Polycystic Ovary Syndrome-Related Infertility Based on the Theory of“Liver and Kidney Homology”

Polycystic ovary syndrome(PCOS)is an endocrine disorder caused by hypothalamic-pituitary-ovarian(HPO)axis dysfunction.In the field of gynecology and reproduction,PCOS has emerged as both a research hot spot and a challenging area of study.According to Chinese medicine,this disease is related to kidney deficiency,phlegm and dampness obstruction,blood stasis and interconnection,Chong pulse impassability,the lack of Ren pulse,and the loss of uterine nourishment,all of which affect the normal development and maturation of eggs as well as the duration at which menstrual blood stores.In this paper,based on the theoretical basis of“liver collects blood,regulates the flow of qi,and is the master of drainage,”we explore the rationality of the treatment of this disease from the perspective of“liver and kidney have the same origin”and the development of PCOS-related infertility in relation to dysfunctional internal organs.We also explore the feasibility of treatment from the perspective of“liver and kidney homology,”expand the ideas for treatment,as well as develop and innovate the application of organ identification in PCOS in relation to infertility.

Clinical effect of under the diaphragm by stasis soup combinated with point thread-embedding on infertility patients with obesity-type polycystic ovary syndrome

Objective:To study the clinical effect of under the diaphragm by stasis soup combinated with point thread-embedding on infertility patients with obesity-type polycystic ovary syndrome (PCOS) and evaluate the the rate of ovulation and pregnancy.Method:Selecting 100 infertility patients with obesity-type PCOS, then they were randomly divided into control group (n=80) and observation group (n=80). The control group patients were given metformin+ under the diaphragm by stasis soup, the observation group were given metformin + exenatide + point thread-embedding, they were treated 3 months. Before and after treatment, we observed the changes of body mass index (BMI), waist-to-hipratio (WHR), fasting plasma glucose (FBG), 2-hour postprandial blood glucose (2hPBG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), homeostasis model assessment of insulin resistance (HOMA-IR), fasting plasma insulin (FINS), follicule-stimulating hormone (FSH), luteinizing hormone (LH), LH/FSH, estrogen (E2), and testosterone (T). At last, we assessed the rate of ovulation and pregnancy.Results: After the treatment, the FBG, 2hPBG, TC, LDL-C, TG, BMI, WHR, HOMA-IR, FINS, LH, LH/FSH, E2, and T were lower than before treatment in both groups, and the difference had statistical significance, and the observation group were lower than control group, and the difference had statistical significance;the HDL-C and FSH were higher than before treatment in both groups, and the difference had statistical significance, and the observation group were higher than control group, and the difference had statistical significance. The rate of ovulation and pregnancy in the observation group were higher than control group, and the difference had statistical significance.Conclusions:Under the diaphragm by stasis soup combinated with point thread-embedding can improve the metabolize of carbohydrate and lipid, and the abnormity of sex hormones, through this process, the rate of ovulation and pregnancy can be raised.

Correlation between IL-1β,IL-1Ra gene polymorphism and occurrence of polycystic ovary syndrome infertility

Objective:To explore the relationship between IL-1β.IL-1Ra gene polymorphism and the occurrence of polycystic ovary syndrome(PCOS) infertility.Methods:A total of 59 PCOS infertility cases visiling the reproductive center of our hospital from Mar.2010 to Mar.2012 and 56 healthy women were selected.ELISA method was used lor the detection of IL-1β.IL-1Ra lewis,and the levels of serum supersensitivity C reaction protein(US-CRP).insulin(FINS),follieule-stimulating hormone(FSH) and fasting blood—glucose(FRG) were detected.PCR analysis technology was adopted to detect the gene polymorphism of the.511 site of IL-1βand the second introne of IL- 1Ra.Results:The levels of IL-1β.IL-1Ra.US-CRP.FINS and FBG in blood scrum of patients in PCOS group were significantly higher than those in control group(P【0.05 or P【0.01).The level of FSH in PCOS group was significantly lower than that in control group(P【0.05).The genotypic frequency of T/T.the 511 site of IL-1βin PCOS group was 42.37%.significantly higher than 1250%in control group 【P【0.01).The frequency of T allele was also significantly higher than that in control group(P【0.01).The genotypic frequency ofⅠ/Ⅴ.the second introne of IL-1Ra in PCOS group was 20.34%,signicianlly higher than 3.57%in control group(P【0.05).The frequency of V allele in PCOS group was significantly higher than that in control group(P【0.05).Conclusions: T allele of the 511 site of IL-1βgene and V allele of the second inlrone of IL-1Ra gene might be the genetic basis of the rising of IL-1β.IL-1Ra and US-CRP levels in blood serum of PCOS patients,and are associated with the infertility occurrence of PCOS patients.

