口服避孕药预处理在PCOS患者行拮抗剂方案中的效果

目的:探讨口服避孕药(OCP)预处理在行IVF/ICSI中多囊卵巢综合征(PCOS)患者行拮抗剂方案中的效果。方法:回顾性分析行拮抗剂方案IVF/ICSI的92名PCOS患者的临床资料,按有无OCP预处理分为OCP+拮抗剂组(A组)和直接拮抗剂组(B组),比较A、B组患者的一般情况、促排卵情况和临床结局。结果:患者的一般情况、Gn使用天数、思则凯使用天数和使用量、受精率、卵裂率、可用胚胎率和优质胚胎率组间均无统计学差异(P>0.05)。A组总Gn使用量、获卵数略低于B组,A组临床妊娠率高于B组,但差异均无统计学意义(P>0.05)。B组发生1例中度卵巢过度刺激综合征(OHSS)。结论:PCOS患者拮抗剂方案促排卵前行OCP预处理有减少总Gn使用量、获卵数和提高临床妊娠率的趋势。

Evaluation of Adiponectin, Resistin, IL-6, TNF-α in Obese and Non-obese Women with Polycystic Ovary Syndrome

Objective To evaluate possible clinical effects of adiponectin, resistin, 1L-6, and TNF-a in obese and non-obese patients with polycystic ovary syndrome （PCOS）. Methods Seventy selected PCOS patients were recruited for this study, and were divided into two groups based on their body mass index （BM1）： 35 obese （BM1 25 kg/m2, group A）, 35 non-obese （BMI〈25 kg/me, group B）. In addition, 35 healthy non-obese women （BMI〈25 kg/m2） were enrolled as the control （group C）. Serum levels of FSH, LH, T, glucose, insulin, adiponectin, resistin, 1L-6, TNF-a. were detected, and compared the differences of them among three groups. Results Blood glucose levels among three groups had no difference （P〉0.05）. Blood insulin level was significantly greater in group A than in group B or group C （P〈0.05）, and a significant difference existed between group B and group C （P〈0. 05）. The ratio of glucose/insulin was significantly higher in group A than in group B or group C （P〈0.05）, and the ratio in group B was significantly higher than that in group C （P〈0.05）. Adiponectin level was significantly lower and resistin level was significantly higher in group A than in group B or group C （P〈0.05）. IL-6 level in group C was significantly lower than that in group A or group B （P〈0.05）, and significant difference was found between group A and group B （P〈0.05）. TNF-a level was a slight high in group B, whereas there was no statistical difference among three groups （P〉0.05）. Conclusion Disturbances of some metabolic and inflammatory adipokines could involve the pathogenesis of PCOS in both obese and non-obese women. Low-grade chronic inflammation might have negative effects on the development of PCOS in non- obese women.

Apolipoprotein B/Apolipoprotein A1 ratio is associated with sex hormone binding globulin and may be an indicator of metabolic syndrome in PCOS women

Objective To identify significant factors related to the apolipoprotein B/apolipoprotein A1 （apoB/A1） ratio and investigate the association between the apoB/A1 ratio and metabolic syndrome （MS） in polycystic ovary syndrome （PCOS） women. Methods Totally 307 subjects with PCOS were collected and recruited fulfilling the revised 2003 Rotterdam diagnostic criteria. MS was diagnosed by the National Cholesterol Education Program-Adult treatment Panel （NCEP-ATP） III criteria. Results The prevalence of MS in PCOS women was 31.6%, whose average age was 26.2 ___＋ 5.2 years. The apoB/A1 ratio was significantly correlated with age, body mass index （BM1）, waist circumference （WC）, hip circumference, waist-to-hip ratio, blood pressure, metabolic abnormalities, sex hormone binding globulin （SHBG）, and free androgen index. In addition, SHBG had a significant association with all five component risk of MS. The increasing apoB/A1 ratio was associated with the prevalence of MS and was one of the risk factors of MS. Conclusion SHBG was considered as an additional potential factor in predicting the metabolic abnormity in PCOS women. The apoB/A1 ratio is associated with SHBG and might be an indicator of MS in PCOS women.

