肥胖型多囊卵巢综合征伴不孕132例临床分析

近年来,不孕症的发病率呈明显上升趋势,其中肥胖型多囊卵巢综合征（polycystic ovary syndrome,PCOS）伴不孕是大多数不孕患者较常见的病因,主要表现为月经失调、闭经或不规则阴道出血、不孕、肥胖、痤疮、多毛等[1],病理特征是持续无排卵、多囊卵巢及高雄激素,是引起子宫内膜癌、     

HOXA10基因在多囊卵巢综合症患者卵巢中的表达

目的 探讨HOXA10基因在卵巢中颗粒细胞的表达及其与多囊卵巢综合征的关系.方法 采用逆转录聚合酶链反应及免疫印迹法分别测定25例多囊卵巢综合征(PCOS)妇女和32例卵巢功能正常(Non-PCOS)妇女卵巢黄素化颗粒细胞中HOXA10 mRNA和蛋白的表达水平.结果 PCOS妇女黄素化颗粒细胞中HOXA10 mRNA的表达和蛋白的表达均低于Non PCOS妇女(P＜0.01,P＜0.05).结论 HOXA10基因在卵巢中有表达,PCOS妇女卵巢黄素化颗粒细胞HOXA10 mRNA和蛋白表达水平明显低于Non-PCOS妇女,提示该基因可能参与了PCOS的发生及发展过程.     

肥胖对多囊卵巢综合征的影响

多囊卵巢综合征(Polycystic Ovary syndrome,PCOS)是女性最常见的生殖内分泌紊乱性疾病,严重影响女性健康。PCOS患者中有50%-70%存在肥胖,肥胖严重影响女性生殖功能,目前关于肥胖对PCOS影响的临床和实验研究很多,但是关于肥胖对PCOS女性生殖影响方面尚未进行系统的归纳总结,本文就肥胖影响PCOS女性生殖障碍的机制、肥胖对PCOS促排卵和辅助生殖技术的应用效果的影响等进行综述,目的是进一步明确肥胖本身及肥胖的治疗在PCOS生殖方面的影响,为PCOS的临床诊疗提供依据。     

多囊卵巢综合征动物模型与中医药干预研究进展

多囊卵巢综合征（PCOS）是涉及多系统的生殖、代谢障碍疾病,临床表现有高雄激素血症、排卵障碍、高胰岛素血症和高LH血症以及肥胖、不孕等,卵巢呈多囊样改变。因其病因病理复杂,生化改变、临床表现多样,为临床研究带来一定困难。因此,利用动物模型进行相关研究显得尤为必要。近年来所采用的PCOS动物模型造模方法主要有雄激素造模法、胰岛素联合人绒毛膜促性腺激素造模法、雌激素造模法、孕激素联合人绒毛膜促性腺激素造模法和芳香化酶抑制剂造模法等。本文对上述造模方法及相关研究进展进行了综述,并探讨了中药、针灸对模型动物的干预作用。     

青少年多囊卵巢综合征的临床、超声和生化特征及其诊断意义

青春期多囊卵巢综合征(PCOS)的诊断具有一定的临床挑战性。迄今未有报道青少年人群PCOS的患病率以及临床、超声和生化特征。为了评估PCOS的临床和生化特征在14~16岁月经初潮女孩中的普遍程度,确定内循环雄激素水平在卵泡期早期的正常范围。本研究进行了一项前瞻性群组研究,研究群组是244名未经选择的月经初潮后的女孩,平均年龄在15.2岁。从一个大的以人口为基础的出生群组(Raine队列)中招募受试者。临床高雄激素血症(HA)使用Ferriman-Gallwey评分进行量化。在卵泡期的初期(第2~第6天),本研究使用免疫法测定循环雄激素和性激素结合球蛋白,并通过经腹部超声检查来评估卵巢形态,得到了青少年女性群体卵泡期初期的雄激素的正常范围。循环游离睾酮水平的前5%和10%分别为45.6 pmol/L和34.5 pmol/L。51%的女孩报告月经不规律。临床HA是罕见的,仅观察到3.5%的女孩罹患此病。平均卵巢体积大于其他报道中成年妇女的卵巢体积,35%的女孩在经腹超声时显示有多囊卵巢形态。按照游离睾酮数值排序,取前5%作为HA。42名女孩(18.5%)符合PCOS的Rotterdam标准,11个女孩(5%)雄激素超出社会标准。本研究表明,月经不规律在青春期是常见的,不涉及临床或生化HA。卵巢体积和形态的PCOS诊断在青春期可能有局限性。     

