多囊卵巢综合征患者阴道微生态变化及其与性激素水平的关系

目的探讨多囊卵巢综合征(PCOS)患者阴道微生态变化及其与性激素水平的关系。方法将2018年7月-2019年7月我院生殖健康与不孕症科收治的132例PCOS患者作为研究组,选择同期在我院进行妇科体检的86例健康女性作为对照组。16S rRNA法和定量PCR反应检测阴道分泌物微生态情况,放射免疫法测定血清中睾酮(T)、卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)、孕酮(P)、催乳素(PRL)水平,分析微生态变化与性激素水平的关系。结果研究组患者阴道分泌物清洁度Ⅳ度检出率,滴虫、假丝酵母菌及线索细胞阳性检出率,阴道微生态失调率,血清T、LH、E2及PRL水平均高于对照组(P0.05),研究组患者血清FSH、P水平低于对照组(P0.05)。阴道微生态失调患者血清中E2水平高于阴道微生态正常患者,P水平低于阴道微生态正常患者(P0.05)。结论 PCOS患者存在阴道微生态失衡,阴道微生态的变化与血清性激素水平存在相关性,考虑激素水平的变化可能参与阴道微生态失调的发生。     

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。     

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。     

2型糖尿病并发多囊卵巢综合征与肠道菌群相关性的研究进展

2型糖尿病并发多囊卵巢综合征（PCOS）的患病率逐年上升,但在临床中并未引起足够重视,二者并发增加了临床治疗难度,对患者的生活带来严重的不良影响。在药物治疗方面,虽然双胍类药物和SGLT-2抑制剂等治疗2型糖尿病并发PCOS具有一定的治疗效果,但受限于疾病发病机制不清及药物相关的不良反应,目前临床治疗此病的治疗效果欠佳,预后一般。研究发现,microRNA的异常表达、线粒体功能障碍、脂联素水平的下降与2型糖尿病并发PCOS密切相关。通过调节肠道菌群,可以调节microRNA的异常表达,改善线粒体功能障碍及升高血浆脂联素水平,提示肠道菌群失调可能是2型糖尿病并发PCOS的关键因素。因此,调节肠道菌群紊乱对治疗2型糖尿病并发PCOS具有重要意义。

     

肠道菌群与多囊卵巢综合征并发抑郁症关系的研究进展

抑郁症是多囊卵巢综合征（polycystic ovary syndrome,PCOS）常并发的精神障碍性疾病,不仅严重影响PCOS患者的生活质量,还会进一步加重内分泌代谢的紊乱,形成恶性循环,增加治疗疾病的难度。目前临床上对PCOS并发抑郁症主要采用分开诊治的方案,并未根据两者之间内在的联系找到针对性的治疗药物。近年的研究表明,PCOS患者的肠道菌群存在明显失衡,而失衡的肠道菌群可通过“肠-脑轴”导致抑郁症的发生。因此肠道菌群与PCOS并发抑郁症的发生密切相关。本文就肠道菌群与PCOS并发抑郁症关系的研究进展进行综述,以期为临床上治疗PCOS并发抑郁症提供参考。     