Management strategy of infertility in polycystic ovary syndrome

Polycystic ovary syndrome(PCOS)is the most common endocrine and metabolic disease in women of reproductive age.PCOS is characterized by ovulatory disruption,which can lead to infertility.Patients with PCOS are also more likely to have poor pregnancy outcomes.For obese women,lifestyle interventions are recommended first,which have general health benefits.For women who have difficulty changing their lifestyle,drugs for the treatment of obesity or bariatric surgery could be considered.Clomiphene citrate is the first-line medication after weight loss that has been utilized in the past.Letrozole is supplanting clomiphene as the best option for ovulation induction for now,particularly in patients with PCOS.Metformin can improve ovulation and pregnancy rates;however,it has minimal effects in terms of raising live birth rates.Second-line therapies include gonadotropins and laparoscopic ovary drilling.In vitro fertilization can be utilized as a third-line treatment for patients with PCOS who have failed ovulation induction therapy or have other infertility factors.In summary,to achieve fertility,patients with PCOS require standardized individualized therapy.

Endometrial Thickness as a Predictor of Endometrial Hyperplasia in Infertile Patients with Polycystic Ovary Syndrome

Background: Women with polycystic ovary syndrome (PCOS) are at higher risk of developing endometrial hyperplasia (EH). This study determined the prevalence of EH among women with infertility due to PCOS and assessed the predictive value of endometrial thickness (ET) measurement by trans-vaginal scan (TVS). Study Type & Population: This was a prospective study on infertile women with and without PCOS in which clinical data, hormonal profile, ET and endometrial biopsy (EB) for histopathological examination were collected. Methods: Thirty-seven women with PCOS and 23 women without PCOS presenting with infertility and/or abnormal uterine bleeding underwent TVS, hysteroscopy, laparoscopy and EB. Results: The overall prevalence of EH was 23.3 % while in PCOS group: 18.3 %. The mean ET (14.8 mm) was significantly higher in patients with EH (t = -2.74, P value = 0.009). The lower value of ET among women with EH was 10 mm. A cut-off point of 9.5 mm was set. An ET of >9.5 mm had 92.9% sensitivity and 51.85% specificity for the presence of EH. Women with ET ≥ 9.5 mm were 1.28 times more at risk of EH than women with ET 9.5 mm. Women with oligomenorrhea and irregular cycles were 5.5 and 13.7 times more at risk of EH compared to those with regular cycles, respectively. ET was positively correlated with insulin resistance (r = 0.439, P = 0.007). Conclusion: ET ≥ 9.5 mm predicts EH in infertile women with PCOS, with a high degree of sensitivity and a moderate degree of specificity. In PCOS patients with oligomenorrhea or irregular cycles, the risk of EH is higher than women with regular cycles.

Use of metformin during pregnancy for women with polycystic ovary syndrome

Objective: The purpose of this article is to review the literature assessing foetal and maternal pregnancy outcomes in women with PCOS who used metformin during pregnancy. Study Design: A literature search was conducted using MEDLINE, with analysis of 25 studies that recorded neonatal and maternal outcomes in women who used metformin during pregnancy. The outcomes assessed in this review include congenital deformities, miscarriages, preterm labour, gestational diabetes (GDM) and pregnancy induced hypertension (PIH). Results: We found that the use of metformin throughout pregnancy correlated with decreased rates of preterm labour, GDM and PIH. Conflicting evidence exists over whether metformin use during pregnancy reduced miscarriage rates. The use of metformin during pregnancy did not increase teratogenicity risks. Conclusion: The use of metformin throughout pregnancy is associated with decreased rates of preterm labour, GDM, and PIH. However, more randomised controls involving larger numbers of participants are required for more definitive results.