多囊卵巢综合征伴胰岛素抵抗的研究进展

多囊卵巢综合征（polycystic ovary syndrome,PCOS）是国内外研究者、医患人员非常关心的育龄期妇女常见的内分泌代谢疾病,其主要表现为闭经、月经量减少、肥胖、不孕、体多毛等。多数伴有胰岛素抵抗（insulin resistance,IR）的发生,胰岛素抵抗（insulin resistance,IR）是指正常水平的胰岛素促进葡萄糖摄取及利用能力下降,机体各组织、器官代偿性分泌胰岛素以维持机体血糖稳定的一种代谢状态。近年来的研究不断证实PCOS患者2型糖尿病、血脂代谢紊乱及代谢综合征（metabolicsyndrome,MS）等并发症的发病率明显增高。运动能够改善2型糖尿病患者胰岛素抵抗的说法已经得到了共识,其分子机制也逐渐分明。PCOS患者胰岛素抵抗的研究目前仍处于进一步探讨阶段,但是经过近几年的努力已经有了新的进展,若在PCOS胰岛素抵抗患者的治疗过程中给予一定的运动干预,相信一定能够有新的突破。本文就PCOS患者胰岛素抵抗研究的机制、诊断及治疗方法的新进展简单做一综述。     

多囊卵巢综合征的小鼠模型

多囊卵巢综合征(polycystic ovary syndrome,PCOS)是育龄女性最常见的生殖内分泌紊乱性疾病之一,其主要的临床特征包括多毛、不排卵或稀发排卵、高雄激素血症、多囊化卵巢、肥胖、血脂紊乱和胰岛素抵抗等生殖和代谢异常两方面。理想的PCOS动物模型应同时具有类PCOS患者的生殖和代谢异常表型,从而为更好地理解PCOS的病理机制提供研究工具。本文综述了目前常用的PCOS小鼠模型,并总结了不同模型的生殖与代谢特征。     

多囊卵巢综合征患者胰岛素受体基因外显子17的多态性研究

目的：探索胰岛素受体基因外显子17 的基因多态性与多囊卵巢综合症（PCOS）的关系,为多囊卵巢综合症的治疗寻找新的途径。方法：利用PCR-SSCP技术检测45 例多囊卵巢综合症患者（实验组）与40 例健康妇女（对照组）全血中胰岛素受体基因外显子17 位点1058 的基因多态性,同时测定PCOS 患者的一般指标及血清学指标。按照体重指数、胰岛素抵抗、有无高雄激素血症比较胰岛素受体基因外显子17位点1058 C、T等位基因出现的频率。结果：实验组患者T 等位基因出现的频率为71.2%,明显高于对照组的25%（P〉0.05）;实验组非肥胖组患者中T 等位基因出现的频率为69.2%,明显高于肥胖组患者的25%（P〈0.01）,亦高于对照组,差异具有统计学意义（P〈0.05）。根据胰岛素受体基因外显子17 出现T、C 基因的频率,将其分为1、2 两组,1 组出现T基因的频率的BMI（20.34± 2.47）明显低于2 组出现C 基因的频率的BMI（26.68± 5.52）;PCOS 患者胰岛素抵抗组与非胰岛素抵抗组中INSR 基因外显子17 出现T、C等位基因的频率无明显差别（P〉0.05）;PCOS 患者高雄激素组组与无高雄激素组中胰岛素受体基因外显子17 出现T、C等位基因的频率无明显差别（P〉0.05）。结论：胰岛素受体基因外显子17 中T/C 单核酸多态性表现与PCOS 患者的发病密切相关,T 等位基因的高发频率与非肥胖因型PCOS 患者的发病密切相关;瘦型PCOS 患者与肥胖型患者胰岛素抵抗的发病机制或许不同;T 等位基的高发频率与PCOS 的主要临床表现如：胰岛素抵抗、高雄激素血症并无明显相关关系。     

