多囊卵巢综合征患者血清抗苗勒管激素与肥胖、胰岛素抵抗程度的相关性分析

目的:探讨多囊卵巢综合征(polycystic ovary syndrome,PCOS)患者血清抗苗勒管激素(anti-Müllerian hormone,AMH)水平与肥胖、胰岛素抵抗(insulin resistance,IR)程度的相关性。方法:选择在我院生殖中心就诊的139名PCOS患者为研究组,并以月经周期正常、因输卵管因素或男性因素导致不孕者48名作为对照组。检测和比较PCOS患者的血清AMH、性激素水平及代谢指标,分析血清AMH水平与PCOS患者肥胖、胰岛素抵抗程度的关系。结果:PCOS组患者体质量指数(body mass index,BMI)、黄体生成素(luteinizing hormone,LH)、睾酮(testosterone,T)、垂体泌乳素(pituitary prolactin PRL)、空腹血糖(fasting plasma glucose,FPG)、空腹胰岛素(fasting insulin,FINS)、稳态模型胰岛素抵抗指数(homenostasis models assessment-insulin resistance index,HOMA-IR)的水平均显著高于对照组(P0.05),PCOS组和对照组年龄、卵泡刺激素(follicle stimulating hormone,FSH)比较差异无统计学意义(P0.05)。PCOS各表型组的血清AMH浓度、LH/FSH比值均明显高于对照组(P0.05)。肥胖组患者的AMH浓度低于正常体重组,BMI、FPG、FINS、HOMA-IR、甘油三脂(triglycerides,TG)水平均高于正常体重组,LH、LH/FSH、高密度脂蛋白(high density lipoprotein,HDL-C)水平均低于正常体重组(P0.05)。高HOMA-IR组患者的血清AMH浓度、LH、LH/FSH水平均明显低于低HOMA-IR组,BMI、T、FPG、FINS、TG、低密度脂蛋白(low density lipoprotein,LDL-C)水平均高于低HOMA-IR组(P0.05)。PCOS患者血清AMH浓度和BMI及HOMA-IR均存在显著负相关。结论:PCOS患者血清的AMH水平较对照组明显升高,与其肥胖、胰岛素抵抗(IR)程度呈显著负相关。     

Gonadotropins at menopause: the influence of obesity, insulin resistance, and estrogens

Obese, postmenopausal women have lower FSH levels. To determine whether this is due to higher estrogen exposure, we compared feedback gonadotropin sensitivity and its relation to insulin resistance in four groups of obese and lean, postmenopausal women. Group one was treated with 400 mg troglitazone (TG) daily for two weeks; 150 clomiphene citrate (CC) was added daily for the second week. Group two received 150 mg CC daily for a week. Group three received 1000 mg metformin (MET) daily for two weeks, with 120 mg raloxifene (RAL) added during the second week. Group four received 120 mg RAL for a week. Before and after each period, a serum pool was obtained from samples taken every minute during a 10 ml interval. The women recruited for this study were categorized as obese or lean based on BMI >/= 29 or BMI < 29, respectively. Obese, menopausal women had lower FSH (45.5 IU/l) and LH (16.2 IU/l) values than those of lean (64.1 IU/l and 23.0 IU/l), but the obese menopausal women had higher leptin, DHEAS, glucose, insulin, and HOMA-IR levels. Log [FSH] was associated with BMI (r = -0.53, P < 0.000001) and number of pregnancies (r = -0.37, P = 0.0009). TG treatment did not change HOMA-IR or gonadotropin levels, but DHEAS and androstenedione levels decreased significantly. CC alone or together with TG, diminished FSH (-7.9 and -9.2) and LH (-2.5 and -3.6) concentrations, with a greater reduction in lean women. MET reduced glucose and the HOMA-IR index without affecting gonadotropin or steroid levels. Conclusions: obese, menopausal women have lower FSH levels due to greater estrogen exposure, by mechanisms unrelated to insulin resistance.     