Study on the Differences of Endocrine and Metabolic Characteristics in Clinical Subtypes of PCOS

Objective To investigate the differences of endocrine and metabolic characteristics in PCOS women among different subtypes. Methods A total of 249 PCOS women were classified into 4 subtypes by Rotterdam criteria： hyperandrogenism （HA） and oligo-ovulation/anovulation （0） and PCO ultrasonography （P） （HA＋O＋P, group A, 111 women）; HA＋O （group B, 9 women）; HA＋P （group C, 22 women） and O＋P （group D, 107 women）. Another 110 infertii＇e women with tubal defects constituted a control group. Endocrine and metabolic characteristics were compared among the 5 groups. PCOS women were then reclassified into 2 groups, according to whether they have hyperandrogenism or not. Endocrine ond metabolic characteristics were then compared again. Results The levels of androstenedione （A）, testosterone （T） and LH/FSH were the highest in group A and group C, secondly in group D, the lowest was in control group. A, T and LH/FSH were the highest in hyperandrogenism group, secondly in non- hyperandrogenism group, whereas the control was the lowest. Menstrual cycle and BMI correlated with glucose and lipid metabolism but showed no correlateion with T and A. Hyperandrogenism group had higher fasting glucose （FG）, glucose at 60 min （G60） and glucose levels under the curve （GLUAUC） and lower disposition index （DI） than non-hyperandrogenism group, however, menstrual cycle, BMI and the lipid indicators had no difference. Conclusion Hyperandrogenism is an important characteristic in F＇COS women. Thus it might be used to classify PCOS into 2 subgroups. Hyperandrogenism and lipid disorders for the formation of PCOS often coexist but each has individual pathogenesis.

Fibrinogen to be a laboratory screening biomarker for polycystic ovary syndrome(PCOS) patients:a Meta-analysis

Objective To assess the fibrinogen levels in polycystic ovary syndrome （PCOS） patients and to fgure out the potential of fibrinogen to be an early phase laboratory biomarker for PCOS diagnosis. Methods A systemic literature research was performed from databases of Medline via OVID, PubMed, Web of Knowledge and the Cochrane library databases, etc. Fifteen studies including 694 PCOS patients and 548 normal controls were selected after quality assessment. Data of fibrinogen levels, age and body weight were extracted and analyzed systemically. Results Fibrinogen increases in PCOS patients with regard to data poolings of overall studies （mean difference=21.51, 95%CI=3.78-39.25, P=0.02）, National Institutes of Health （NIH）-based studies （mean difference=8. 50, 95%CI=0.91-16. 09, P= 0. 03） and Rotterdam-based studies （mean difference=45.61, 95%CI=12.18-79.03, P=0.007） respectively. PCOS patients are younger （mean difference= -2.15, 95%CI= -3.65 - -0. 64, P=0. 005） and with heavier body weight （mean difference=0.92, 95%CI=0.59- 1.25, P〈0.001） than normal controls. Conclusions Increasing in PCOS patients, fibrinogen might be used as a diagnosis biomarker for PCOS, especially in the population with younger age and heavier body weight, which indicates that fibrinogen might be used as an early phase laboratory screening biomarker in clinical practice.

