拮抗剂方案中HCG扳机日直径16~18 mm卵泡比例对PCOS患者IVF-ET结局的影响

目的探讨拮抗剂方案中人绒毛膜促性腺激素(HCG)扳机日直径16~18 mm卵泡比例对接受拮抗剂方案的多囊卵巢综合征(PCOS)患者体外受精-胚胎移植(IVF-ET)结局的影响。方法回顾性分析2016年1月至2021年12月于南京医科大学附属妇产医院行IVF-ET助孕的PCOS患者的临床资料。根据HCG扳机日双侧卵巢直径16~18 mm卵泡比例以三分位法将患者分为三组,该比例<0.43为A组(262例),0.43~0.56为B组(267例),≥0.56为C组(247例)。比较三组一般临床资料、超促排卵周期情况、胚胎发育情况、体外受精周期后首次冻融胚胎移植(FET)情况以及妊娠、围产期结局。结果B组基础促黄体生成素(LH)、基础LH与基础促卵泡激素(FSH)比值显著高于A组和C组,差异有统计学意义(P<0.05)。A组促性腺激素(Gn)使用总量高于B组和C组,HCG扳机日雌二醇(E_(2))水平低于B组、C组,差异有统计学意义(P<0.05)。B组和C组获卵数、2原核(PN)数、卵裂数、囊胚形成数以及可移植胚胎数高于A组,差异有统计学意义(P<0.05)。C组囊胚形成率高于A组和B组,高评分囊胚率高于B组,差异有统计学意义(P<0.05)。三组移植胚胎数、移植胚胎天数、内膜准备方案及内膜厚度比较差异无统计学意义(P>0.05)。三组胚胎着床率、生化妊娠率、临床妊娠率、流产率、活产率、妊娠期糖尿病发生率及妊娠期高血压发生率等比较差异无统计学意义(P>0.05)。结论在拮抗剂方案中,HCG扳机日直径16~18 mm卵泡比例可反映卵母细胞发育潜能,当该比例≥0.56时可获得较好的获卵数、2PN数、卵裂数、囊胚形成数以及可移植胚胎数,在一定程度上可作为PCOS患者HCG扳机时机的参考指标,但该比例并不影响后续首次FET的妊娠结局。

Effects of Qigongwan on Wnt/β-catenin Signaling Pathway in Rats with Polycystic Ovary syndrome

[Objectives] To explore the therapeutic effect and mechanism of Qigongwan on PCOS model rats by detecting the changes in sex hormone levels in rats with polycystic ovary syndrome (PCOS), and observing the effects of ovarian pathological morphological changes, apoptosis and expression of Wnt/β-β catenin signaling pathway protein. [Methods] Ten of 40 female SD rats were randomly selected as the normal group, and the other 30 rats were treated with letrozole combined with high-fat diet to establish the PCOS rat model. After successful modeling, the model group was randomly divided into Qigongwan group, positive Daying-35 (Ethinylestradiol and Cyproterone Acetate Tablets) group and model group, with 10 rats in each group. Qigongwan group was given 14.7 g/(kg·d) by gavage, Daying-35 group was given 0.21 mg/(kg·d) by oral gavage, and normal group and model group were given the same amount of distilled water, and the intervention lasted for 21 d. ELISA method was used to detect the levels of hormones such as follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone (T), estradiol (E 2) and progesterone (P) in serum. HE staining was used to observe the pathological morphological changes of ovarian tissues;TUNEL staining was used to observe apoptosis of ovarian tissue granule cells;the expression of Wnt, β-catenin protein in rat ovarian tissue was detected by immunohistochemistry. [Results] (i) Compared with the model group, Qigongwan group and Daying-35 group could significantly increase serum E 2 and P levels, significantly reduce serum T levels ( P <0.01), significantly reduce serum LH levels and LH/FSH ratio ( P <0.01), and increase serum FSH levels ( P <0.05) in different degrees. (ii)The results of HE staining showed that compared with the model group, Qigongwan and Daying-35 groups could improve follicular development and reduce atretic follicles in different degrees. Compared with Daying-35 group, the number of GC layers in Qigongwan group was significantly increased. (iii) The results of TUNEL staining showed that compared with the model group, the rate of TUNEL-positive cells in the Qigongwan group and Daying-35 group decreased significantly ( P <0.01). (iv) The immunohistochemical results showed that compared with the model group, the expression levels of wnt and β-catenin in the Qigongwan group and the Daying-35 group increased in different degrees ( P <0.05), and the expression range increased. [Conclusions] Qigongwan can regulate the secretion level of sex hormones such as FSH and LH, improve the pathological damage of ovarian tissue, and inhibit apoptosis of ovarian granule cells, and its mechanism may be related to the activation of Wnt/β-catenin signaling pathway.

