健康对照组。所有入组的患者首先检测睾酮、雄烯二酮、雌激素、胆固醇、血糖、胰岛素和hs-CRP生化指标。q RT-PCR检测外周血mi RNA-21的表达水平。结果观察组和对照组的体重正常或肥胖患者,睾酮和雄烯二酮显著高于对照组患者(P0.05)。同时,观察组肥胖患者雌激素水平明显低于对照组肥胖患者(P0.05),而胰岛素和hs-CRP高于对照组肥胖患者(P0.05)。另外,观察组肥胖患者mi RNA-21外周血表达水平明显高于对照组肥胖患者(P0.05)。结论 PCOS患者高雄激素和肥胖相关,且促进外周血mi RNA-21的表达。雄激素特别是睾酮在mi RNA对PCOS患者的疾病发展过程中起到重要的作用。     

高雄激素性月经异常的早卵泡期内分泌表现

月经异常是临床上的常见病多发病,可以有各 种各样的表现。我们选择一组高雄激素性月经稀发、月经量过少、闭经的病人作为受试组,在早卵泡期采 血做六项性激素、硫酸脱氢表雄酮和胰岛素测定,并 与月经周期正常的健康妇女相比较,以期了解这类 月经异常的发病机理。现将结果报告如下。 资料和方法 一、选择血睾酮>60ng/dl的月经稀发、月经量过少、闭经的病人,在临床排除了多囊卵巢综合征后     

多囊卵巢综合征与抗苗勒氏管激素的相关分析

目的探讨抗苗勒氏管激素（AMH）与多囊卵巢综合征（PCOS）的发生、发展的关系；方法测定56例PCOS患者血清AMH、性激素并与30例正常妇女进行对照；结果PCOS组血清AMH明显高于对照组，PCOS组中高睾酮组AMH明显高于非高睾酮组，差异有极显著性；PCOS组中血清AMH水平与睾酮水平呈显著相关（r=0．713，P=0．001）；结论AMH可能参与PCOS卵泡发育异常的发生、发展并与性激素合成失调有关，测定血清AMH水平为诊断和研究PCOS提供了一个重要的突破点。     

多囊卵巢综合征妇女内源性胰岛素释放与睾酮反应的相关性研究

本研究以36例PCOS妇女和20例正常月经周期妇女为研究对象。通过测定激素基础水平,观察在糖耐量试验中胰岛素对糖负荷的反应和睾酮的变化以及分析体脂与胰岛素的关系。发现PCOS妇女有较高的空腹血糖水平、空腹血清胰岛素与空腹血清睾酮呈显著正相关(r=0.65,P<0.01)。在糖负荷期PCOS组血清胰岛素释放显著高于对照组(P<0.01),同时,总睾酮与总胰岛素呈正相关(r=0.69,P<0.01)。PCOS肥胖者总胰岛素对糖负荷的反应最大,对照非肥胖者反应最小(F=3.02,P<0.01)。PCOS妇女体脂百分率与空腹血清胰岛素呈正相关(r=0.523,P<0.05)。由此提示(1)PCOS妇女内源性胰岛素释放是PCOS雄激素增高的原因之一;(2)PCOS妇女体脂过多可能在PCOS的高胰岛素血症和胰岛素抵抗中起有部分作用。     

多囊卵巢综合征女性一级亲属胰岛素抵抗及高雄激素血症的临床分析

目的检测多囊卵巢综合征（PCOS）一级亲属的胰岛素及雄激素水平,进一步分析其胰岛素抵抗或高雄激素血症的发病情况。方法选择50例PCOS一级亲属为实验组,50例无PCOS家族史的正常健康者作为对照组,检测两组胰岛素、血脂、血糖、瘦素以及生殖激素睾酮、雄烯二酮水平情况。结果与正常对照组相比,PCOS一级亲属血脂、血糖明显高于对照组,胰岛素敏感性指数降低,胰岛素抵抗指数显著升高（P〈0．05）;游离睾酮、雄烯二酮与对照组差异明显,明显高于正常水平（P〈0．05）,血清瘦素水平与正常组间无明显差异。结论PCOS女性一级亲属较正常健康者更易诱发胰岛素抵抗及高雄激素血症,更容易并发PCOS。     

