关键词： 肥胖   不孕   多囊卵巢综合症   治疗手段   月经紊乱   医学中心   药物治疗   武汉大学   人民医院   患者   促排卵   雌激素   误诊   体重   思想   生殖   生育   女生   疗效   减重  

摘要： 草率误诊为"多囊卵巢综合症",治疗上"大动干戈",动辄给予长期雌激素、促排卵等治疗手段,不仅疗效不好,更给患者增加严重思想负担.武汉大学人民医院生殖医学中心杨菁主任指出,在月经紊乱甚至停经的女生中,60%是超重.在减少5%-10%体重后,绝大多数人月经可以恢复.其中,只有6%-7%的患者是多囊卵巢综合症,可能会影响将来生育,在减重的同时需要用药物治疗.

关键词： 多囊卵巢综合症   TNF   胰岛素抵抗   高雄激素血症   ovary   囊性变   病理生理   卵泡膜细胞   脂联素基  

摘要： 多囊卵巢综合症(polycysitic ovary syndrome, PCOS)是一种具有多种致病因素、临床表现多态性的综合症,基本的病理生理改变为慢性持续的无排卵和高雄激素血症。对这个疾病的认识,最早仅仅局限于将其描述为一种硬化囊性变卵巢或囊性退化卵巢,直至1962年,

关键词： 多囊卵巢综合症   GnRH拮抗剂   GnRH激动剂   体外受精-胚胎移植  

摘要： 目的:探讨思则凯方案(group1),长方案(group2)和HMG促排卵方案(group3)对多囊卵巢综合症(PCOS)患者行体外受精-胚胎移植(IVF-ET)治疗的临床疗效影响。方法:回顾性分析2004年3月～2006年6月88例PCOS患者采取3种治疗方案的疗效,每组30个周期。比较各组间FSH用药天数、获卵数、受精率、卵裂率、优质胚胎数、临床妊娠率、卵泡过度刺激综合征(OHSS)发生率、流产率。结果:3组的用药天数group2最短,与其它两组比较均有显著性差异;group1和group2的获卵数与group3比较有显著性差异(P<0.01);优质胚胎数group3也相对较高(P<0.01);受精率、卵裂率、HCG注射日内膜厚度、LH值,OHSS发生率、临床妊娠率,流产率比较差异无显著性,但group3流产发生率也偏高。结论:对行IVF-ET治疗的PCOS患者使用GnRH拮抗剂缩短了Gn的用药时间和用量,降低了OHSS的发生率,减轻了病人的经济负担和精神压力,是PCOS患者IVF-ET治疗的可选方案之一。

关键词： 超声诊断   多囊卵巢综合症  

摘要： 目的探讨多囊卵巢综合征(PCOS)超声图像特征及诊断价值.方法对56例临床诊断为多囊卵巢综合症患者声像图特征进行回顾性分析,并结合基础体温测定(BBT)、性激素六项、宫颈黏液等检查进行对照.结果多囊卵巢综合症的基础体温测定为单相,性激素测定显示LH/FSH>3,声像图表现双侧卵巢增大,包膜较厚,卵泡数目增多,卵巢髓质增大,回声增强.结论超声诊断多囊卵巢综合症,不仅有助于了解卵巢的动态变化,且能对药物治疗的效果进行监测,为妇产科内分泌疾病的诊断和治疗提供了新方法,同时为多囊综合症的筛选检查,提供有价值的诊断依据.

关键词： INTIMA-MEDIA THICKNESS   NORMAL-WEIGHT WOMEN   C-REACTIVE PROTEIN   INSULIN-RESISTANCE   YOUNG-WOMEN   CARDIOVASCULAR RISK   OVERWEIGHT WOMEN   PLASMA-LEVELS   OBESE WOMEN   DYSFUNCTION  

摘要： Objective: There is evidence of preclinical cardiovascular disease even in young women with polycystic ovary syndrome (PCOS). The aim of our study was to assess and compare the effects of metformin (MET) and rosiglitazone (ROSI) on endothelial function in PCOS patients. Methods: For 6 months, 26 women with PCOS received either MET or ROSI. Blood samples for assessment of androgens, lipids and high-sensitive C-reactive protein were taken at baseline and at endpoint. Endothelium-dependent flow-mediated dilation (FMD) and glyceryl trinitrate-induced endothelium-independent dilation of brachial artery were studied before and after treatment. Homeostasis model assessment (HOMA(IR)) calculation was applied as a measure of insulin resistance (IR). Results: With treatment, FMD of brachial artery improved significantly from 4.2 +/- 6.6 to 10.2 +/- 5.9% in MET group (P = 0.036) and from 2.9 +/- 3.2 to 7.6 +/- 4.9% in ROSI group (P = 0.026). MET being as effective as ROSI (P = 0.70). The endothelium-independent dilation did not change. Additionally, administration of MET was associated with a significant decrease in HOMA(IR) (P = 0.003), serum total and serum-free testosterone (P = 0.045 and P = 0.008 respectively) and significantly higher frequencies of menstrual bleeding (P = 0.006). Conclusion: A 6-month therapy with insulin sensitizers. MET and ROST, resulted in marked improvement of endothelial function in young PCOS patients without clinically evident atherosclerosis who were not severely insulin resistant. Neither drug was superior to the other. We conclude that therapeutic intervention with either insulin sensitizer may reverse the atherosclerotic process in PCOS patients at its early stage.