二甲双胍联合炔雌醇环丙孕酮片治疗对多囊卵巢综合征患者临床疗效及糖脂代谢的影响

摘要 目的：研究二甲双胍联合炔雌醇环丙孕酮片治疗多囊卵巢综合征（polycystic ovarian syndrome,PCOS）患者的临床疗效及对患者糖脂代谢的影响。方法：选取2018年1月~2020年12月在我院接受治疗的60例PCOS患者作为研究对象,随机数表法均分为对照组和研究组：对照组患者接受炔雌醇环丙孕酮片治疗,而研究组患者接受二甲双胍联合炔雌醇环丙孕酮片治疗。比较两组患者治疗后排卵和妊娠情况,并比较治疗前后性激素水平和糖脂代谢的变化。结果：研究组治疗总有效率为83.33%,显著高于对照组63.33%的治疗总有效率（P<0.05）。治疗前,两组患者血清卵泡刺激素（Follicle Stimulating Hormone, FSH）、黄体生成素（Luteinizing hormone, LH）、雌二醇（Estradiol, E2）、睾酮（Testosterone, T）等性激素水平,空腹血糖（fasting plasma glucose, FPG）、空腹胰岛素（Fasting serum lisulin, FINS）、口服葡萄糖耐量试验（oral glucose tolerance test, OGTT）2 h血糖和胰岛素等糖代谢指标以及甘油三酯（Triglycerides, TG）、胆固醇（Total cholesterol, TC）、高密度脂蛋白（High density lipoprotein, HDL）和低密度脂蛋白（Low density lipoprotein, LDL）等脂代谢指标脂代谢指标比较均无显著差异（P>0.05）;治疗后,所有患者血清FSH、LH、T、E2、TG、LDL、TC、FPG、FINS、OGTT 2h PG和OGTT 2h INS均较治疗前显著降低（P<0.05）,而HDL较治疗前升高（P<0.05）;研究组患者治疗后血清FSH、LH、T、E2、TG、LDL、TC、FPG、FINS、OGTT 2h PG和OGTT 2h INS均较显著低于对照组患者（P<0.05）,而HDL显著高于对照组患者（P<0.05）。结论：二甲双胍联合炔雌醇环丙孕酮片治疗多囊卵巢综合征临床效果显著,可有效改善患者糖脂代谢水平。     

血清OC、TSP-1、ANGPTL2与多囊卵巢综合征患者胰岛素抵抗、性激素和卵巢间质血流的关系研究

摘要 目的：分析血清骨钙素（OC）、血小板反应蛋白-1（TSP-1）、血管生成素样蛋白2（ANGPTL2）与多囊卵巢综合征（PCOS）患者胰岛素抵抗（IR）、性激素和卵巢间质血流的关系。方法：选取2020年1月～2022年4月内蒙古自治区人民医院收治的125例PCOS患者（PCOS组）,根据稳态模型评估（HOMA）-IR分为IR组68例和非IR组57例,另选取同期67例体检健康成年女性（对照组）。收集研究对象HOMA-IR和性激素、卵巢间质血流指标,采用酶联免疫吸附法检测血清OC、TSP-1、ANGPTL2水平。比较PCOS组与对照组、IR组与非IR组之间性激素、卵巢间质血流指标、血清OC、TSP-1、ANGPTL2水平的差异。采用Pearson/Spearman相关性分析法分析PCOS患者血清OC、TSP-1、ANGPTL2水平与HOMA-IR、性激素和卵巢间质血流指标的相关性。结果：PCOS组HOMA-IR、黄体生成素（LH）、LH/促卵泡生成素（FSH）、睾酮（T）、收缩期峰值速度（PSV）、ANGPTL2水平高于对照组,搏动指数（PI）和阻力指数（RI）、OC、TSP-1水平低于对照组（P＜0.05）。IR组LH、LH/FSH、T、PSV、ANGPTL2水平高于非IR组,PI、RI、OC、TSP-1水平低于非IR组（P＜0.05）。Pearson/Spearman相关性分析显示,PCOS患者血清OC、TSP-1水平与HOMA-IR、LH、LH/FSH、T、PSV呈负相关,与PI、RI呈正相关（P＜0.05）;血清ANGPTL2水平与PCOS患者HOMA-IR、LH、LH/FSH、T、PSV呈正相关,与PI、RI呈负相关（P＜0.05）。结论：血清OC、TSP-1在PCOS患者血清中低表达,ANGPTL2在PCOS患者血清中高表达,三者与PCOS患者IR、性激素和卵巢间质血流密切相关。     

Effects of metformin on the expression of GLUT4 in endometrium of obese women with polycystic ovary syndrome