Mental Health Status Assessment in Polycystic Ovarian Syndrome Infertility Patients: A Pilot Study

Polycystic ovary syndrome（PCOS） is a major endocrine disorder afflicting women of reproductive age. Women with PCOS are more likely to suffer from mental health disturbances than healthy women. The ＂infertility＂ suffered by PCOS patients would also lead to mental health disturbances. Symptom Checklist 90（SCL-90） and questionnaire which includes patients＇ socio-economic and demographic data were used to assess the mental health status of PCOS（n=103） and non-PCOS（n=110） infertile patients. Logistic regression analysis and t-tests were used for comparative analysis. The data demonstrated that scores of depression, interpersonal sensitivity, obsessive-compulsive, and hostility symptoms in PCOS infertile patients were significantly higher than those in the non-PCOS infertile patients（P〈0.05）. Logistic regression analysis revealed that acne had negative effect on mental health status（P〈0.05）. Secondary infertile PCOS patients were more easily to suffer from somatization, interpersonal sensitivity, obsessive-compulsive, anxiety, hostility and paranoid ideation symptoms than the primary infertile PCOS patients（P〈0.05）. The results suggested that the PCOS patients especially the secondary infertile PCOS patients had obvious mental health disturbances. The acne might play an importance role in the occurrence of mental health disturbances in PCOS patients. PCOS related symptoms may be risk factors of mental health status in PCOS patients with infertility. More attention should be paid to the PCOS infertile patients, and mental health therapy should be considered if necessary.

Integrative techniques using acupuncture,Chinese herbal medicine,diet,and supplements for polycystic ovary syndrome:a case report

Patients with a diagnosis of polycystic ovary syndrome （PCOS） are on the rise. About 4%-12% of women are currently estimated to have this condition. It is hypothesized that PCOS appears in women who have long-standing insulin resistance （1R）, which leads to high androgen and testosterone levels; this ultimately disrupts their menstrual cycles. Some researchers attribute IR to genetic factors, although there have been only minute changes in the human genome in the past 20 000 years. However, even with a stable gene pool, genes can be turned on and offby the environment, food and air quality and toxin exposure.

Endocrine Indices of PCOS in Women with Polycystic Ovaries but without Diagnostic Features of PCOS: A Study of an Infertility Clinic Population

Background: The presence of polycystic ovarian morphology (PCO) without the other characteristics of the polycystic ovarian syndrome (PCOS) is insufficient for the diagnosis of PCOS and there is little justification for follow up in endocrine clinics for women with PCO morphology alone. A few studies have been reported regarding the endocrine features of asymptomatic women with PCO with conflicting data about endocrine profiling. The aim of this study was to assess whether women with PCO, but who have no symptoms of PCOS differ, endocrinologically, from women with normal ovaries.?Methods: We analysed the results of ultrasound and endocrine investigations in 576 consecutive women who attended the infertility clinic between 1993 and 1995 at the Reproductive Medicine Unit of St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, UK. Results: Three hundred and twenty eight women had PCO and 248 had normal ovaries. Among the 328 women with PCO, 169 (51.5%) had PCOS according to Rotterdam criteria. The remaining women with PCO had no symptoms of the syndrome (n = 159);they had a history of regular menses, had proven ovulatory cycles and had neither clinical nor biochemical evidence of hyperandrogenism. However, these women had higher timed LH [median (IQR) 5.3 (4.2) IU/l vs 4.8 (3.4) IU/l, respectively;p = 0.044] and testosterone [2.0 (0.8) nmol/l vs 1.8 (0.8), respectively;p = 0.009] compared with women with normal ovaries (although by definition within the normal range). There was no difference in BMI or FSH between the two groups. Among the 169 women with PCOS, 45.0% (n = 76) were anovulatory without hyperandrogenism, 34.3% (n = 58) fulfilled the NIH criteria and 20.7% (n = 35) were ovulatory with hyperandrogenism. The proportion of hyperandrogenism among anovulatory women with PCO is 43.3% (58 out of 134).?Conclusions: Women with PCO, but no symptoms of the syndrome, differ endocrinologically compared with women with normal ovaries: they had higher timed LH and testosterone (although by definition within the normal range). These data suggest that despite the lack of symptoms of PCOS, women presenting to an infertility clinic with PCO represent a milder phenotype of those with overt PCOS, but fall on the same spectrum.

