关键词： 病因病机   不孕症   多囊卵巢综合症   中医辨证分析   子宫内膜异位症   免疫性不孕   医学分类   功能障碍  

摘要： 不孕症病因的西医学分类较多,但结合现代临床实际分析,以下丘脑-垂体-卵巢调节轴功能障碍、感染及创伤、多囊卵巢综合症(PCOS)、子宫内膜异位症(EM)及免疫性不孕等病因为主,根据焦丽[1]对213例不孕妇女病因调查分析,以上病因在不孕症中所占比例高达90 %.越来越多的妇科工作者认识到中医治疗不孕症具有优势,但就各类病因的中医辨证分析仍不够成熟.我们在西医认识的基础上,对上述常见病因的中医辨证分析作了一些探索,不揣陋见,与同道商榷.

关键词： PAF acetylhydrolase   gene polymorphism   inflammation   polycystic ovary syndrome   CORONARY-ARTERY-DISEASE   TYPE-2 DIABETES-MELLITUS   PAF ACETYLHYDROLASE   INSULIN-RESISTANCE   CARDIOVASCULAR-DISEASE   PHOSPHOLIPASE A(2)   MISSENSE MUTATION   OBESE WOMEN   GLUCOSE   ATHEROSCLEROSIS  

摘要： Low-grade chronic inflammation and greater risks of cardiovascular diseases are often present in patients with polycystic ovary syndrome (PCOS). Platelet-activating factor (PAF) acetylhydrolase (PAF-AH) hydrolyzes and inactivates PAF and PAF-like oxidized phospholipids that are potent lipid mediators involved in inflammation and atherosclerosis. Deficiency of this enzyme is caused by a missense mutation (G994 -> T) in exon 9 of the plasma PAF-AH gene. The aim of the study was to investigate a possible association of this polymorphism with the risk of PCOS and to evaluate the effects of the genotype on the activity and distribution of PAFAH in Chinese patients. A total of 661 subjects (346 patients with PCOS and 315 healthy control women) from a population of Chinese Han nationality in Chengdu area were included in this study. PAFAH G994T genotype was studied using PCR and restriction fragment length polymorphism analysis. Total plasma PAF-AH, high-density lipoprotein (HDL)-associated PAF-AH (H-PAF-AH) and low-density lipoprotein (LDL)-associated PAF-AH (L-PAF-AH) activities were measured by the trichloroacetic acid precipitation procedure using [(3)H-acetyl] PAF and PAF C-16 as a substrate. The prevalence of the mutant genotype (GT + TT) was significantly more frequent in patients with PCOS than in control subjects (12.7 versus 6.0%, P = 0.003). Genotype (GT + TT) remained a significant predictor for PCOS (P = 0.020) in prognostic models including age, body mass index, insulin resistance index, triglyceride, HDL and LDL as covariates. There was a significant difference in plasma PAF-AH, L-PAF-AH and H-PAF-AH activities between GG and GT genotypes in both the patient and control groups. The ratio of L-PAF-AH to H-PAF-AH activities was significantly higher after adjustment for multiple variables in patients with GT genotype compared with patients with GG genotype (P = 0.003). There were no significant differences in clinical, biochemical and metabolic parameters accor

关键词： 临床医药   医学教育   缺血性心脏病   多囊卵巢综合症   基质金属蛋白酶   答题卡   病毒载体   始动因素   高胰岛素血症   细胞外基质  

关键词： 葛根素   多囊卵巢综合症  

摘要： 目的:观察葛根素对多囊卵巢综合症(PCOS)大鼠血清性激素的作用。方法:胰岛素联合HCG诱导复制PCOS大鼠模型,分为空白对照组、模型对照组、葛根素组,葛根素组用葛根素注射模型大鼠。观察三组大鼠体重、卵巢病理学改变、雌激素(E2)、孕激素(P)、雄激素(T)、卵泡刺激素(FSH)、黄体生成素(LH)的变化。结果:与模型对照组相比,葛根素组大鼠体重、卵巢的大小、重量、色泽和病理学形态发生明显改变,T、LH明显降低,FSH升高(P<0.05),与空白对照组相比无明显差异(P>0.05)。结论:葛根素可以改善多囊卵巢综合症大鼠卵巢功能和血清异常性激素水平。

关键词： 多囊卵巢综合症   不孕   中西医结合治疗  

摘要： 目的探讨多囊卵巢导致不孕中西医结合治疗的临床应用价值。方法对120例多囊卵巢综合症合并不孕症患者随机分为两组,治疗组60例用克罗米芬、HCG、二甲双胍等西医,根据女性月经周期中卵泡的不同阶段,加用不同的中药治疗;对照组60例单纯应用上述西药治疗,观察两组的妊娠率。结果治疗一年后观察疗效,治疗组妊娠率为58.33%,对照组妊娠率为13.33%;两组差异有统计学意义(P<0.05)。结论中西医结合治疗多囊卵巢导致的不孕可取得满意的疗效,值得临床推广应用。

关键词： 多囊卵巢综合症   临床分析   病理生理变化   育龄妇女   胰岛素抵抗   终身性疾病   心血管疾病   临床表现  

摘要： 多囊卵巢综合症是一种发病多因性,临床表现呈现多态性的内分泌综合症,病理生理变化复杂,且近年发现雄激素升高为其主要特征,常伴有血糖升高、胰岛素抵抗等异常[1~3]。它是育龄妇女常见的涉及诸多因素的终身性疾病,也是育龄妇女月经紊乱的最常见原因,若其病理生理长期得不到纠正,则不仅影响生殖健康,更影响机体的全身健康。患此病的妇女更有发展为代谢和心血管疾病的高风险。本研究对我院门诊确诊并随诊的16例患者进行综合分析。