The objective was to explore the effects of metformin on the expression of endometrial glucose transporter 4 (GLUT4) and analyze the related factors of GLUT4 in patients with polycystic ovary syndrome (PCOS). This study included 20 obese patients with PCOS (PCOS group) and 20 obese patients who had infertility caused by oviducal or pelvic factors but had no PCOS (control group). Follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol-2 (E(2)), testosterone (T), fasting serum glucose (FSG), fasting insulin serum (FINS), homeostasis model assessment-insulin resistance (HOMA-IR), and endometrial GLUT4 expression were determined in the two groups. In PCOS group, patients were given 500 mg of metformin three times per day for 3 mo, and then the parameters above were determined again and compared with that before metformin treatment. The parameters above also were compared between PCOS and control groups. The correlation of GLUT4 with its related factors was analyzed. The levels of T, FINS, and HOMA-IR were higher in PCOS group than in the control group (P < 0.01). The levels of protein and mRNA of endometrial GLUT4 were lower in the PCOS group than in the control group (P < 0.001). The expression of protein and mRNA of endometrial GLUT4 increased after metformin treatment (P < 0.001). HOMA-IR was negatively correlated with GLUT4 expression (P = 0.027). In patients with PCOS, the levels of protein and mRNA of endometrial GLUT4 were lower compared with that in non-PCOS women, and HOMA-IR was strongly associated with endometrial GLUT4 expression. Metformin may up-regulate endometrial GLUT4 expression to improve endometrial IR.     

基于P-mTOR/mTOR通路探讨来曲唑片联合益母草颗粒对多囊卵巢综合征患者的作用及其机制研究

摘要 目的：基于磷酸化雷帕霉素靶蛋白（P-mTOR）/雷帕霉素靶蛋白（mTOR）通路探讨来曲唑片联合益母草颗粒对多囊卵巢综合征（PCOS）患者的作用及其机制研究。方法：选取2021年4月至2022年8月期间济南市第二妇幼保健院收治的142例PCOS患者,按照随机数字表法将患者分为对照组（接受来曲唑片治疗,n=71）和研究组（接受来曲唑片联合益母草颗粒治疗,n=71）。对比两组性激素指标、空腹血糖（FPG）、空腹胰岛素（FINS）、胰岛素抵抗指数（HOMA-IR）、血清P-mTOR、mTOR水平。结果：两组治疗3个月后黄体生成素（LH）、雌二醇（E₂）、睾酮（T）下降,促卵泡激素（FSH）上升,且研究组的LH、E₂、T低于对照组,FSH高于对照组（P<0.05）。两组治疗3个月后FPG、HOMA-IR、FINS下降,且研究组低于对照组（P<0.05）。两组治疗3个月后血清P-mTOR及mTOR水平下降,且研究组低于对照组（P<0.05）。结论：益母草颗粒、来曲唑片联合治疗可能通过调控P-mTOR/mTOR通路改善PCOS患者的性激素、血糖水平及胰岛素抵抗。     

A Model Combining Testosterone,Androstenedione and Free Testosterone Index Improved the Diagnostic Efficiency of Polycystic Ovary Syndrome

ObjectiveHyperandrogenism is frequently observed in patients with polycystic ovary (PCO). The purpose of this study was to develop an easy-to-use tool for predicting polycystic ovary syndrome (PCOS) and to evaluate and compare the value of androstenedione (Andro) and other hormone indicators in the diagnosis of patients with hyperandrogenic PCOS.MethodsThis study included 139 women diagnosed with hyperandrogenic PCOS according to the Rotterdam criteria and 74 healthy control women from Shanghai Tenth People's Hospital. The serum hormone levels of the patients and controls were measured using a chemiluminescence immunoassay and incorporated for further analysis.ResultsTotal testosterone (TT), Andro, dehydroepiandrosterone sulfate (DHEAS), and free androgen index (FAI) were significantly higher in the PCOS group than the control group. Further, Andro, follicle-stimulating hormone (FSH), luteinizing hormone (LH), TT, FAI, and LH/FSH in the hyperandrostenedione group were higher than the normal Andro group. The Youden index was the highest for Andro (0.65), with 81.82% sensitivity and 83.16% specificity. Correlation analysis showed that FSH, LH, TT, FAI, insulin sensitivity index, and LH/FSH were positively correlated with Andro, while fasting blood glucose and 2-hour postprandial blood glucose were negatively correlated with Andro.ConclusionsThe model using Andro, TT, and FAI may help to identifying women with undiagnosed PCOS. Serum Andro is a meaningful biomarker for hyperandrogenism in PCOS patients and may further aid disease diagnosis.     