Study of Association between Polycystic Ovary Syndrome and Dietary Intake

Objective To compare dietary intake and composition of women with and without polycystic ovary syndrome （PCOS）, and finally to figure out the relationship between dietary intake and PCOS.Methods Eighty-six women attending an outpatient gynecological endocrinology unit, underwent evaluation of anthropometry, dietary intakes by means of a food frequency questionnaire （FFQ）, 47 women with PCOS and 39 age-matched control women were investigated. Dietary intake was assessed by 24 h recalls. Associations between nutrients, BMI, WHR and glycometabolic measurements of PCOS were analyzed using multiple linear correlation and multiple linear regression analysis.Results 1） Obesity PCOS patients （BMI ≥25 kg/m2） took significantly more carbohydrates （P〈0.05） and fat （P〈0.01） of diet than the control women in 24 h before the first visit. There was significantly lower ratio of protein （P 〈0.01 ） and higher ratio of lipid （P〈0.01） in obesity PCOS patients than those in the control. Obesity PCOS women took significantly more calories （P〈O.05） and higher ratio of lipid （P〈O.O1） than non-obesity PCOS women （BMI〈25 kg/m2）. There were no significantly statistical differences between the non-obesity PCOS women and controls. 2） There were positive correlations between BMI and energy lipid intake, but negative correlations between BMI and the ratio of protein in the diet intake （P〈0.05）. In PCOS women, fasting insulin （FINS）, area under curve of insulin （IA UC）, and homeostasis model assessment of insulin resistance （HOMA-IR） were all positively related with BMI （all P〈0.05）. 3） Multiple stepwise regression analysis showed that BMI was positively associated with the amount of fat and negatively associated with the ratio of protein in diet in 24 h （both P〈0.001）. HOMA-IR was positively related with fat intake and negatively related with protein composition （both P〈0.05）.Conclusion The statistical differences exist in the nutritional composition of obesity PCOS patient＇s diets, which may contribute to obesity PCOS development.

Is There A Relationship between Polycystic Ovary Syndrome and Endometriosis?

The endocrinologic and metabolic abnormalities of women with polycystic ovary syndrome （PCOS） can result in a series of endometrial diseases. Abnormalities of hyperandrogenism and hyperinsulinemia that may be found in PCOS can elevate the levels of E2 indirectly, reduce progesterone secretion and induce some growth factors such as vascular endothelial growth factor （VEGF） and insulin-like growth factors （IGFs） over expression, which may have a major impact on endometriosis occurrence and development. We suppose that there is a possible connection between PCOS and endometriosis.

Evaluation of Circulating Antisperm Antibody in Infertile Women with Polycystic Ovary Syndrome

Objective To evaluate levels of the circulating antisperm antibody （ASA） in infertile women with polycystic ovary syndrome （PCOS）.Methods Forty-six infertile women with PCOS were enrolled into this study. The serum was screened by the indirect immunobead test for ASA type IgG and IgA according to the WHO laboratory manual.Results Of the 46 patients assessed for ASA-IgG, 3 cases had immunobead binding which were 20%, 27% and 35%, respectively, and the sub-positive rate was 6.5%. No case had the clinical positive level according to the WHO criteria （50% or more of the motile sperm with immunobead binding）. ASA-IgA was not detected in all cases. Conclusion The circulating ASA is not associated with the pathogenesis of infertile women with PCOS.

Analysis on Reverse of Atypical Endometrial Hyperplasia by Drugs in Patients with Polycystic Ovary Syndrome

Objective To analyze the efficacy and safety of drugs on reverse of atypical endometrial hyperplasia in patients with polycystic ovary syndrome （PCOS）. Methods Seventeen patients with PCOS complicated by atypical endometrial hyperplasia （9 patients who were treated with progestin but not reversed were considered as group A; 8 patients who were untreated were considered as group B） were retrospectively analyzed Both groups received oral glucose tolerance test （OGTT） and insulin release test, to check whether the patients had insulin resistance （IR） or hyperinsulinemia. The 17 patients were treated with oral contraceptives combined with metformin. Results After the 17 patients with PCOS complicated by IR and hyperinsulinemia received drug treatment for 3 -6 cycles, atypical endometrial hyperplasia was success- fully reversed Conclusion Oral contraceptives combined with metformin is a clinically practical and effective method for treatment of PCOS complicated by atypical insulin-resistant endometrial hyperplasia.

