关键词： 多囊卵巢综合症   复方环丙孕酮   盐酸二甲双胍   马来酸罗格列酮  

摘要： 目的 探讨应用复方环丙孕酮分别与胰岛素增敏剂盐酸二甲双胍和马来酸罗格列酮治疗多囊卵巢综合症（PCOS）的临床效果.方法 选择在我院就诊的PCOS患者45例,随机分成两组,A组（复方环丙孕酮和盐酸二甲双弧）25例,B组（复方环丙孕酮和马来酸罗格列酮）20例,治疗疗程3个月经周期.比较两组患者用药前后体重、血糖及胰岛素水平、生殖激素水平变化及排卵和月经改善情况.结果 A组治疗后患者体重降低（P＜0.05）,两组治疗后体重比较,差异有统计学意义（P＜0.05）;两组患者空腹胰岛素、胰岛素抵抗指数等显著下降,B组治疗后数值低于A组（P＜0.05）;两组患者治疗后血清睾酮较治疗前明显降低,与治疗前相比,差异有高度统计学意义（P＜0.01）,但两者之间差异无统计学意义（P＞0.05）;两组患者治疗后排卵率比较,B组高于A组,差异有统计学意义（P＜0.05）.结论 应用复方环丙孕酮与胰岛素增敏剂治疗PCOS患者,可以明显改善患者的胰岛素抵抗、内分泌及代谢紊乱.盐酸二甲双胍有轻微降低体重的作用,价格便宜;马来酸罗格列酮减轻胰岛素抵抗及提高排卵率效果优于盐酸二甲双胍,但因用药安全性问题及价格较贵,仍以盐酸二甲双胍为一线用药.

关键词： fetal reprogramming   polycystic ovary syndrome   small for gestational age   hyperandrogenism   anovulation   HORMONE-BINDING GLOBULIN   INSULIN-RESISTANCE   METABOLIC SYNDROME   ANDROGEN EXCESS   NEWBORN-INFANTS   2003 CONSENSUS   BIRTH-WEIGHT   FETAL-GROWTH   PCOS   TESTOSTERONE  

摘要： There is evidence that intrauterine growth restriction, resulting in newborn girls that are small for gestational age (SGA), may be related to the onset of polycystic ovary syndrome (PCOS). Thus, we studied whether women born SGA have a higher prevalence of PCOS than women born appropriate for gestational age (AGA). This was a prospective birth cohort study of 384 women born at term between June 1, 1978, and May 31, 1979, in Ribeirao Preto, Brazil. After exclusion, 165 women effectively participated in this study, of whom 43 were SGA and 122 were AGA. The prevalence of PCOS was analysed. At a mean age of 29 years, the women agreed to follow the study protocol, which included: anamnesis, physical examination, serum tests [follicle stimulating hormone, luteinizing hormone, total and free testosterone, dehydroepiandrostenedione sulphate, 17-OH-progesterone, fasting insulin, sex steroid-binding globulin (SHBG) and fasting glucose] and pelvic ultrasound. Data regarding gestational age, birthweight, age at menarche and maternal data were obtained from the files of the cohort. The adjusted relative risk (RR) values of the SGA, insulin resistance, body mass index, maternal smoking and parity variables were analysed using Poisson regression with robust adjustment of variance for the prediction of PCOS. The prevalence of PCOS was higher in the SGA group than in the AGA group [adjusted RR = 2.44, 95% CI (1.39-4.28)]. Hyperandrogenism was more prevalent in the SGA women than in the AGA women (P = 0.011). Circulating SHBG was lower in the SGA women than in the AGA women (P = 0.041), but fasting insulinemia was similar in both groups. The prevalence of PCOS in SGA women was twice as high as in AGA women in our study population.

关键词： Hyperhomocysteinemia   Methylenetetrahydrofolate reductase   MTHFR   C677T   Polymorphism   Polycystic ovary syndrome   PLASMA HOMOCYSTEINE LEVELS   RISK-FACTOR   CARDIOVASCULAR-DISEASE   VASCULAR-DISEASE   INSULIN-RESISTANCE   COMMON MUTATION   YOUNG-WOMEN   HYPERHOMOCYSTEINEMIA   LIPOPROTEIN   FREQUENCY  

摘要： Higher Levels of Hcy are associated with several clinical conditions, among them non-insulin-dependent diabetes mellitus, endometrial dysplasia and hypertension with insulin resistance, and polycystic ovary syndrome. The purpose of this study was to investigate the serum homocystein levels and other metabolic parameters in relationship with the MTHFR C677T gene polymorphism in patients with PCOS. Our study included 86 young women with PCOS constituting the study group and 70 healthy women constituting the control group. Homocystein levels, metabolic, and hormonal parameters were measured, and genetic analysis of the MTHFR C677T gene polymorphism was performed in all the subjects. A statistically significant difference was observed in mean homocystein levels between patients with PCOS when compared to the control group. The MTHFR 677 CC genotypes had significantly higher proportions in the control group compared to the PCOS patients (chi(2) = 21.381, P < 0.001). Our data show that homocystein levels were higher than normal subjects in patients with PCOS and that the MTHFR C677T gene polymorphism does not influence homocystein levels of patients with PCOS.