Kiss1和GPR54基因多态性与多囊卵巢综合征相关性分析

本研究旨在探讨Kiss1和GPR54基因多态性与多囊卵巢综合征的相关性。利用超声检查卵巢体积、血清睾酮、游离雄激素指数情况;临床评估患者身高(cm)和体重(kg)、BMI、静息血压、痤疮和黑棘皮病的分布;ELISA酶联免疫法检测血清中的kisspeptin和睾酮水平,使用Next generation sequencing方法(LGC group, Germany)对基因(Kiss1, GPR54)进行测序。结果显示,PCOS患者比对照组女性具有更高的BMI和mFG评分,PCOS患者血清Kisspeptin和睾酮浓度显著提高,且LH浓度也显著高于对照组(p<0.05)。GPR54和Kiss1 2个基因在患者体内存在多态性;测序分析结果显示GPR54基因存在的2个新的SNP位点(chr19:918686, A→G和chr19:918735, A→G),这2个新的多态性位于内含子区域(内含子2),Kiss1基因也存在两个SNP,位于非翻译变体5的末端(rs5780218)和外显子3 (rs4889),即GPR54基因存在A→G多态性,Kiss1基因为CTT→CT/G→C多态性,且相关性关联分析结果表明,GPR54基因型多态性(Chr19:918735)与PCOS风险增加相关(p<0.05);而Kiss1 SNP的基因型与PCOS风险之间没有关联。此外,PCOS与GPR54和Kiss1基因的单倍型没有显著关联。本研究推论对PCOS发生风险的遗传影响可能不仅是通过直接改变Kiss1/GPR54相互作用,而且还可能通过改变个体与环境因素的相互作用。     

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。     

高雄激素相关的慢性炎症与多囊卵巢综合征的研究进展

多囊卵巢综合征是育龄妇女常见的慢性炎症代谢性疾病,70%以上患者出现高雄激素血症。下丘脑-垂体-性腺相关激素是月经周期和卵巢活动的调节器,脑神经元分泌的Kisspeptin、褪黑素通过下丘脑-垂体-卵巢轴调节Gn RH神经元AMH、Gn RH的表达,卵巢促性腺激素、雄激素水平增高,有利于慢性炎症的形成,促进多囊卵巢综合征的发生发展。本文综述了近几年多囊卵巢综合征中雄激素相关的慢性炎症研究,并根据相关研究提出了一些见解,希望能为多囊卵巢综合征的研究提供一些新的思路。     

补肾活血中药加克罗米芬治疗多囊卵巢综合征所致不孕症的临床观察

目的观察补肾活血中药加克罗米芬治疗多囊卵巢综合征致不孕症的临床疗效。方法随机抽取我院2013年6月~2014年6月收治的多囊卵巢综合征致不孕症患者50例为观察组,采用补肾活血中药加克罗米芬治疗;同时抽取同期患者50例为对照组,采用克罗米芬治疗。观察比较两组患者的治疗效果。结果观察组治疗总有效率为94.0%,优于对照组的70.0%,差异具有显著统计学意义(χ2=13.25,P0.05);两组患者SHBG、排卵情况、月经量化评分分析,观察组均优于对照组(t/χ2分别为7.501,13.64,2.43,均P0.05)。结论补肾活血中药加克罗米芬治疗多囊卵巢综合征致不孕症具有较为理想的治疗效果,可在临床上推广使用。     

多囊卵巢综合征并发抑郁症的研究现状

多囊卵巢综合征(polycystic ovary syndrome,PCOS)是育龄女性最常见的内分泌疾病之一,表现为生殖和代谢异常。近些年来,越来越多的人群学研究发现,PCOS病人患精神心理疾病,尤其是抑郁症的发生率高于正常人群。本文概述了PCOS并发抑郁症的相关危险因素和可能机制,并简要论述了PCOS的治疗药物对抑郁症作用的最新研究进展。     

多囊卵巢综合征患者与健康人群肠道菌群差异性分析

目的 比较多囊卵巢综合征(PCOS)患者与健康人群间肠道菌群的差异,为后续研究提供参考.方法 采用16SrDNA扩增子测序法对30例PCOS患者(PCOS组)和20例健康人(健康组)粪便标本中菌群结构进行分析,并比较两组之间的区别.结果 与健康组相比,PCOS组患者肠道菌群α多样性降低.PCOS组患者肠道厚壁菌门(Fi...     