Circulating anti-Müllerian hormone as predictor of ovarian response to gonadotrophins in women with polycystic ovary syndrome

Objective To investigate the impact of high circulating anti-Müllerian hormone（AMH）on the outcome of ovulation induction using human menopausal gonadotropin（hM G）in women with polycystic ovary syndrome（PCOS）.Methods This prospective study included 63 anovulatory women with PCOS who underwent hM G ovarian stimulation. Serum AMH concentrations were compared between responders and non-responders. The receiver-operating characteristic（ROC）curve was used to evaluate the prognostic value of circulating AMH.Results hM G responders had a significantly lower serum AMH concentration compared with non-responders（8.43±2.18 μg/L vs 11.05±2.85 μg/L, P〈0.001）. In multivariate Logistic regression analysis, AMH was an independent predictor of ovulation induction by hM G in PCOS patients. ROC curve analysis showed AMH was a useful predictor of ovulation induction by hM G in PCOS patients, having 91.7% specificity and 66.7% sensitivity when the threshold AMH concentration was 10.12 μg/L.Conclusion Serum AMH can be used as an effective parameter to predict ovarian response to hM G treatment in PCOS patients.

Study on the Clinical and Endocrine Characteristics of Polycystic Ovary Syndrome with Different Ovarian Morphology

Objective To evaluate the differences of the clinical manifestation and endocrine situation in patients with different ovarian morphology of polycystic ovary syndrome （PCOS）. Methods A total of 234 PCOS patients were enrolled according to the ovary morphology and divided into three groups： 112 patients with B-polycystic ovary mor- phology （both two ovaries were PCOM, B-PCOM）, 50 with U-PCOM （only one ovary was PCOM） and 72 with N-PCOM （none was PCOM）. There were 39 infertile women without PCOS as control group. Data were analyzed by using SPSS 15.0 software. ResuIts There was no statistical difference in body mass index （BM1） among the three groups of PCOS. The endometrial thickness increased in patients with B-PCOM and decreased with N-PCOM. The levels of testosterone, androstenedione and luteinizing hormone increased in PCOS groups, especially in N-PCOM patients. HOMA-IR increased, HOMA-fl, disposition index （DI） and △160/AG60 decreased in patients with N- PCOM compared with in B-PCOM and U-PCOM groups. Higher level of total choles- terol （TC） and lower level of high-density lipoprotein （HDL）-C existed in PCOS patients, especially in N-PCOM. There were positive correlations between oligo-anovulation, endometrial thickness, LH/FSH ratio, fasting insulin （FINS）, the area under curve of glucose（A UCcLu） and PCOM, while there was a negative correlation between HOMA- IR and PCOM. Conclusion There are relationships among hyperandrogenism, hyperinsulinemia, insulin resistance （IR） and ovary morphology in PCOS patients. PCOS patients with- out PCOM have more serious IR and hyperandrogenism.

Effect of Metformin on Tyrosine Kinase Autophosphorylation of Erythrocyte Insulin Receptor from Women with Polycystic Ovary Syndrome