关键词： BONE-MINERAL DENSITY   KAPPA-B LIGAND   INSULIN-RESISTANCE   CIRCULATING OSTEOPROTEGERIN   RECEPTOR ACTIVATOR   INHIBITORY FACTOR   RANK LIGAND   WEIGHT-LOSS   IN-VITRO   TESTOSTERONE  

摘要： Objective: Osteoprotegerin (OPG), an inhibitor of osteoclastic bone resorption. has a variety of functions including anti-inflammatory effects and a possible cardiovascular protective role. Both low-grade chronic inflammation and cardiovascular risk are increased in women with the polycystic ovary syndrome (PCOS). We aimed to study serum OPG concentrations in PCOS patients. Design: Case-control study including 40 PCOS patients matched with 40 non-hyperandrogenic women for age and body mass index. Methods: Basal Serum sampling and standard oral glucose tolerance test, and measurement of serum OPG concentrations by commercial ELISA. Results: Serum OPG concentrations were lower in women with PCOS compared with those of controls (304 +/- 120 vs 363 +/- 105 pg/ml respectively: F=7.641. P=0.007) independently of obesity No differences were observed in serum receptor activator of nuclear factor-kappa B ligand (RANKL) levels and in the RANKL/OPG molar ratio. A multivariate linear regression model (R-2=0.208. F=6.579. P=0.001) showed that PCOS (beta=-0.281, P=0.008). obesity (beta=-0.245, P=0.022) and age (beta=0.296, P=0.006) were predictive of serum OPG concentrations. Conclusions: Serum OPG concentrations are reduced in PCOS patients independently of obesity. Considering the anti-inflammatory effects of OPG, its reduced serum concentrations might contribute to the proinflammatory state and cardiovascular risk of PCOS patients.

关键词： 来曲唑   促排卵   多囊卵巢综合症  

摘要： 来曲唑在治疗不孕症的临床应用具有较大潜力,有高效选择性抑制芳香化酶的活性、显著降低雌激素水平、不与雌激素受体结合、半衰期短的优越性。使用来曲唑有促排卵作用,能避免过度刺激卵巢,保证排卵功能健全,而且通常是单一排卵,对子宫内膜容受性影响小,提高妊娠率;若联合用药,可大大减少外源性促性腺激素的剂量;其促排卵副作用小,安全性好,胎儿致畸率很小。来曲唑可能成为新一代促排卵药物。

关键词： 多囊卵巢综合症   胰岛素抵抗   粒层细胞   酪氨酸磷酰化   罗格列酮  

摘要： 目的:研究罗格列酮对多囊卵巢综合征(PCOS)患者卵巢黄素化颗粒细胞胰岛素受体底物-1(IRS-1)和IRS-2蛋白表达及酪氨酸磷酸化的影响。探讨罗格列酮改善PCOS卵巢局部胰岛素抵抗的作用。方法:收集行IVF-ET治疗的11例PCOS患者(PCOS组)和15例排卵正常患输卵管性不孕患者(对照组)促排卵后黄素化颗粒细胞行体外培养,分别用不同浓度罗格列酮(0、1、10、100、1000、10000nmol/L)处理细胞48h,采用RT-PCR、免疫印迹(Western blotting)及免疫沉淀法分别检测卵巢黄素化颗粒细胞IRS-1和IRS-2mRNA的表达、蛋白含量及酪氨酸磷酸化水平。结果:(1)与对照比较,PCOS组黄素化颗粒细胞IRS-1mRNA表达及蛋白含量显著增加(P<0.05),IRS-2mRNA表达及蛋白含量显著降低(P<0.05),IRS-1和IRS-2酪氨酸磷酸化水平均显著降低(P<0.05,P<0.05);(2)不同浓度罗格列酮作用后,PCOS组黄素化颗粒细胞IRS-1mRNA及蛋白表达显著降低,IRS-2mRNA及蛋白表达显著增加,同时IRS-1和IRS-2酪氨酸磷酸化水平也显著增加,而正常对照组黄素化颗粒细胞IRS表达及酪氨酸磷酸化水平无显著变化。结论:PCOS患者卵巢局部存在胰岛素抵抗,其原因可能与IRS-1和IRS-2蛋白表达及酪氨酸磷酸化异常有关;罗格列酮可以通过调整IRS-1和IRS-2表达失衡,提高IRS-1和IRS-2酪氨酸磷酸化水平,改善PCOS患者卵巢局部胰岛素抵抗。

关键词： 多囊卵巢综合症   达英-35   二甲双胍  

摘要： 目的针对肥胖型多囊卵巢综合征（PCOS）胰岛素抵抗和高雄激素的临床特征，用达英-35联合二甲双胍进行治疗，对其疗效进行评价。方法将肥胖型PCOS36例，随机分为两组，A组服用达英-35联合二甲双胍，B组单用达英-35，连续服用3个月，停药1个月再复查。于早卵泡期（月经3～7d）或闭经期（B超下无优势卵泡），患者于清晨空腹抽取静脉血，化学发光法测定性激素水平，含卵泡刺激素（follicule-stimulating mormone，FSH）、黄体生成素（luteo-tropic normone，LH）、雌二醇（eslradiol，E2）、泌乳素（prolactin，PRL）、睾酮（testosterone，T），以及行糖耐量及胰岛素释放实验分析，体重指数（BMI），腰围／臀围（WHR）等分析治疗前后内分泌的改变情况。结果A组能有效抑制肥胖，雄激素合成，改善胰岛素抵抗，减轻体重，为促排卵治疗创造条件。结论达英-35联合二甲双胍治疗能更好地改善肥胖型PCOS内分泌环境。

关键词： 多囊卵巢综合症   不孕症   补肾活血化痰方   疗效  

摘要： 多囊卵巢综合征(PCOS)是妇科常见的内分泌疾病,常引起不孕,笔者近4年来采用自拟补肾活血化痰方治疗本病30例,取得一定疗效,现报告如下.