内蒙古地区汉族多囊卵巢综合征患者临床特征研究

目的:分析总结多囊卵巢综合(Polycystic ovary syndrome,PCOS)合并不育患者的临床及内分泌代谢特征,为PCOS的临床诊治提供依据.方法:回顾性分析120例PCOS患者(其中肥胖型73例,非肥胖型47例)的临床特征及内分泌、空腹血糖(FPG)、空腹胰岛素(FINS)等检查指标.用稳态模型胰岛素抵抗指数(HOMA-IR)、稳态模型胰岛素分泌指数(HOMA-IS)、空腹胰岛素敏感指数(ISI)评估胰岛素敏感性.结果:两组患者睾酮(T)、黄体生成素(LH)、卵泡刺激素(FSH)、LH/FSH无显著差别.肥胖组的FPG和FINS水平明显高于非肥胖组.两组胰岛素抵抗(IR)发生率分别为86.30%和51.06%.肥胖组的IR、ISI均明显高于非肥胖组.结论:PCOS患者肥胖发生率较高,肥胖型PCOS患者较非肥胖型患者存在更严重的代谢紊乱.减重、改善IR不仅可以改善PCOS不育情况,更是预防2型糖尿病、心血管疾病等远期并发症的关键.     

二甲双胍改善多囊卵巢综合征并激活雌性生殖干细胞

多囊卵巢综合征(polycystic ovary syndrome, PCOS)是生育年龄妇女常见的一种复杂的内分泌及代谢异常所致的疾病,是女性不孕的重要因素。二甲双胍是临床应用最广泛的经典口服降糖药物,近年来被应用于PCOS治疗,但其作用机制尚不明确。本研究通过建立小鼠PCOS模型,论证二甲双胍对PCOS的改善作用及其机制。4～5周龄雌性C57BL/6J小鼠连续21天给予来曲唑(每天灌胃1 mg/kg)联合高脂饮食,建立PCOS模型。成模后灌胃给予二甲双胍(每天200 mg/kg),1个月后取材,期间检测体重并进行糖耐量试验。取材后行苏木素-伊红(H&E)染色检测卵巢病理改变;ELISA法测定血清中抗缪勒氏管激素(anti-Mullerian hormone, AMH)、卵泡刺激素(follicle-stimulating hormone, FSH)、黄体生成素(luteinizing hormone,LH)、雌二醇(E2)、睾酮等激素水平;免疫组织化学及免疫荧光染色法检测雌性生殖干细胞(femalegermlinestemcells,FGSCs)标志物DDX4/MVH及PC...     

Polycystic ovary syndrome: Challenges in adolescence

Polycystic ovary syndrome (PCOS) is one of the most common endocrine diseases in women of reproductive age. PCOS typically develops during adolescence and is a heterogeneous syndrome classically characterized by features of anovulation combined with signs of androgen excess (hirsutism, acne). Increasing obesity in adolescents probably exacerbates signs of PCOS, contributing to its earlier recognition. Recognizing the features of this syndrome can be very challenging in adolescence. Although adolescents’ concerns are often cosmetic, if left untreated these girls are at risk for diabetes, metabolic syndrome, and infertility as they mature. Efforts should be made to diagnose and treat PCOS to minimize the development of symptoms and prevent the onset of cardiovascular and metabolic disturbances.     

Improved resolution of the human adipose tissue proteome at alkaline and wide range pH by the addition of hydroxyethyl disulfide

Polycystic ovary syndrome is a very common disease affecting 6.5% of women. It is frequently associated with obesity with the link between the two disorders being insulin resistance. From morbidly obese women submitted to surgical treatment of obesity, we obtain intra-abdominal adipose tissue samples in order to compare protein patterns between women with and without polycystic ovary syndrome by two-dimensional gel electrophoresis (2-DE) analysis. Adipose tissue is a complex material extremely rich in lipids. To improve protein solubilization a lysis buffer containing 8.4 M urea, 2.4 M thiourea, 5% 3-((3-cholamidoproyl)dimethyl-amino)-1-propanesulfonate and 50 mM dithiothreitol was used and samples were centrifuged to remove fat. Hydroxyethyl disulfide was added to increase resolution in the alkaline region (Olsson, I., Larsson, K., Palmgren, R., Bjellqvist, B., Proteomics 2002, 2, 1630-1632) and it also improved resolution in a wide pH range (3-10). Our work shows for the first time 2-DE maps of human adipose tissue and identifies some of the proteins by mass spectrometry. This information will aid studies on metabolic diseases such as polycystic ovary syndrome, obesity, hypertension and type 2 diabetes.     