Impact of bariatric surgery on androgen profile and ovarian volume in obese polycystic ovary syndrome patients with infertility

Obesity has major adverse effects on reproductive performance and fertility potential especially in women with polycystic ovary syndrome. In this study, we aimed to evaluate the consequences of excess weight reduction by bariatric surgery on androgen levels, and ovarian volume by ultrasonography in obese polycystic ovary patients. This one year Cohort study was carried out in Zagazig university hospitals. The study included 36 infertile women with PCOS and obesity, who underwent bariatric surgery(sleeve gastrectomy or gastric bypass). Patients were evaluated for free and total serum testosterone levels, Sex hormone binding globulin (SHBG), free androgen index (FAI) and also ovarian volume by ultrasound pre-operatively, 6 months and 1 year after surgery. The results showed significant reduction in Body Mass Index, free and total serum testosterone levels and rise in SHBG and regulation of menstrual cycle at 6 and 12 months after operation. Free androgen index and ovarian volume by ultrasound also significantly decreased (p < 0.001) .As a conclusion, Bariatric surgery results in durable loss of weight and restores the normal physiological balance of androgenic milieu and ovarian morphology by ultrasound, in infertile women who have Polycystic ovary syndrome.     

多囊卵巢综合征患者血清VitD水平及与炎症因子之间的相关性研究

目的 了解多囊卵巢综合征（PCOS）患者血清中25-羟维生素D（25-OH-VitD3）水平情况,并探讨其与白细胞介素-6（IL-6）、肿瘤坏死因子（TNF-α）、转化生长因子（TGF-β）、单核细胞趋化蛋白-1（MCP-1）及C-反应蛋白（CRP）之间的相关性。方法 选择2017年8月—2018年12月来医院妇科门诊就诊并确诊为PCOS的患者共135例作为PCOS组,选择同期来医院体检的健康妇女共120例作为对照组,采用化学发光法检测血清中25-OH-VitD3水平,免疫比浊法检测CRP水平及采用酶联免疫吸附法（ELISA）检测IL-6、TNF-α及TGF-β水平,并对检测结果进行统计学分析。结果 PCOS组患者血清中25-OH-VitD3水平为31.87±6.29 nmol/L,明显低于对照组的65.08±13.76 nmol/L,差异有统计学意义（t=3.190,P<0.05）。PCOS组患者血清IL-6、TNF-α、TGF-β、MCP-1及CRP水平分别为23.71±11.23 ng/L、20.54±3.16 ng/L、76.54±8.03 ng/L、375.92±40.15 ng/L及13.48±3.10 mg/L,均明显高于对照组,差异均有统计学意义（t=9.065,8.091,10.178,13.052,7.059,Ps<0.05）。通过Pearson相关性分析,25-OH-VitD3水平与IL-6、TNF-α、TGF-β、MCP-1及CRP水平均呈明显的负相关（r= -0.562,-0.628,-0.780,-0.850,-0.505,Ps<0.05）。结论 25-OH-VitD3低表达水平可能通过其免疫调节及抑制炎症因子生成能力下降,引起各种炎症因子水平升高,导致PCOS的发病。因此,维生素D可能与PCOS病的发生和发展有密切关系。     

Modelling the control of ovulation and polycystic ovary syndrome

 The control of ovulation in mammalian species appears to be a highly robust process. The primary mechanism is believed to be competition amongst a group of developing follicles, mediated by a hormonal feedback loop involving in the first instance the pituitary. Successful follicles reach maturity and ovulate, the remainder atrophy and die. A model of this control process has been derived by Lacker and his group. Based on simple qualitative assumptions about the hormonal feedback loop, this is able to reflect many of the basic physiological features of ovulation in mammals. However, a fundamental hypothesis of Lacker’s work is that all follicles are identical and respond to hormonal signals in precisely the same way. Not only is this improbable, but it also leads to several aspects of the model which are qualitatively unrealistic, most notable of these is its inability to accurately model the condition known as Polycystic Ovary Syndrome. This common malfunction of the ovulatory control mechanism accounts for up to three-quarters of cases of anovulatory infertility in humans and its understanding is therefore of considerable medical significance. In this paper we extend the analysis of Lacker’s model to the case of non-identical follicles; this allows us to obtain behaviour much closer to that observed in PCOS patients and to draw some tentative conclusions about the mechanisms underlying this condition. Received 19 August 1996; received in revised form 14 February 1997     