关键词： 卵巢过度刺激症   补肾法   多囊卵巢综合症   2009年   妊娠   治疗   西药   月经稀发  

摘要： 1 病例讨论患者,30 岁,月经稀发10年,诊断为多囊卵巢综合症,原发不孕.因' 停经37d,下腹胀10d' 于2009 年8 月5 日入院,LMP:2009年6月30日.月经周期第7～11d开始每天服用克罗米芬100 mg,B 超监测卵泡未见发育,故予月经第14d起隔日肌注HMG 150u,连用4次,月经周期第21d查B超提示:左侧卵巢优势卵泡3～4个,最大22mm×18mm,右侧卵巢优势卵泡3～4个,最大24mm×21mm,注射HCG10000IU ,24 ～36 h内适时指导性交.周期28 d出现下腹部腹胀,并呈渐进性加剧,稍有腹痛,尿HCG可疑阳性,停经35d时血HCG:120mIU/mL.

关键词： 多囊卵巢综合症   补肾调经育子汤   二甲双胍   中西医结合疗法  

摘要： 目的:观察补肾调经育子汤合西药治疗多囊卵巢综合征不孕的疗效。方法:将66例该病患者随机分为两组,治疗组36例予自拟补肾调经育子汤口服,同时加服二甲双胍薄膜片;对照组单服二甲双胍薄膜片。两组均3个月经周期为1个疗程。结果:治疗组排卵27例,排卵率为75.0%(95%CI=60.9%～89.1%);对照组排卵11例,排卵率为36.7%(95%CI=19.5%～53.9%);治疗组妊娠21例,妊娠率58.3%(95%CI=42.2%～74.4%);对照组妊娠7例,妊娠率23.3%(95%CI=8.2～38.4);两组排卵率(χ2=9.8442,P<0.01)、妊娠率(χ2=8.2066,P<0.01)比较,差异显著。结论:补肾调经育子汤配合二甲双胍薄膜片对多囊卵巢综合症所致不孕疗效优于单用二甲双胍薄膜片,其收益为OR=0.19(95%CI=0.07～0.56),NNT=3(95%CI=1.61～6.95);其收益为OR=0.22(95%CI=0.07～0.64),NNT=3(95%CI=1.70～9.05)。

关键词： 二甲双胍   吡格列酮   多囊卵巢综合症   :514357广东省丰顺县黄金卫生院  

摘要： 目的：探讨应用二甲双胍联合吡格列酮治疗多囊卵巢综合症的临床效果。方法：选择2006年8月～2008年10月确诊为多囊卵巢综合症的女性患者156例分为治疗组和对照组，每组各78例。对照组单用二甲双胍治疗；治疗组在对照组的基础上，加用吡格列酮治疗，均治疗6个周期。观察两组患者血清激素水平，空腹血糖及胰岛素水平，并应用经阴道B超检查卵巢的变化。结果：治疗后，两组患者血清LH、T、空腹血糖、空腹胰岛素及稳态模型的胰岛素抵抗指数均有不同程度的下降；两组患者双侧卵巢体积均缩小，卵泡数较前减少。上述各项指标治疗组改善较对照组更加明显。治疗组疗效优于对照组。结论：应用二甲双胍联舍吡格列酮治疗多囊卵巢综合症方法简单，疗效确切。

关键词： aquaporin-9   granulosa cells   polycystic ovary syndrome   hyperandrogenism   ADRENAL ANDROGEN EXCESS   WATER CHANNELS   SYNDROME PCOS   HORMONE   SERUM   PREVALENCE   APOPTOSIS   DIAGNOSIS   STEROIDS   BINDING  

摘要： Background: The present study was designed to evaluate whether the alteration of aquaporin-9 (AQP-9) expression in granulosa cells (GCs) of patients with polycystic ovary syndrome (PCOS) was associated with the hyperandrogenism in follicular fluid (FF). Methods: We recruited infertile women with PCOS (n = 14) and infertile women with tubal blockage (controls, n = 31) for this study. We examined total testosterone (TT), free androgen index (FAI), sex hormone-binding globulin (SHBG), FSH, LH and estradiol in FF. Real-time PCR and western blotting were performed to assess AQP-9 expression in GCs, including effects of dihydrotestosterone (DHT) in vitro. Results: AQP-9 protein was localized in the nucleus, cytoplasm and cell membrane of the human GCs. The TT, FAI and LH levels were all higher, and SHBG levels lower, in the FF of women with PCOS versus controls (P = 0.0145, 0.0001, 0.0191, 0.0001, respectively). AQP-9 mRNA level in GCs of patients with PCOS was tightly correlated with the TT, SHBG levels and FAI in FF (P = 0.0020, 0.0001, 0.0020, respectively). In vitro, DHT (10(-9) mol/l) decreased AQP-9 mRNA (lowest at 12 h) and protein levels in control GCs (P = 0.0005, 0.0247, respectively). The inhibitory effect of DHT on AQP-9 mRNA was attenuated by LY294002, a phosphatidylinositol 3-kinase (PI3K) inhibitor (P = 0.0013). Fifty micromolar 4-(hydroxymercuri) benzoic acid sodium salt (PMB) and 10(-9) mol/l DHT blunted the swelling of GCs in hypotonic medium, respectively (P = 0.0350, 0.0027). Conclusion: Hyperandrogenism in FF of women with PCOS inhibited AQP-9 in GCs through the PI3K pathway.