Surgical management of metabolic dysfunction in PCOS

Metabolic disturbances are common in women with polycystic ovary syndrome (PCOS). Obesity is the major link in the association of PCOS with diabetes, metabolic syndrome, hypertension, low-grade chronic inflammation and increased body iron stores, among others. Metabolic prevention in PCOS women should start as early as possible, usually meaning at diagnosis. Among preventive strategies, those promoting a healthy life-style based on diet, regular exercising and smoking cessation are possibly the most effective therapies, but also are the most difficult to achieve. To this regard, every effort must be made to avoid weight gain and obesity, given the deleterious impact that obesity exerts on the metabolic and cardiovascular associations of PCOS. Unfortunately, classic strategies that address obesity by life-style modification and dieting are seldom successful on a long-term basis, especially in women with severe obesity. In selected cases, metabolic surgery in severely obese women may resolve signs and symptoms of PCOS restoring insulin sensitivity and fertility, and avoiding the long-term risks associated with PCOS and morbid obesity. Surgical techniques for bariatric surgery have evolved in the past decades and newer procedures do not longer carry the severe side effects associated with earlier bariatric procedures. The choice of bariatric procedure should consider both the severity of obesity and the possibility of future pregnancy, since fertility may be restored by the sustained and marked weight loss usually attained after bariatric surgery. Finally, avoidance of the risks associated with morbid obesity compensate for the possible residual risks for pregnancy derived from the previous bariatric procedure itself.     

Association of MEP1A gene variants with insulin metabolism in central European women with polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) shows not only hyperandrogenemia, hirsutism and fertility problems, but also metabolic disturbances including obesity, cardiovascular events and type-2 diabetes. Accumulating evidence suggests some degree of inflammation associated with prominent aspects of PCOS. We aimed to investigate the association of genetic variants 3′UTR rs17468190 (G/T) of the inflammation-associated gene MEP1A (GenBank ID: NM_005588.2) with metabolic disturbances in PCOS and healthy control women.     

Quality of life and marital sexual satisfaction in women with polycystic ovary syndrome

Polycystic ovary syndrome affects 5-10% of women in the developed world, making it the most common endocrine disorder among women of reproductive age. The symptoms typically associated with polycystic ovary syndrome: amenorrhea, oligomenorrhea, hirsutism, obesity, subfertility, anovulation and acne can lead to a significant reduction in female life quality.The aim of the study was to evaluate the effect of polycystic ovary syndrome on quality of life and marital sexual satisfaction. Fifty women with polycystic ovary syndrome were qualified to the study as the research group. The control group consisted of fourty healthy women. A specific questionnaire was used as a research tool in this study. It included the socio-demographic part, polycystic ovary syndrome's symptomatology and validated scales: Polish version of Short Form-36 Health Survey (SF-36) and Index of Sexual Satisfaction (ISS). The mean age of researched women was 28.9+/-5.6 years, and in the control group - 30.5+/-5.3 years (p>0.05). Quality of life parameters for women with polycystic ovary syndrome were lower than for the controls in the aspect of: general health (p<0.01), limitations due to physical health (p<0.05), limitations due to emotional problems (p<0.001), social functioning (p<0.01), energy/fatigue (p<0.001) and emotional wellbeing (p<0.01). Studied women showed worse marital sexual functioning (p<0.05). Marital sexual dysfunctions were diagnosed in 28.6% of women with polycystic ovary syndrome and in 10.5% of healthy women (p<0.05). Polycystic ovary syndrome decreases quality of life and marital sexual functioning among women. A negative effect of hirsutism severity on general well-being and marital sexual life is also observed.     

Hirsutism: common clinical problem or index of serious disease?