两种SD大鼠多囊卵巢综合征模型的比较研究

目的比较两种SD大鼠多囊卵巢综合征动物模型的建模效果。方法建立两种PCOS动物模型。观察各组大鼠卵巢形态学、性激素及空腹血糖和胰岛素的变化。结果DHEA建模组大鼠的体重显著低于对照组（P〈0．05）;hCG建模组大鼠卵巢重量和体积均显著高于对照组（P〈0．05）。两建模组大鼠卵巢卵泡多呈囊性扩张,颗粒细胞层数减少,卵泡膜细胞、间质细胞增生。两建模组大鼠血清T、FINS、FBG和HOMA指数均显著高于对照组（P〈0．05）;DHEA建模组LH水平较对照组无显著性差异;hCG建模组大鼠血清LH、LH／FSH比值均显著高于对照组（P〈0．05）。DHEA建模组FSH水平显著高于对照组（P〈0．05）。结论利用hCG诱导SD幼年雌性大鼠出现了与PCOS患者极为相似的卵巢病理改变及LH、雄激素水平升高和胰岛素抵抗等典型内分泌变化,其建模效果优于DHEA。     

Androgen excess is associated with the increased carotid intima-media thickness observed in young women with polycystic ovary syndrome

BACKGROUND: We evaluated carotid intima-media thickness (CIMT) as an early marker of atherosclerosis, as well as its main determinants among androgen excess, obesity and insulin resistance, in patients with polycystic ovary syndrome (PCOS). METHODS: We selected 40 PCOS patients and 20 non-hyperandrogenic women who were similar in terms of age and grade of obesity. Complete clinical, metabolic and hormonal profiles and left common CIMT measurements were obtained. RESULTS: Patients with PCOS presented with increased mean CIMT values when compared with controls (F = 8.575; P = 0.005), and this was independent of obesity. Five PCOS patients but no controls had increased CIMT values. CIMT correlated directly with serum total and free testosterone, androstenedione and dehydroepiandrosterone-sulfate levels and mean 24-h heart rate (HR), and inversely with the insulin sensitivity index (ISI), but no correlation was observed with the body mass index (BMI). Multiple stepwise linear regression models showed that in PCOS patients, the main determinants of CIMT were serum total testosterone or androstenedione concentrations, with no influence of ISI or the mean 24-h HR. CONCLUSIONS: Compared with control women, PCOS patients present with an increased CIMT, independent of obesity and related directly to androgen excess; this suggests that hyperandrogenism is associated with atherosclerosis and cardiovascular risk in these women.     

白细胞介素18和白细胞介素10参与多囊卵巢综合征发病的初步研究

目的探讨血清炎症因子白细胞介素18（IL-18）、白细胞介素10（IL-10）与多囊卵巢综合征（PCOS）发病的关系。方法选取48例PCOS患者和32例对照,分为肥胖组与非肥胖组。测定血清空腹血糖（FBG）、空腹胰岛素（FINS）、卵泡刺激素（FSH）、黄体生成素（LH）和睾酮（T）;酶联免疫吸附试验（ELISA）方法检测血清IL-18、IL-10。结果 PCOS组血清IL-18水平高于对照组,IL-10水平低于对照组,差异有显著性;PCOS肥胖组与非肥胖组相比,IL-18水平升高,IL-10水平下降,差异有显著性;两PCOS组与各自对照组相比,IL-18水平升高,IL-10水平下降,差异有显著性。PCOS组患者血清IL-18与BMI、WHR、FINS及HOMA-IR呈显著正相关,血清IL-10与WHR、FINS及HOMA-IR呈显著负相关。结论 PCOS患者血清中IL-18水平明显升高,IL-10水平明显下降,并且在肥胖的PCOS患者中升高和下降的更明显。慢性炎症可能参与PCOS的发病,并且与胰岛素抵抗和肥胖有关。     

Follistatin and activin A serum concentrations in obese and non-obese patients with polycystic ovary syndrome.