关键词： C-REACTIVE PROTEIN   INSULIN-RESISTANCE   GLUCOSE-TOLERANCE   ANDROGEN LEVELS   WOMEN   CHILDREN   PREVALENCE   RISK   ASSOCIATION   HYPERINSULINEMIA  

摘要： Objective: Polycystic ovary syndrome (PCOS) in adult women is associated with increased risk of metabolic syndrome (MS) and atherosclerosis. We evaluated the spectrum of metabolic dysfunction in relationship with hyperandrogenemia (HA) in adolescent girls with PCOS. Materials and methods: Ovulatory function, acne, hirsutism (HS), body mass index (BMI), body composition, fasting lipids, glucose, insulin, free testosterone (FT), high-sensitivity C-reactive protein (hs-CRP), and HbA1c were evaluated in 103 girls. The homeostatic assessment model equations (HOMA-IR and HOMA-%B) were used for determination of insulin resistance and beta-cell function respectively. Results: The oligo-ovulation (Oligo) + HA + HS (n=44), Oligo + HA (n=28), and Oligo + HS (n=31) phenotypes had similar BMI. However, hyperandrogenemic phenotypes had higher prevalence of acanthosis nigricans (AN) and acne (P<0.01) and higher insulin, HOMA-IR, HOMA-%B, HbA1c, and hs-CRP levels than Oligo + HS group (P<0.01). Serum FT was correlated with HOMA-IR (r=0.38, P<0.01), HOMA-%B (r=0.49, P<0.01), hs-CRP (r=0.42, P<0.01), AN (r=0.39, P<0.01), and HbA1c (r=0.27, P<0.01). Furthermore, 34% of girls met diagnostic criteria for MS displaying higher BMI, FT, HOMA-%B, HOMA-IR, hs-CRP, and HbA1c than subjects without MS (P<0.01). Using combined HOMA-IR >= 4.0 and hs-CRP>3.0 cut-off values, 71.4% of MS versus 23.5% non-MS group were considered at risk of diabetes and atherosclerosis (P<0.0001). Conclusions: Hyperandrogenemic PCOS phenotypes have greatest degree of insulin resistance and inflammation. The use of insulin resistance and inflammatory markers may help identify adolescent girls with PCOS at risk of cardiometabolic syndrome.

关键词： 达英-35   多囊卵巢综合征  

摘要： 目的:观察达英-35(炔雌醇环丙酮)治疗多囊卵巢综合征(PCOS)的临床疗效分析。方法:选取我院确诊的29例PCOS患者,记录服用达英-35后阴道出血及不良反应情况,检查体重指数、血压、乳腺;治疗前及治疗后测定卵泡期黄体生成素,促卵泡激素,睾酮的变化;治疗前及治疗后行B超并记录子宫体积。结果:治疗后腰/臀比值、体重指数、睾酮及卵泡期黄体生成素/促卵泡激素比值明显降低(P<0.05)。结论:达英-35能有效改善多囊卵巢综合症患者临床症状,恢复排卵及月经周期。降低胰岛素抵抗及高雄激素血症。

关键词： 来曲唑   克罗米酚   多囊卵巢综合症   促排卵  

摘要： 目的:比较来曲唑(LE)和克罗米酚(CC)对PCOS患者促排卵疗效,探讨LE治疗PCOS的临床效果。方法:经达英-35和二甲双胍治疗后的PCOS患者56例拟行促排卵治疗,分为LE组30例和CC组26例,分别于月经第5日开始口服LE和CC。阴道超声监测卵泡发育,当卵泡直径≥18mm时,皮下注射重组人绒毛膜促性腺激素(HCG)诱发排卵。于HCG日取肘静脉血测定黄体生成素(LH)、雌二醇(E2)、睾酮(T),并观察子宫内膜厚度、子宫动脉血流情况、排卵率、LUF发生率及妊娠率等。结果:LE组的周期排卵率、妊娠率及LUF发生率与CC组相比差异无统计学意义(P>0.05);LE组HCG日血清E2水平显著低于CC组(P<0.05),但子宫内膜厚度较CC组厚(P<0.05),且HCG日优势卵泡数、子宫动脉血流情况及单卵泡排卵率均优于CC组(P<0.05)。结论:在PCOS促排卵治疗中,LE促单卵泡排卵率高,子宫内膜容受性好,可降低多胎及OHSS的发生率并带来良好的妊娠率,更适合应用于PCOS患者的促排卵治疗。