Polycystic Ovary Syndrome (PCOS) and Fertility

The polycystic ovary syndrome (PCOS) is defined as a combination of hyperandrogenism (hirsutism and acne) and anovulation (oligomenorrhea, infertility, and dysfunctional uterine bleeding), with or without the presence of polycystic ovaries on ultrasound. It represents the main endocrine disorder in the reproductive age, affecting 6% - 15% of women in menacme. It is the most common cause of infertility due to anovulation, and the main source of female infertility. When in the presence of a menstrual disorder, the diagnosis of PCOS is reached in 30% - 40% of patients with primary or secondary amenorrhoea and in 80% of patients with oligomenorrhea. PCOS should be diagnosed and treated early in adolescence due to reproductive, metabolic and oncological complications which may be associated with it. Treatment options include drugs, diet and lifestyle improvement.

Polycystic Ovarian Syndrome and Female Infertility

Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in women of reproductive age, associated with chronic anovulation and hyperandrogenism. The cause of PCOS is multi-factorial and the mechanism is still unclear. A number of complications are closely related with PCOS such as infertility, hairy and obesity. Approximately up to one-third of females with PCOs have issues with infertility. Obesity is an independent factor which exacerbates infertility in PCOS, reduces the efficacy of infertility treatment and provokes a greater risk of miscarriage. Preconception counseling and guidelines play an initial major role in infertility treatment. The option of the most appropriate treatment depends upon various factors such as age, tubal patency, quality of sperm, experience, and duration of previous treatments and the level of anxiety of the couple. Tubal patency test and semen analysis are mandatory to decide the suitable treatment. Treatment modalities have two measures—non-pharmacological and the pharmacological. Oral clomiphene citrate remains the first line treatment to trigger ovulation. Gonadotrophin and laparoscopic ovarian drilling (LOD) surgery are the other treatment option. In vitro fertilization (IVF) and embryo transfer are the third line treatment and IVF remains the first option in the patient with diagnosed and established bilateral tubal occlusion and/or concentration of recovered motile sperm less than or equal to 5 million. Here, etiology, pathophysiology and molecular mechanisms of PCOS are reviewed, and perspectives are given for further research. The recent development, treatment, and diagnosis of PCOS are also highlighted. The summary will be of guiding significance in the prevention and treatment of PCOS.

Clinical effectiveness of the various approaches for infertility treatment in women with PCOS and hyperprolactinemia

【Objective】To evaluate the clinical efficiency of different treatments cancellation and infertility in women with PCOS and hyperprolactinemia.【Method】We performed retrospective analysis of 502consecutive case histories during 5 years of reproductive results of treatment of women is with anovulatory infertility,caused by different factors.Aim of the study was to determine the efficiency of conservative and surgical treatment.【Result】Differentiated application of conservative medical therapy allows to attain the effect of proceeding in a fertile function in 33,8%of patients.It is found that surgical induction of ovulation by ovarian laparoscopic partial degradation is an option in the management of female infertility associated with PCOS,especially as a second-line treatment after the failure of clomiphene citrate treatment,enhancing the efficiency of complex infertility treatment to 40%.【Conclusions】It is feasible to develop an algorithm differentiated use of infertility treatments in women with PCOS and hyperprolactinemia.