Hirsutism is a clinical condition commonly encountered in the practice of primary care medicine. The etiology and the age of the patient when it occurs vary widely. Causes range from a basic illness or condition (drug exposure, smoking, idiopathic, and obesity) to complex and serious diseases (Cushing's syndrome, neoplasms, congenital adrenal hyperplasia, insulin-resistance syndromes, hyperprolactinemia, polycystic ovary syndrome, and hyperthecosis). Hirsutism may appear in childhood as well as in older persons. Some drugs (oral contraceptives, L-thyroxine, danazol, and diazoxide), tobacco smoke, some syndromes (polycystic ovary syndrome, obesity, insulin resistance, hyperprolactinemia, hyperthecosis, congenital adrenal hyperplasia, and idiopathic), and some neoplasms (adrenal or ovarian) may lead to hirsutism. The most frequently defined "causes" of hirsutism are polycystic ovary syndrome and idiopathic hirsutism. In hirsutism of gradual onset, hyperprolactinemia, insulin-resistance syndromes, hyperthecosis, polycystic ovary syndrome, and idiopathic hirsutism may be responsible. Cushing's syndrome, neoplasms, and congenital adrenal hyperplasia should be suspected if there has been rapid onset.     

Metabolic syndrome in polycystic ovary syndrome

Both metabolic syndrome (MS) and polycystic ovary syndrome (PCOS) are common among women. The exact prevalence of MS in women with PCOS is dependent upon the diagnostic criteria used for each. However, the frequent co-occurrence of both MS and PCOS in women is suggestive of a common aetiology. In this short review article we argue that insulin resistance, as a consequence of abdominal obesity, may represent such a common aetiology. We also review the literature on the prevalence of MS in women with PCOS and consider the impact that the particular criteria used to diagnose both MS and PCOS may have had on these estimates of prevalence.     

Polycystic Ovary Syndrome,Depression, and Affective Disorders

ObjectiveTo assess the prevalence of depression and psychologic disorders and their effect on the quality of life in women with polycystic ovary syndrome.MethodsWe performed a PubMed search of major relevant articles published during the period from 1985 to 2009 dealing with polycystic ovary syndrome, associated psychologic morbidity, and the relationship to clinical and biochemical changes affecting the quality of life.ResultsIn patients with polycystic ovary syndrome, the presence of depression and allied disorders was frequently noted to diminish mental well-being, affect, and self-worth. The symptoms often associated with this syndrome, such as hirsutism, obesity, irregular menses, and subfertility, were a major source of psychologic morbidity. Obesity was the most prevalent cause of mental distress, whereas other features such as hirsutism and infertility were less well defined as major factors. Although the findings in some studies have been inconclusive, the presence of clinically significant eating disorders and a 7-fold increase in the suicide rate have been reported in women with polycystic ovary syndrome.ConclusionWomen with polycystic ovary syndrome have a high risk for depression and affective disorders that impair their quality of life. The presence of obesity, eating disorders, hirsutism, poor self-image, and a significant suicide rate makes evaluation of their emotional state an integral part of their assessment and treatment. For adequate treatment of the woman with polycystic ovary syndrome, a biopsychosocial model should be used, with all aspects of the patient’s mental status considered before implementation of optimal intervention. (Endocr Pract. 2009;15:475-482)     

脂肪因子与代谢综合征关系的研究进展

代谢综合症是一系列代谢和心血管功能失调的临床特征,包括中心性肥胖、高血压、血脂异常、高血糖及胰岛素抵抗等,其发病机制及如何预防及控制代谢综合症正日益成为目前的学术热点。目前已经公认,脂肪不仅是能量存储器官,也是一个重要的内分泌器官。脂肪组织分泌的生物活性分子被称为脂肪因子。近年来的研究表明,脂肪因子广泛参与肥胖、2型糖尿病、高血压病及心血管疾病等一系列代谢相关性疾病的病理生理过程。脂肪因子能通过介导一系列的信号转导通路,并广泛参与机体复杂的代谢平衡网络的调节。脂肪因子的失衡能导致机体发生对胰岛素敏感性改变等一系列的生物学反应,从而在肥胖和代谢综合症的病理过程中发挥重要的作用。本文综述了脂肪因子与代谢综合征的关系的研究进展。