Synchrony between Ovarian Function &Sleep in Polycystic Ovary Syndrome Patients

Polycystic ovary syndrome (PCOS) is a complex, multifaceted, heterogeneous disorder, affecting 4% to 18% of reproductive-aged women and is associated with reproductive, metabolic and psychological dysfunction. In this study we determined the relationship between the time to sleep and serum levels of neurohormones in polycystic ovary syndrome (PCOS). Totally 77 PCO patients(case group) and 97 non-PCOS infertile women (control subjects) participated in this study between February 2012 and February 2013. A PSQI sleep questionnaire was completed by each patient in both groups. PSQI sleep questionnaire score and serum concentration of adrenaline, noradrenaline, melatonin, β-endorphin, cortisol and progesterone were compared in two groups. The results of the study indicate that serum levels of melatonin and β-endorphin were lower in women with PCOS. Serum level of stress hormones, adrenaline and noradrenaline were significantly correlated with patients’ sleep time in study group. Serum level of adrenaline in control group was significantly lower in women who wake up earlier in the morning. All hormones except for cortisol had no significant correlation with PSQI global score in both groups and also the people who sleep less than 8 hours had lower cortisol level. These data showed that changes in cortisol in PCO women were due to damage of disturbed sleep at night. Our preliminary work provided this study with new insight into the interactions between sleep-wake cycles in PCO women with specific sleep patterns.

苍附导痰汤对肥胖型PCOS-IR模型大鼠卵巢TLR4/NF-κB p65信号通路的影响

目的 探讨苍附导痰汤对肥胖型PCOS-IR (polycystic ovarian syndrome-insulin resistance, PCOS-IR)模型大鼠卵巢Toll受体4(TLR4)/核转录因子κB p65(NF-κB p65)信号通路的调控作用。方法 48只♀大鼠随机分为正常组8只和模型组40只。来曲唑(1 mg·kg^(-1))联合高脂饮食建立肥胖型PCOS-IR大鼠模型,快速革兰染色法观察动情周期,挑选24只模型大鼠随机分为:模型组、阳性药(二甲双胍135 mg·kg^(-1))组、苍附导痰汤高、低剂量(57.96、14.49 g·kg^(-1))组,每组各6只,药物干预21 d。观察动情周期、卵巢和子宫指数变化;血液生化仪测定空腹血糖(FBG)和血脂(甘油三酯TG和总胆固醇TC)变化;酶联免疫吸附(ELISA)法测定空腹胰岛素(FINS)水平;免疫组化法和荧光定量PCR法检测卵巢中TLR4和NF-κB p65蛋白及基因的表达。结果 与正常组比较,模型组大鼠动情周期紊乱,卵巢多囊性改变明显,FBG、TG、TC含量和FINS、HOMA-IR水平上调,卵巢中TLR4和NF-κB p65蛋白及mRNA表达均增加(P<0.05);与模型组比较,苍附导痰汤高剂量组大鼠排卵周期得到改善,卵巢多囊性改变减轻,上述指标出现明显逆转(P<0.05)。结论 苍附导痰汤能有效改善肥胖型PCOS-IR大鼠卵巢排卵和糖脂代谢功能,作用机制可能与调控卵巢TLR4/NF-κB p65信号通路有关。

PCOS代谢异常特点与蒙医证型间的相关性研究

目的:探讨多囊卵巢综合征(PCOS)患者不同蒙医证型与代谢异常特点的相关性。方法:通过回顾性分析48例PCOS患者,采集临床资料、子宫超声筛查及血清糖代谢指标,按照蒙医临床证候诊断标准进行蒙医辨证分型(巴达干-赫依盛型、血热盛型、气血瘀盛型、聚合盛型),分析其代谢异常特点与不同蒙医证型的相关性。结果:1.在4组蒙医证候类型中以巴达干-赫依盛型为主,其次为血热盛型,气血瘀盛型及聚合盛型最少。2.巴达干-赫依盛型和血热盛型FINS、HOMA-IR水平明显优于另外两种蒙医证型,组间差异具有统计学意义(P<0.05)。结论:PCOS蒙医证型以巴达干-赫依盛型、血热盛型为主,巴达干-赫依盛型的特点较为突出。PCOS患者的代谢异常特点与蒙医证型具有一定相关性,巴达干-赫依盛型组与血热盛型组具有更明显的肥胖、代谢紊乱且与胰岛素抵抗功能作用密切相关。

艾炳蔚教授基于“血不利则为水”治疗肥胖型PCOS的经验

“血不利则为水”是张仲景关于津血病理关系的重要理论。现代医家认为,肥胖型多囊卵巢综合征(PCOS)病机属本虚标实,以肾虚为本、痰瘀互结为标。痰瘀等有形实邪阻滞冲任胞宫,血行不畅,进而导致气、血、水相互为病,缠绵难愈,故活血利水是治疗肥胖型PCOS的根本大法,即血水同治、标本兼顾。基于此,艾师从临床与古籍出发,探索“血不利则为水”对针灸治疗肥胖型PCOS的临床指导意义,并从中获益匪浅。