Partial deficiency in 21-hydroxylase in certain forms of hirsutism

The ACTH test is important when hirsutism occurs in women with a slight 21-hydroxylase deficiency, and normal basal 17-OH Progesterone (17-OH-P/plasma levels). Extensive hormonal assays: LH, FSH, Prolactin, 17 beta-estradiol (E2), Estrone, 17OH-P, Androstenedione, Testosterone, Cortisol (C), Dehydroepiandrosterone-S (DEA-S) were carried out in 36 hirsute women. 13 of these presented hormone levels as found in polycystic ovary syndrome (PCOS), 6 women presented a slight 21-hydroxylase deficiency (increased plasma 17-OH-P and decreased C after ACTH test with significant, p less than 0.01, increase of 17-OH-P/C and 17 women presented idiopathic hirsutism (IH). The hormonal pattern, in the basal condition, is not different in IH or in slight 21-hydroxylase deficiency. The ACTH test is able to differentiate between IH and adrenal hirsutism.     

The effect of weight loss on inflammation in obese women with polycystic ovary syndrome

INTRODUCTION: The aim of the present study was to evaluate the effect of modest weight reduction on serum concentrations of tumour necrosis factor alpha (TNF-alpha), TNF soluble receptors (sTNFRs) and interleukin-6 (IL-6) in obese women with polycystic ovary syndrome (PCOS). MATERIAL AND METHODS: The study group consisted of 15 obese women with PCOS (mean age 28.5 +/- 7.7 years). Serum concentrations of TNF-alpha, sTNFRs and IL-6, insulin, FSH, LH, DHEAS, androstendione, total and free testosterone, cortisol, 17OH-progesterone, oestradiol and sex hormone binding globulin (SHBG), glucose, total cholesterol, HDL cholesterol and triglycerides were measured before treatment and after 10% weight loss. All patients were advised to follow a 1000-1200 kcal diet with a limited intake of simple carbohydrate and animal fats and to exercise regularly (30 min, 3 times a week). Body composition was measured by bioimpedance. Serum concentrations of TNF-alpha, sTNFRs and IL-6 were determined by enzyme linked immunosorbent assay (ELISA). Plasma insulin, FSH, LH, DHEAS, androstendione, total and free testosterone, cortisol, 17OH-progesterone, oestradiol and SHBG were measured by a commercial RIA. Blood glucose, total cholesterol, HDL cholesterol and triglycerides were measured by an enzymatic procedure. RESULTS: We observed no differences in serum concentrations of TNF-alpha, sTNFRs or IL-6 after treatment. CONCLUSIONS: It seems that more than a modest weight reduction is necessary to obtain a decrease in serum concentrations of proinflammatory cytokines and an improvement in ovarian function in obese women with polycystic ovary syndrome.     

Effect of dexamethasone on plasma concentrations of LH, FSH and testosterone in women with hirsutism.

Thirty sexually mature women with hirsutism were treated with 3 x 1.5 mg dexamethasone per day over a period of three days. Before and after treatment, plasma concentrations of luteinizing hormone (LH), follicle stimulating hormone (FSH), and testosterone were determined. While an effect of dexamethasone on LH plasma levels could not be established statistically, FSH and testosterone plasma concentrations decreased significantly in comparison to their initial values (p less than 0.01). Special attention is directed to the different effects of dexamethasone on LH and FSH plasma concentrations.     