Association of sleep characteristics and night shift work with self-reported diagnosis of polycystic ovary syndrome:a questionnaire-based cross-sectional study

Objective:To examine the association between sleep characteristics and night shift work and the risk of polycystic ovary syndrome(PCOS)in Chinese women and to investigate their relationship with infertility in PCOS.Methods:From March 21,2021 to April 31,2021,3927 Chinese women with or without PCOS were recruited online.All participants completed WeChat-based electronic questionnaires.Sleep characteristics were measured using the Pittsburgh sleep quality index.Results:A total of 2871 women were included in the final analysis.Sleep duration(odds ratio[OR],0.857;95%confidence interval[CI],0.763-0.963),sleep midpoint(OR,1.142;95%CI,1.049-1.244),sleep disturbance(OR,1.320;95%CI,0.957-1.146),daytime dysfunction(OR,1.136;95%CI,1.030-1.253),and night shift work(OR,1.628;95%CI,1.264-2.097)were associated with a higher risk of PCOS.After adjusting for confounders,including age,body mass index,smoking status,and coffee and tea drinking status,sleep disturbance(OR,1.314;95%CI,1.111-1.555),daytime dysfunction(OR,1.143;95%CI,1.034-1.264),and night shift work(OR,1.800;95%CI,1.388-2.333)remained associated.In addition,sleep disturbance(OR,1.887;95%CI,1.400-2.542)and subjective sleep quality(OR,1.299;95%CI,1.037-1.627)were associated with infertility in women with PCOS,and sleep disturbance(OR,1.750;95%CI,1.281-2.390)remained significant after adjusting for confounders.Conclusions:Sleep disturbance,daytime dysfunction,and night shift work are significantly associated with PCOS.Screening for sleep disturbances and providing appropriate treatment could be potential strategies for managing PCOS and its long-term complications.

Gestational Diabetes and Infertility

Gestational diabetes mellitus (GDM) is one of the most common pregnancy complications which affect the mother and offspring. In addition to adverse perinatal outcomes, it may lead to permanent health problems for the mother, such as type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD), while increasing the risk of future obesity, CVD, T2DM and GDM in the child. Approximately 15% of women seek fertility treatment. Over the last decade, it has come to attention that patients with an infertility history are more prone to having GDM during their pregnancies, and this review examines the relationship between GDM and infertility. The elevated estrogen, progesterone, leptin, placental lactogen and growth hormone are the main reasons for increased insulin resistance during pregnancy. Despite some confounding factors in the mechanism of GDM in patients with an infertility history, infertility treatment increases the risk, according to numerous studies. The obesity epidemic and associated disorders have become a significant public health concern worldwide. Lifestyle modification for weight loss before pregnancy is encouraged, but there is no strong evidence for improvement in perinatal results. GDM, infertility and infertility treatment have a potential risk of alteration in the embryo’s environment and cause epigenetic reprogramming, which may be inherited to the next generation. The fertility treatment impacts the patient’s and offspring’s health. Patients should be informed about the risks so that they consent and get involved in the decision. Infertility treatment may be accepted as a reason for high-risk pregnancy, and patients can be screened for GDM in early pregnancy.

尿酸与女性生殖系统疾病及妊娠结局的相关性

尿酸(uric acid)是内、外源性嘌呤代谢的最终产物,在正常情况下,人体内尿酸的合成和排泄处于动态平衡状态。研究显示,血尿酸水平与女性生殖系统疾病、妊娠结局紧密相关。多囊卵巢综合征(polycystic ovary syndrome,PCOS)女性发生高尿酸血症的风险高于非PCOS女性,在通过辅助生殖技术助孕的PCOS患者中,血尿酸水平升高与临床妊娠率和活产率的降低及低出生体质量儿风险增加独立相关。白细胞介素-1β可能是血尿酸和子宫内膜异位症之间的连接桥梁,引起子宫内膜蜕膜化功能失调,从而导致不孕。同时孕妇血尿酸水平升高可引起妊娠期高血压、子痫前期和妊娠期糖尿病等妊娠并发症,导致子代早产、低出生体质量等不良妊娠结局。综述尿酸对育龄期女性的生殖健康和妊娠结局的影响,为临床制定诊疗策略提供有意义的参考。