Objective To document the possible effect of tyrosine kinase autophosphorylation on erythrocyte insulin-receptor after 12 weeks of metformin administration from the women with polycystic ovary syndrome （PCOS）. Methods Thirty non-obese （BMI〈25 kg/m2） healthy women with normal reproductive cycles were evaluated by conventional criteria as the control 30 non-obese women with PCOS were categorized as nob-PCOS group, 40 obese women with PCOS （BMI 25 kg/m2） were categorized as ob-PCOS group. Subjects with PCOS were given metformin 850 mg/d for 12 weeks. The autophosphorylation of insulin receptor p Yl158, pyl162/1163 and insulin receptor-fl subunit （IR-~） from the solubilised erythrocyte were detected by ELISA. Results 1） Only the autophosphorylation level of p Yl l 58 in nob-PCOS and ob-PCOS groups was lower （P〈O.05） than that in control group and it can be increased after insulin stimulation （P〈O.05）; no similar changes were found in pYl162/1163 （P〉O.05）, even insulin-stimulated insulin receptor （P〉O.05） from both of PCOS groups. 2） After metformin administration, the p Y1158, p Y1162/p Y1163 autophosphorylation levels were increased （P〈O.O1） and further increased after plus insulin stimulation in vitro （P〈0. 01）. The p Y1162/1163 autophosphorylation level was increased in nob-PCOS group （P〈0.01） and ob-PCOS group （P〈0.05）. 3） No difference was found in concentration of IR-B between control group and both of PCOS groups following metformin administration （P〉0.05）. In summary, oral administration of metformin led to an significant increase in tyrosine kinase activity in both groups of PCOS. Conclusion The impairment of tyrosine autophosphorylation at pYl158 may contribute to insulin resistance, the tyrosine kinase activity per receptor of solubilised erythrocytes were significantly increased by metformin administration and the effect of metformin on insulin-receptor tyrosine kinase activity appeared to be independent of either of these variables.

Metformin for adolescents with polycystic ovary syndrome

Polycystic ovary syndrome （PCOS） is a common endocrine disorder in women of reproductive age characterized by chronic anovulation, hyperhandrogenism, and is increasingly recognized as a disease developed in adolescent period. The management of adolescents with PCOS is a difficult challenge. The objective of the review was to provide an overview on the effects of metformin for adolescents with PCOS.

Expression and Significance of Prosaposin (PSAP) in A Rat Model of Letrozole-induced Polycystic Ovary Syndrome

Objective To investigate the prosaposin （PSAP） expression in polycystic ovaries. Methods The expression of PSAP was examined using immunohistochemistry, quantitative RT-PCR and Western blotting in a rat model with letrozole-induced polycystic ovary syndrom （PCOS）. Results Letrozole-induced PCOS rat models were similar to those in human PCOS in endocrine disturbances, metabolic characteristics and morphology features. And in these models both mRNA and protein levels of PSAP were significantly increased. Conclusion PSAP was overexpressed in the letrozole-induced PCOS rat model and might play an important role in the oceurance and development of PCOS.

Effects of Rosiglitazone on Adiponectin Expression in 3T3-L1 Adipocytes at High Levels of Both Testosterone and Insulin In Vitro Culture

Objective To evaluate effects of rosiglitazone （RSG） on the expression of adiponectin in mature adipocytes at high levels of both testosterone （T） and insulin in vitro culture. Methods Mouse 3T3-L1 preadipocytes were induced to be mature adipocytes and used in this study. According to RSG concentrations, the cells added with T （10^-5 mol/L） and insulin （10^-4 mol/L） were divided into 4 groups： free-RSG group （0 mol/L RSG, FR-TI）, low-dose group （10^-9 mol/L RSG, LR-TI）, middle-dose group （lO-7mol/L RSG, MR-T1） and high-dose group （10^-6 mol/L RSG, HR-TI）. Besides, the cells added with RSG without T and insulin were also divided into 4 groups： FR, LR, MR, and HR. These 8 groups were incubated for 42 h. Cell viability was determined by MTT assay. Expression of adiponectin was detected by Western blotting. Results The maximum viability in FR-TI group was observed at point of 42 h. The growth of the adipocytes was significantly inhibited in MR-TI group compared with FR-TI （P〈0.01）. The level of adiponectin in MR-TI group was higher than that in LR- TI group （P〈0.01）. However, with RSG increasing; HR-TI group showed the lowest level of adiponectin among three treatment groups （P〈0.01）. In addition, adiponectin expression in MR-TI group was significantly higher than that in MR group （P〈0.01）. Conclusion RSG could increase the expression of adiponectin in 3T3-L1 adipocytes under high levels of both T and insulin, but it acts in a narrow concentration range.