Analysis of VEGF gene polymorphisms and serum VEGF protein levels contribution in polycystic ovary syndrome of patients

Vascular endothelial growth factor (VEGF) is a well-known factor in reproductive function and contributes to the pathogenesis of polycystic ovary syndrome (PCOS). Genetic variations in VEGFA gene were suggested to contribute alterations in VEGF secretion and PCOS. This study evaluated the association of VEGFA SNPs with altered VEGF secretion level and PCOS among ethnically-matched control women. This prospective case–control study was conducted from 2016 to 2018 and comprised of 55 women with PCOS and 52 control subjects. ELISA was used to measure VEGF levels; and various other related bio chemicals whereas the genotyping of VEGFA variants was performed through the analysis of nine SNPs of VEGF. PRL, E2, PRGE testosterone and glucose level were found to be insignificantly different. The levels of FSH, LH, LH/FSH, TT, insulin, SHBG and HOMA-IR were significantly higher in the study group. Among the nine tested variants of VEGF SNPs, two SNPs rs3025020 and rs833061, consisted of TT (Recessive and Dominant homozygous, respectively) which were marginally higher in test. The SNP rs1570360 had significantly higher GG allele (32.73%) which was recessive homozygous. There was no significant difference observed in genotype frequencies related to higher value of VEGF. The genotype frequencies for the studied SNPs were in alignment with Hardy–Weinberg equilibrium (HWE). The mean serum VEGF levels got significantly increased in PCOS group. No significant association was found between VEGF genotypes and its serum levels. VEGF levels in rs699947 (AA-major homozygous), rs3025039 (CC-major homozygous) and rs833061 (TT & CC-major & minor homozygous) genotypes were significantly higher in PCOS. The study results evidently proved that the allelic variants in genes may be a factor for PCOS and VEGF serum levels with respect to few SNP variants only. These findings indicated that VEGF may be involved in PCOS status and confirmed the previous association between genetic variants in VEGF, serum level of VEGF protein and PCOS.

     

加味补中益气汤治疗肥胖型多囊卵巢综合征患者的疗效及对子宫内膜容受性和糖脂代谢的影响

摘要 目的：探讨加味补中益气汤治疗肥胖型多囊卵巢综合征（PCOS）患者的疗效及对子宫内膜容受性和糖脂代谢的影响。方法：选择2018年3月~2020年5月期间我院收治的肥胖型PCOS患者280例，采用抽签法分为观察组140例和对照组140例。对照组给予二甲双胍片治疗，观察组给予加味补中益气汤治疗，对比两组疗效、体质量指数（BMI）、腰臀比、性激素指标[雌二醇（E2），促黄体生成激素（LH）、卵泡刺激素（FSH）]、子宫内膜容受性指标[子宫内膜厚度、子宫内膜螺旋动脉搏动指数（PI）与阻力指数（RI）]、糖脂代谢指标[总胆固醇(TC)、低密度脂蛋白 (LDL-C)、甘油三酯(TG)、高密度脂蛋白 (HDL-C)、空腹血糖（FPG）]。结果：观察组的临床总有效率为92.14%（129/140），高于对照组的80.71%（113/140）（P<0.05）。治疗3个月经周期后，两组BMI、腰臀比、PI、RI、LH、FSH、TC、LDL-C、TG、FPG均下降，且观察组低于对照组（P<0.05）。治疗3个月经周期后，两组子宫内膜厚度、HDL-C、E2升高，且观察组高于对照组（P<0.05）。结论：加味补中益气汤治疗肥胖型PCOS患者，可降低患者体质量，调节性激素、子宫内膜容受性和糖脂代谢水平，具有较好的疗效。     

Assessment the Correlations of Hormones,Lipid Profiles,Oxidative Stress,and Zinc Concentration in Iraqi Women with Polycystic Ovary Syndrome

Background: Polycystic ovary syndrome (PCOS) is a hormonal disorder in women with unknown causes and is the leading cause of infertility in women of reproductive age, presenting a wide range of clinical manifestations worldwide. The objective of study is to compare the correlation between hormones, lipid profile, oxidative stress and Zinc concentration in PCOS patients. Methods:The present study examined hormone levels (progesterone, prolactin, luteinizing and follicle stimulation hormones (LH and FSH, respectively), antioxidant factors (catalase, glutathione-s- transferase), lipid profiles and zinc concentration of 50 Iraqi women patients’ diagnosis with PCOS and 40 healthy women, divided in two age groups of 15-29 and 30-45 years. Body mass index was estimated for two age groups.Results:The results showed decreasing of catalase, glutathione, and Zn concentrations with an increase in age. A slightly significant increase in LH and prolactin and decrease in high-density lipoprotein (HDL-C) with an increase in age in the patient group compared to the control group was noted. Conclusion:Our study demonstrated that some factors (such as family history, genetics, environmental, etc…) could play a role in altering hormone levels, lipid profiles, and antioxidant. Controlling these factors may be useful for reducing the PCOS-associated problems in women’s health. Needed extensive studies to assess the correlation with insulin resistant and obesity.Key Words: Hormones disorders, Lipid profile, Polycystic ovary syndrome, Zinc element      

Trend of Cardio-Metabolic Risk Factors in Polycystic Ovary Syndrome: A Population-Based Prospective Cohort Study

Objective

To see the changes of cardio-metabolic risk factors overtime in polycystic ovary syndrome vs. control women.