中药滋阴补阳方剂治疗肾气亏虚型多囊卵巢综合征不孕症对患者超声动态多参数的影响评价

目的评价中药滋阴补阳方剂治疗肾气亏虚型多囊卵巢综合征不孕症对患者超声动态多参数的影响。方法选取2022年1月至2023年1月江西省妇幼保健院收治的80例肾气亏虚型多囊卵巢综合征患者作为研究对象,按照随机数字法将其分为观察组(40例)与对照组(40例)。对照组采用枸橼酸氯米芬片治疗,观察组在对照组方法的基础上联合中药滋阴补阳方剂治疗。比较两组患者的治疗效果、卵泡发育情况、激素水平、子宫动脉血流灌注情况及子宫内膜厚度。结果观察组的有效率高于对照组,差异有统计学意义(P<0.05);观察组治疗后的卵泡及优势卵泡数目多于对照组,差异有统计学意义(P<0.05);观察组治疗后的黄体生成素(LH)、促卵泡激素(FSH)、睾酮(T)均低于对照组,雌二醇(E2)高于对照组,差异有统计学意义(P<0.05);观察组治疗后的搏动指数(PI)、阻力指数(RI)均低于对照组,差异有统计学意义(P<0.05);观察组治疗后的子宫内膜厚度高于对照组,差异有统计学意义(P<0.05)。结论将中药滋阴补阳方剂应用于肾气亏虚型多囊卵巢综合征不孕症患者治疗中,可积极改善患者的激素水平及子宫动脉血流灌注情况,同时能够促进卵泡发育,增加子宫内膜厚度,改善症状,值得推广。

尤昭玲教授基于“生殖链”假说运用“生殖五论”治疗妇科生殖疾病的经验

宫腔粘连、多囊卵巢综合征、子宫内膜异位症、不孕症等生殖疾病是影响女性生殖健康的重点、难点问题。全国名中医尤昭玲创新性提出“生殖链-生殖链终端-终端效应”临证假说,凝练出以“时空论”为核心的“生殖五论”,指导妇科疾病的诊断、治疗和管理。围绕“生殖链-生殖链终端-终端效应”临证假说,提出胞宫-内环-外环3条病邪侵袭路径,构成妇科疾病的多元化病因,将生殖链假说融入妇科生殖疾病的认知、诊疗、评估、评价、管理各个环节中。重视生殖链终端结局,总结出以“时空论”为核心的生殖五论,分别应用“巢宫论”“卵膜论”“冰山论”“纳胎论”指导卵巢-子宫疾病、卵泡-子宫内膜疾病、巢衰-泡竭疾病、妊娠疾病的诊断与治疗。对于生殖疾病,关注“巢-泡-宫-膜-带-管-腔”7个部位,综合运用“调泡三部曲”“调泡八法”“调膜十法”等方法指导临床处方用药。评估管理时,结合疾病特点,将生殖疾病分为中医全病程管理、中医全生命周期管理两类,分类管理,维系女性生殖健康、孕育安全。

维生素D_(3)对多囊卵巢综合征孕妇血脂代谢和妊娠并发症的影响

目的观察补充维生素D_(3)对多囊卵巢综合征孕妇的血脂代谢和妊娠并发症的影响。方法选取福建省立医院2021年1月2022年12月就诊的多囊卵巢综合征孕妇50例作为观察组,自妊娠12周前开始,每日口服400单位维生素D_(3)滴剂。采用1∶1配对,配对因素为年龄、孕次、产次和体重指数,选取同期于福建省立医院分娩,且妊娠期间未服用维生素D_(3)的多囊卵巢综合征孕妇50例作为对照组。比较两组孕妇基线及孕37周的外周血25-羟基维生素D水平、血脂代谢指标,以及妊娠并发症情况。结果孕37周时,与对照组相比,观察组的外周血25-羟基维生素D水平明显升高[(34.55±5.71)ng/ml比(19.12±4.57)ng/ml,t=15.497,P<0.001],而甘油三酯[(1.50±0.37)mmol/L比(1.66±0.42)mmol/L]、总胆固醇[(4.66±0.62)mmol/L比(4.99±0.83)mmol/L]和低密度脂蛋白[(2.69±0.47)mmol/L比(2.87±0.61)mmol/L]水平均较对照组明显降低(P均<0.05)。相关性分析结果显示,观察组孕妇妊娠37周时的外周血25-羟基维生素D水平与甘油三酯(r=﹣0.612,P<0.001)、总胆固醇(r=﹣0.670,P<0.001)和低密度脂蛋白(r=﹣0.688,P<0.001)水平呈负相关,与高密度脂蛋白水平呈正相关(r=0.652,P<0.001)。观察组患者的妊娠并发症总发生率明显低于对照组(64.00%比92.00%,χ^(2)=11.422,P=0.001)。结论多囊卵巢综合征孕妇补充维生素D_(3),有利于纠正患者自身的血脂代谢紊乱,减少妊娠并发症,改善分娩结局。