BACKGROUND: Activin promotes ovarian follicular development, inhibits androgen production and increases FSH and insulin secretion. Follistatin, an activin-binding protein, neutralizes activin bioactivity. Therefore, a decrease in the ratio of activin/follistatin might encourage characteristic features of polycystic ovary syndrome (PCOS). We investigated whether women with PCOS showed disordered follistatin and/or activin serum concentrations. METHODS: The study group included 24 obese and 20 non-obese (body mass index vertical line and <27 kg/m2 respectively) clomiphene-failure PCOS patients. The control group included 16 obese and 46 non-obese patients with normal ovulatory cycles. Blood samples were obtained from the patients on day 3-5 of a progesterone-induced or spontaneous cycle and were assayed for LH, FSH, testosterone, 17-hydroxy-progesterone, androstenedione, follistatin, activin A, fasting glucose and insulin. RESULTS: Follistatin concentrations were comparable between obese and non-obese PCOS patients (mean +/- SE; 1171 +/- 103 and 1045 +/- 159 pg/ml respectively) and significantly higher than their respective controls (628 +/- 61 and 592 +/- 49 pg/ml, P < 0.0001 and P < 0.02 respectively). Activin A concentrations were comparable between the four groups (590 +/- 35, 513 +/- 74, 661 +/- 87 and 595 +/- 43 pg/ml in obese and non-obese PCOS and controls respectively). Stepwise regression analyses for relationships between follistatin or activin A levels and all other variables indicated that follistatin was significantly and independently positively affected by PCOS (P < 0.0001), age (P < 0.02), androstenedione (P < 0.03) and weight (P < 0.05). Activin A was significantly and independently negatively affected by PCOS (P < 0.003) and FSH (P < 0.03), and positively affected by weight (P < 0.009) and androstenedione (P < 0.02). CONCLUSIONS: Serum follistatin is increased in PCOS patients, regardless of obesity. PCOS is the most significant variable that relates to high follistatin and low activin A serum concentration. A high follistatin/activin ratio could well contribute to the pathophysiology of PCOS.     

Serum anti-Müllerian hormone levels remain high until late reproductive age and decrease during metformin therapy in women with polycystic ovary syndrome

BACKGROUND: Anti-Müllerian hormone (AMH) is secreted by granulosa cells of ovarian early developing follicles and its serum levels have been shown to correlate with small antral follicle number. Since the pronounced androgen secretion from follicles/stroma in women with polycystic ovary syndrome (PCOS) remains until late reproductive age, and since AMH reflects the number of antral follicles, it was of interest to study the possible age-related relationship between AMH, androgens and follicle number in women with PCOS and in control women. Moreover, the possible effect of metformin on serum AMH levels and the relationship to follicle count and volume were studied. METHODS: Forty-four healthy women (aged 21-44 years) and 65 women with previously diagnosed PCOS (aged 16-44 years) participated in the study. Serum basal AMH levels were correlated with those of serum androstenedione, testosterone, estradiol (E2), LH, FSH and inhibin B, and with follicle number. The effect of metformin on serum AMH concentrations, follicle number and ovarian volume was studied in 26 women (aged 20-41 years) with PCOS after 6 months of treatment. RESULTS: Serum AMH levels were 2- to 3- fold higher in PCOS women than in healthy women. In control women, serum AMH levels correlated positively with those of serum androstenedione (r = 0.564, P < 0.001) and testosterone (r = 0.328, P = 0.036) and negatively with serum FSH concentrations (r = -0.374, P = 0.012) and age (r = -0.691, P<0.001). In women with PCOS, serum AMH levels correlated positively with those of androstenedione (r = 0.311, P = 0.011) and testosterone (r = 0.310, P = 0.011) and with follicle count (r = 0.352, P = 0.012), and negatively with age (r = -0.300, P = 0.014). Serum AMH levels, the number of antral follicles and ovarian volume decreased significantly during metfromin treatment. CONCLUSIONS: Serum AMH levels decreased with age both in healthy women and in women with PCOS, although they were always 2- to 3-fold higher and remained elevated until 40 years of age in PCOS subjects. Thus, since serum AMH levels correlate well with antral follicle count and serum androgen levels, the measurement of AMH could be used as a tool to assess ovarian ageing, to diagnose polycystic ovaries/PCOS and to evaluate treatment efficacy.     

Six-month treatment with low-dose dexamethasone further reduces androgen levels in PCOS women treated with diet and lifestyle advice, and metformin

BACKGROUND: The purpose of this study was to investigate the effect of low-dose dexamethasone on androgen levels in women with polycystic ovary syndrome (PCOS) treated with diet and lifestyle counselling, and metformin. METHODS: A prospective, randomized, double blind, placebo-controlled study was carried out. Thirty-eight women with PCOS were randomized to either dexamethasone 0.25 mg daily or placebo for 26 weeks. All received diet and lifestyle counselling at inclusion and metformin 850 mg three times daily during the whole study. Main outcome measures were: androgen levels, body mass index (BMI), insulin c-peptide, fasting glucose and serum lipids. Two-tailed t-tests and Pearson's statistics were used. RESULTS: Compared with the placebo, dexamethasone reduced testosterone by 27%, androstenedione by 21%, dehydroepiandrosterone sulphate by 46% and free testosterone index by 50% in women with PCOS treated with diet and lifestyle advice, and metformin. BMI, fasting glucose, insulin c-peptide and serum lipid levels were unaffected. CONCLUSIONS: Six-month, low-dose dexamethasone treatment further reduces androgen levels in metformin-treated PCOS women.