Methods

This study was conducted on 637 participants (85 PCOS and 552 control reproductive aged, 18–45 years) of Tehran Lipid and Glucose Study (TLGS), an ongoing population-based cohort study with 12 years of follow-up. The cardiovascular risk factors of these groups were assessed in three-year intervals using standard questionnaires, history taking, anthropometric measures, and metabolic/endocrine evaluation. Generalized estimating equation was used to analyze the data.

Results

Overall mean of insulin (3.55, CI: 0.66–6.45), HOMA-IR (0.63, CI: 0.08–1.18), and HOMA-β (45.90, CI: 0.86–90.93) were significantly higher in PCOS than in healthy women after adjustment for age, BMI, and baseline levels. However, the negative interaction (follow-up years × PCOS status) of PCOS and normal women converged overtime. Comparing third follow-up with first, insulin and HOMA-IR decreased 10.6% and 5%, respectively in PCOS women; and increased 6.7% and 14.6%, respectively in controls (P<0.05). The results did not show any significant result for other cardio-metabolic variables including WC, lipid profile, FPG, 2-h PG, SBP, and DBP.

Conclusion

While the insulin level and insulin resistance rate were higher in reproductive aged PCOS than in healthy women, the difference of these risk factors decreased overtime. Thus, the metabolic consequences of PCOS women in later life may be lower than those initially anticipated.     

二甲双胍对多囊卵巢综合征肥胖型患者LH 和FSH 的影响

目的:探讨二甲双胍对多囊卵巢综合征肥胖型患者血清中胰岛素、LH和FSH水平的影响。方法:将84例PCOS肥胖型患者随机分成44例对照组(克罗米芬)和40例观察组(二甲双胍),采用放射免疫法测定黄体生成素(LH)和卵泡刺激素(FSH)的水平,分别于服药前(0分钟)和服后60、120分钟经前臂静脉采血,测血糖浓度及血清胰岛素水平。结果:对照组患者治疗前0min、60min及120min的血糖OGTT分别为(4.57±0.25)mmol/L、(8.38±7.05)mmol/L及(7.21±0.12)mmol/L,治疗后0min、60min及120min的血糖OGTT无明显变化。观察组患者治疗前0min、60min及120min的血糖OGTT分别为(4.11±0.31)mmol/L、(8.23±6.57)mmol/L及(7.25±0.13)mmol/L,治疗后0min、60min及120min的血糖OGTT明显降低。对照组患者治疗前血清中胰岛素为(47.32±9.52)U/m l,治疗后为(42.25±7.65)U/ml,治疗前后无明显差异。观察组患者治疗前血清中胰岛素为(46.41±6.11)U/ml,治疗后血清胰岛素水平明显降低。对照组患者治疗后血清中LH为(17.22±2.14)mU/ml,FSH为(1.24±0.33)mU/m l,而与对照组相比,观察组患者血清中的LH明显降低,而FSH水平升高。结论:二甲双胍导致多囊卵巢综合征患者血清中胰岛素水平降低,从而减轻了胰岛素对LH的刺激作用,使LH水平下降,FSH升高,进而改善机体的激素紊乱,最终达到治疗PCOS的目的。     

Plasma level of calcitonin gene-related peptide in patients with polycystic ovary syndrome and its relationship to hormonal and metabolic parameters