关键词： 多囊卵巢综合症   胰岛素抵抗   PI3K/Akt信号通路  

摘要： 多囊卵巢综合症(PCOS)是女性常见的生殖功能障碍性疾病,主要表现为卵巢的雄激素过多及排卵障碍,是引起女性不排卵性不孕的主要原因。PCOS患者主要表现为胰岛素抵抗和高胰岛素血症,而PI3K/Akt信号通路是胰岛素发挥生理作用的主要信号通路,并且Akt的下游底物GSK-3是糖原合成的主要调控因子,本文就PI3K/Akt与胰岛素抵抗的关系做一综述,并对PCOS的治疗进行了展望。

关键词： GnRH antagonists   GnRH agonists   polycystic ovary syndrome   ovarian hyperstimulation syndrome   pregnancy rates   IN-VITRO FERTILIZATION   FOLLICLE-STIMULATING-HORMONE   HYPERSTIMULATION-SYNDROME   LIVE BIRTH   METAANALYSIS   GONADOTROPIN   WOMEN   RISK   PCOS   PROBABILITY  

摘要： Women with polycystic ovary syndrome (PCOS) are at risk of developing ovarian hyperstimulation syndrome (OHSS) during ovarian stimulation. Use of GnRH antagonist in the general subfertile population is associated with lower incidence of OHSS than agonists and similar probability of live birth but it is unclear if this is true for patients with PCOS. Our aim was to compare the flexible GnRH antagonist and GnRH agonist long protocols in patients with PCOS undergoing IVF (primary end-point: ongoing pregnancy rate per patient randomized). In this randomised controlled trial (RCT), 220 patients with PCOS were randomly allocated in two groups: long GnRH agonist down-regulation protocol (n = 110) and flexible GnRH antagonist protocol (n = 110). No differences were observed in ongoing pregnancy rates [50.9 versus 47.3%, difference 3.6%, 95% confidence interval (CI): -9.6 to +16.8%] in the agonist and antagonist protocols, respectively. Incidence of OHSS Grade II was lower in the antagonist compared with agonist group (40.0 versus 60.0%, difference -20.0%, 95% CI: -7.1 to -32.9%, P < 0.01). Duration of stimulation (10 versus 12 days, difference 2 days, 95% CI: +1 to +2, P < 0.001) and total gonadotrophin required (1575 versus 1850 IU, difference -275 IU, 95% CI: -25 to -400, P < 0.05) were also lower in the antagonist compared with agonist protocol. The current RCT suggests that the flexible GnRH antagonist protocol is associated with a similar ongoing pregnancy rate, lower incidence of OHSS grade II, lower gonadotrophin requirement and shorter duration of stimulation, compared with GnRH agonist. The GnRH antagonist might be the treatment choice for patients with PCOS undergoing IVF. The study was registered at ***. ID: NCT00417144.

关键词： 多囊卵巢综合症   肾虚痰阻   病理机制  

摘要： 多囊卵巢综合征(PCOS)是青少年到生育年龄妇女发生高雄激素性无排卵现象中的最常见且较复杂的病种之一。肾虚痰阻是多囊卵巢综合症发病的基本病机,而补肾化痰调周法是治疗多囊卵巢综合症的重要潜法。

关键词： 时段性   多囊卵巢综合症   胰岛素抵抗  

摘要： 目的探讨时段性胰岛素检测在多囊卵巢综合征患者中评估胰岛素抵抗的临床应用。方法对53例多囊卵巢综合征（Polycystic ovary syndrome，PCOS）的患者进行LH、FSH、E2、P、T、PRL检测，OGTr及胰岛素释放试验检测，按HOMA—IR指数分为两组：HOMA—IR〉1．66为Ⅰ组，HOMA—IR〈1．66为Ⅱ组；按胰岛素水平分为两组：≥80uU／ml为第Ⅲ组，胰岛素〈80uU／ml为第Ⅳ组。结果Ⅰ组：BMI（kg／m^2）、LH／FSH、T、AUCI、AUCG、ISI值，组间比较Ⅰ组明显高于Ⅱ组，差异有统计学意义（P〈0．01）；Ⅰ组胰岛素≥80uU／ml有23例，胰岛素〈80uU／ml，6例，其中7例胰岛素恢复延迟，Ⅱ组胰岛素≥80uU／ml有10例，胰岛素〈80uU／ml有15例，其中3例胰岛素恢复延迟；根据胰岛素值分组：胰岛素≥80uU／ml有32例，胰岛素〈80uU／ml，21例；Ⅱ组：BMI、LH／FSH、T、ISI、AUCG值，组间比较Ⅲ组明显高于Ⅳ组，两组比较差异有统计学意义（P〈0．01），HOMA—IR：Ⅲ组为1．3±0．7，1V组为0．2±0．9，Ⅲ组明显高于Ⅳ组两组比较有统计学意义（P〈0．01），胰岛素值灵敏度83．11％；特异性62．67％；阳性预测值71．02％，阴性预测值为74．94％。结论研究结果提示PCOS患者在时段性胰岛素≥80uU／ml预示有IR的高风险因素。应用时段性检测胰岛素≥80uU／ml作为判断IR的指标，对临床工作有一定的指导意义。