血清lncRNA-XIST、lncRNA-MALAT1水平与多囊卵巢综合征不孕症患者胰岛素抵抗及促排卵治疗后妊娠结局的关联性研究

目的探讨lncRNA-XIST、lncRNA-MALAT1与多囊卵巢综合征(PCOS)不孕症患者胰岛素抵抗及促排卵治疗后妊娠结局的关联性。方法招募2020年2月至2022年1月于唐山市妇幼保健院进行促排卵治疗的125例PCOS不孕症患者(PCOS不孕症组),另选取同期体检健康的女性125名作为对照组。比较两组血清lncRNA-XIST、lncRNA-MALAT1水平及稳态模型评估的胰岛素抵抗指数(HOMA-IR)。采用Pearson相关分析探讨血清lncRNA-XIST、lncRNA-MALAT1水平与HOMA-IR的相关性。采用多因素logistic回归分析探讨影响PCOS不孕症患者促排卵治疗后妊娠结局的因素。结果与对照组比较,PCOS不孕症组血清lncRNA-XIST水平及HOMA-IR较高,lncRNA-MALAT1水平较低,差异有统计学意义(P<0.05)。HOMA-IR与血清lncRNA-XIST水平呈正相关(r=0.689,P<0.001),与血清lncRNA-MALAT1水平呈负相关(r=-0.771,P<0.001)。PCOS不孕症患者经促排卵治疗后累积临床妊娠率为43.20%(54/125)。多因素logistic回归分析结果显示,较高的促黄体生成素(LH)/卵泡刺激素(FSH)比值[OR(95%CI)=1.121(1.005~1.278)]和血清lncRNA-XIST水平[OR(95%CI)=1.252(1.014~1.449)]是促进PCOS不孕症患者治疗后未妊娠的独立危险因素(P<0.05),较高的血清抗米勒管激素(AMH)水平[OR(95%CI)=0.518(0.348~0.771)]、lncRNA-MALAT1水平[OR(95%CI)=0.394(0.238~0.652)]是促进PCOS不孕症患者治疗后获得妊娠的保护因素(P<0.05)。结论PCOS不孕症患者血清lncRNA-XIST呈高表达,lncRNA-MALAT1呈低表达,且两个指标水平与胰岛素抵抗、促排卵治疗后妊娠结局密切相关。

金哲辨治未破裂卵泡黄素化综合征经验

总结金哲教授治疗未破裂卵泡黄素化综合征(LUFS)经验。根据B超下卵泡大小,LUFS可分为小卵泡型、卵泡滞留型和卵泡持续增大型,其中卵泡滞留型多合并子宫内膜异位症和多囊卵巢综合征,不同分型的LUFS各有其特点,金教授认为应分型辨证。治疗上,需总体把握种子调经这一核心思想辨证论治,并根据月经周期的阴阳消长规律进行分期论治。创立“育卵三法”分期论治小卵泡型LUFS;卵泡滞留型LUFS合并子宫内膜异位症者,以化瘀为首,合并多囊卵巢综合征者,以利湿化痰、散瘀调经为主;对于持续增长型LUFS,则以化痰消癥为法,分期治疗。