The aim of the study was to evaluate the plasma level of calcitonin gene-related peptide (CGRP) in patients with polycystic ovary syndrome (PCOS) and its relationship to hormonal and metabolic parameters. We also observed the effect of CGRP on testosterone (T) and estradiol (E(2)) release in cultured human granulosa cells. PCOS subjects (n=215) and matched healthy control women (n=103) at age of 22-38 years were enrolled in this study. We analyzed plasma CGRP concentrations, relationship of plasma CGRP with insulin resistance (IR), body mass index (BMI), luteinizing hormone/follicle-stimulating hormone (LH/FSH) ratio and T. The T and E(2) release levels of cultured human granulosa cells treated by CGRP were also measured. The results showed that plasma CGRP concentrations were significantly higher in women with PCOS than those of control subjects. In women with PCOS, there was a strong positive correlation between the plasma CGRP level with HOMA-IR, AUC-insulin, AUC-glucose, the ratio of LH/FSH and plasma T concentration. Human granulosa cells expressed CGRP receptor. Exogenous CGRP caused an elevation of T and E(2) released from the human granulosa cells. These findings suggest that CGRP may participate in the pathophysiological process of PCOS.     

游离睾酮指数联合血清GnSAF、SHBG对多囊卵巢综合征不孕患者IVF-ET治疗妊娠结局的预测价值

摘要 目的：探讨游离睾酮指数（FAI）联合血清促性腺激素平抑因子（GnSAF）、性激素结合球蛋白（SHBG）对多囊卵巢综合征（PCOS）不孕患者体外受精-胚胎移植（IVF-ET）治疗妊娠结局的预测价值。方法：选取2020年1月～2022年6月湖南省妇幼保健院生殖医学中心收治的197例PCOS不孕患者为PCOS组,根据IVF-ET治疗妊娠结局分为妊娠失败组和妊娠成功组,另选取同期68名体检健康妇女为对照组。收集PCOS不孕患者临床资料,计算FAI并检测血清GnSAF、SHBG水平。采用单因素和多因素Logistic回归分析PCOS不孕患者IVF-ET治疗妊娠结局的影响因素,采用受试者工作特征（ROC）曲线分析FAI和血清GnSAF、SHBG对PCOS不孕患者IVF-ET治疗妊娠结局的预测价值。结果：PCOS组FAI和血清GnSAF水平高于对照组,SHBG水平低于对照组（P＜0.05）。197例PCOS不孕患者IVF-ET治疗妊娠成功率为51.27%（101/197）。单因素分析显示,妊娠失败组体质指数、黄体生成素（LH）、LH/促卵泡生成素（FSH）、睾酮、抗苗勒管激素（AMH）、FAI、GnSAF高于妊娠成功组,FSH、受精率、优胚率、SHBG低于妊娠成功组（P＜0.05）。多因素Logistic回归分析显示,体质指数增加和LH、LH/FSH、AMH、FAI、GnSAF升高为PCOS不孕患者IVF-ET治疗妊娠失败的独立危险因素,SHBG升高为其独立保护因素（P＜0.05）。ROC曲线分析显示,FAI和血清GnSAF、SHBG联合预测PCOS不孕患者IVF-ET治疗妊娠结局的曲线下面积大于FAI、GnSAF、SHBG单独预测。结论：FAI和血清GnSAF、SHBG水平联合预测PCOS不孕患者IVF-ET治疗妊娠结局的价值较高。     

新疆维汉民族多囊卵巢综合征患者CYP17基因多态性及与发病机制的关系

目的:探讨细胞色素P450酶17(CYP17)基因多态性及其与多囊卵巢综合征(PCOS)发病机制的关系。方法:选择2015年1月~2017年2月我院收治的新疆维汉民族PCOS患者260例为PCOS组,另选取同期在我院门诊检查的健康育龄妇女237例为对照组,采用限制性片段长度多态性聚合酶链反应(PCR-RFLP)技术检测两组受试者的CYP17基因多态性,比较两组等位基因及基因频率的分布,结合其临床资料分析CYP17基因多态性与PCOS发病机制的关系。结果:PCOS组体质量指数(BMI)、卵泡刺激素(FSH)水平低于对照组,黄体生成激素(LH)、睾酮(TES)及黄体生成激素与卵泡刺激素的比值(LH/FSH)高于对照组,差异有统计学意义(P0.05)。PCOS组CYP17基因A1A1、A1A2、A2A2型频率分别为34.62%、41.92%、23.46%,与对照组的34.18%、43.88%、21.94%比较差异无统计学意义(P0.05);PCOS组等位基因A1、A2频率为55.58%、44.42%,与对照组的56.12%、43.88%比较差异无统计学意义(P0.05);PCOS组不同CYP17基因型者的FSH、LH及LH/FSH水平整体比较差异无统计学意义(P0.05);PCOS组BMI水平A2A2A1A2A1A1,TES水平A2A2A1A1A1A2,差异均有统计学意义(均P0.05);对照组不同CYP17基因型者的BMI、FSH、LH、TES及LH/FSH水平整体比较差异均无统计学意义(P0.05)。结论:CYP17基因-34bp处T/C单核苷酸多态性是人群中一种常见的碱基置换,与PCOS的发病机制无明显的相关性。     