多囊卵巢综合征和肠道菌群的关系及中药防治研究现状

多囊卵巢综合征是育龄期女性最常见的疾病之一,以多种内分泌代谢紊乱为特征。近年来的研究发现肠道菌群和多囊卵巢综合征的发生发展相关,肠道菌群和中医的关系已成为研究热点。本文分析了肠道菌群及其代谢产物和肠道屏障在多囊卵巢综合征发生发展中的作用,总结了单味中药和复方中药通过影响肠道菌群改善多囊卵巢综合征的研究进展。今后研究中应进一步探索与多囊卵巢综合征相关的特异菌属,探索中药有效成分及作用靶点,为中医治疗多囊卵巢综合征提供新思路。     

Current and future aspects of several adjunctive treatment strategies in polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is a common endocrinopathy in women of reproductive age. PCOS is characterized by hyperandrogenism, menstrual disorders, and polycystic ovarian morphology. PCOS patients have an increased risk of type 2 diabetes, cardiovascular disease, and infertility. The mechanism of PCOS is not yet fully understood, but insulin resistance and genetic factors may play distinct roles in the pathomechanism.There is ongoing research on new therapeutic modalities for women with PCOS. In this minireview, we assessed the evidence for the effectiveness and safety of selected adjunctive agents (metformin, statins, resveratrol, melatonin, and inositols) for the treatment of women with PCOS. Metformin is a safe medication used in PCOS for 25 years that is currently recommended in select PCOS subpopulations, such as adolescents, women with metabolic disorders, and infertility infertile women undergoing ovarian hyperstimulation. Statins are also suggested in PCOS therapy, as these compounds decrease testosterone concentrations, improve lipid profiles, and ameliorate inflammatory reactions. Despite promising results, the role of statins in PCOS management needs to be further validated. Dietary supplements have also been tested in PCOS patients. Resveratrol was shown to decrease total testosterone production and improve fasting insulin but, until recently, only in one randomized study. Data on the therapeutic efficacy of melatonin and inositols on endocrine and metabolic abnormalities are limited and inconclusive. The multifactorial etiology of PCOS makes tailoring of its treatment more demanding, and there is a constant need for causative and effective modes of PCOS therapy.     

Proteomics and polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is a complex endocrine disorder of heterogeneous etiology. Proteomics techniques have been used for elucidating the physiopathology of PCOS, yet the proteins identified so far were rarely the same across tissues and studies. The present review discusses the current challenges in the application of proteomics to the study of PCOS. A well-defined research design and an appropriate selection of study populations, samples and proteomic platforms are essential in clinical proteomics. Furthermore, the findings derived from proteomic approaches should be validated by complementary techniques, and the reproducibility of the results has ideally to be confirmed by different studies. Only when meeting these requirements, the proteins identified by proteomic techniques should be considered as candidates for future studies aiming to define specific molecular phenotypes of PCOS and their possible role in the metabolic and hormonal abnormalities characteristic of this syndrome.     

粪菌移植对多囊卵巢综合征的影响

多囊卵巢综合征是无排卵不孕女性常见的内分泌紊乱疾病,临床表现为月经不调、高雄激素血症和卵巢多囊样改变等,并伴有糖代谢和脂代谢异常。肠道菌群不仅作用于肠道,还调节营养摄取、脂肪储存和胰岛素敏感性,与多囊卵巢综合征有着密切关系。肠道菌群失调可能导致慢性低度炎症状态,免疫系统的激活会干扰胰岛素受体,提高胰岛素水平,促进卵巢睾酮的产生,导致多囊卵巢综合征。粪菌移植可以恢复肠道菌群失调和重建黏膜屏障,从而调节性类固醇的浓度、改善发情周期、恢复卵巢正常形态、降低空腹胰岛素水平、改善胰岛素抵抗、增加胰岛素敏感性和减轻慢性炎症等,对多囊卵巢综合征具有一定的治疗效果。