Association of Angiotensin-Converting Enzyme gene polymorphism in Pakistani women with the atypical steroidogenesis in Polycystic ovarian syndrome: A case-control study

BackgroundPolymorphism in the angiotensin-converting enzyme gene (ACE) is responsible for elevated ACE concentrations in plasma. High ACE levels induce insulin resistance and hyperandrogenism, which are the main attributes of polycystic ovary syndrome (PCOS). Therefore, it was hypothesized that I/D polymorphism plays a role in the pathogenesis of PCOS.ObjectiveA case-control study was designed to investigate the association of I/D polymorphism of the ACE gene with PCOS in Pakistani women of reproductive age.MethodsACE I/D polymorphism was assessed in 252 women of age group 16–40 years. For genotypic analysis, PCR amplification of genomic DNA was carried out. Statistical analysis was performed to interpret the results using SPSS software.ResultsOur study showed that PCOS women were more likely to have a high body mass index and waist circumferences. Most PCOS patients had menstrual irregularities 99.3%, hirsutism 75.2% and cysts in ovaries 66.6%, along with other hyperandrogenic conditions (P-value = 0.001). The genotypic and allelic frequencies were significantly different between patients and controls. There was a significant association of three genotypes with the ratio of LH: FSH among PCOS patients (P = 0.05). Anthropometric characters, comorbidities, clinical symptoms, and PCOS conditions showed no statistical significance with ACE polymorphism.ConclusionsACE I/D polymorphism was not found associated with clinical conditions of PCOS in women of reproductive age. However, it was associated with atypical steroidogenesis. So, it indicates that ACE I/D polymorphism aggravates the pathogenesis of PCOS.     

益气健脾方联合复方左炔诺孕酮对多囊卵巢综合征的临床疗效及对vaspin和leptin的影响

目的:研究益气健脾方联合复方左炔诺孕酮对多囊卵巢综合征(polycystic ovary syndrome,PCOS)的临床疗效及对丝氨酸蛋白酶抑制剂(visceral adipose tissue-derived serine protease inhibitor,vaspin)和瘦素(leptin)的影响。方法:选取2019年2月至2020年4月期间我院收治的80例PCOS患者,采用随机数字表法分为对照组和观察组,每组40例。对照组给予复方左炔诺孕酮片,观察组在对照组的基础上加服益气健脾方,治疗3个月经周期后对比两组患者的疗效。分别于治疗前后检测两组患者的激素水平、糖脂代谢指标及血清vaspin和leptin的水平。观察并记录两组患者治疗期间发生的不良反应。结果:治疗后观察组总有效率高于对照组(P<0.05)。治疗后两组患者的睾酮(testosterone, T)、促黄体生成素(luteinizing hormone, LH)和LH/促卵泡素(Follicle stimulating hormone, FSH)均显著降低(P<0.05),且观察组的T、LH和LH/FSH降低较为明显(P<0.05)。治疗后两组患者的空腹血糖(fasting blood glucose, FBG)、空腹胰岛素(fasting insulin, FINS)、Homa IR、总胆固醇(total cholesterol, TC)、甘油三酯(triglyceride, TG)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol, LDL-C)均显著降低,高密度脂蛋白(high-density lipoprotein cholesterol, HDL-C)显著升高(P<0.05),与对照组治疗后相比,观察组治疗后的FBG、FINS、Homa IR、TC、TG、LDL-C均较低,HDL-C较高(P<0.05)。治疗后vaspin和leptin均显著降低(P<0.05),且观察组治疗后的vaspin和leptin的表达水平较低(P<0.05)。两组患者不良反应总发生率无统计学差异(P>0.05)。结论:益气健脾方联合复方左炔诺孕酮可有效提高对PCOS的临床疗效,改善患者的激素水平及糖脂代谢指标,降低血清vaspin和leptin的水平,且不增加不良反应发生率。