Thyroid Disorders in Women with Polycystic Ovary Syndrome

Background: Polycystic ovary syndrome (PCOS) is one of the common endocrinopathies of women in the reproductive age group. Thyroid hormones have various effects on the reproductive system of female. PCOS and thyroid dysfunction are linked to each other since several years. Objective: To evaluate and detect the thyroid dysfunction in patients with PCOS attending in a tertiary care hospital in Bangladesh. Methodology: This was a prospective cross sectional study conducted from November 2018 to October 2019 at Department of Obstetrics and Gynecology in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh on one hundred and fifty (150) PCOS women of reproductive age (15 - 45 years). All data of the study subjects regarding socio-demographic, anthropometric and clinical manifestations were recorded accordingly. Their thyroid function tests (serum level of FT3, FT4, TSH) were done at the hospital laboratory and results were recorded. Result: Mean (±SD) age of the study subjects was 24.57 ± 4.27 years. The maximum numbers [108 (72.0%)] of PCOS women were between 18 - 25 years age group. Among total (150) study population, 51 (34.0%) were overweight, 36 (24.0%) were obese and 63 (42.0%) were within normal weight level. Hirsutism was found in 87 (58%) study subjects while 24 (16%) subjects had acne in their face, 54 (36%) subjects had oligomenorrhea and 45 (30%) subjects had irregular periods. Among 150 PCOS women, 120 (80%) were married and 30 (20%) were single;of them primary infertility was detected in 58 (48.33%) women followed by the normal fertility status [51 (42.5%)] and 11 (9.17%) had secondary infertility. Among total (150) study subjects, 105 (70%) were in euthyroid state, hypothyroidism was found in 33 (22.0%) subjects and hyperthyroidism was detected in 12 (8%) subjects. Conclusions: Present study demonstrated that, thyroid disorders are prevalent in 30.0% of PCOS patients. Hypothyroidism is almost three-fold more prevalent than hyperthyroidism.

A Network Pharmacology Analysis of Cang Fu Dao Tan Formula for the Treatment of Obese Polycystic Ovary Syndrome

Objective To explore the potential molecular targets of Cang Fu Dao Tan Formula(CFDTF)in the treatment of obese polycystic ovary syndrome(PCOS)using network pharmacology and bioinformatic approaches.Methods The potential blood-entry active compounds and targets of CFDTF were retrieved from the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform(TCMSP),and obese PCOS related gene targets were retrieved from GeneCard databases.A protein-protein interaction(PPI)network of CFDTF component-targets and obese PCOS diseasetargets was constructed using STRING.Gene Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway analysis of the intersection network were conducted using a Bioconductor database.Results In total,114 active compounds were screened according to oral bioavailability(OB)and drug similarity(DL),and 328 targets related to these constituents were obtained.Further,2559 target genes directly related to obese PCOS were obtained from the GeneCard databases,and 82 genes were obtained from the intersection of the component-target and disease-target PPI network.These genes were mainly involved in response to steroid hormones,nutrient levels and lipopolysaccharide as well as in other biological processes.Their molecular functions were mainly related to nuclear receptor activity,phosphatase binding and cytokine activity,and they were enriched in the cytoplasm,cell membrane and membrane region.Conclusions CFDTF consists of 114 active compounds that are responsible for its pharmacodynamic effects.It mainly regulates the AGE-RAGE signaling pathway in diabetic complications,bladder cancer,and hepatitis B and in other signaling networks.These findings provide certain theoretical and scientific basis for the treatment of obese PCOS with Chinese medicine.

Hyponeurotrophinemia in Serum of Women with Polycystic Ovary Syndrome as a Low Grade Chronic Inflammation

Introduction: This study aimed to discuss about neuroimmune-pathophysiology of polycystic ovary syndrome (PCOS). Nerve growth factor (NGF) as modulator of neuro-endocrine-immune (NEI) system plays a critical role in tissue survival and homeostasis maintenance. It is a strong marker for sympathetic nerve activity. Women with PCO have enhanced ovarian NGF production. Over the past few decades, PCOS has been discussed as a low grade chronic inflammatory disease. In this study, we investigated the neuromodulator role of serum NGF and inflammatory cytokines (IL-1α, β, 17A and TNF-α) in women with PCOS. Material and Methods: 171 patients were investigated in two groups: study (n = 85 PCO) and control (n = 86). Serum levels of NGF-α and interleukins IL-1α, IL-1β, IL-17A and TNFα were determined in both groups by ELISA kit. Results: Data of this study showed that the level of NGF-α and IL-17A in serum of PCO women were lower than control group (p α, IL-1β were higher than control group in PCO women (p < 0.001). Conclusion: Probably inflammatory background in PCOS is the main cause of increased serum levels of IL-1α, IL-1β. Reduction of IL-17A and NGF in serum of PCO patients might be under the direct influence of the hyperactivity of sympathetic nervous system (SNS).

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.

益肾健脾养血通利方对Poresky PCOS大鼠模型的影响

目的 :观察益肾健脾养血通利方对PCOS大鼠的作用及其作用机制进行初步探讨。方法 :选用Poresky的PCOS动物 ,观察大鼠体重、动情周期、血清胰岛素和IGF I水平、性激素以及病理组织学的变化。结果 :本方能降低PCOS大鼠的体重、维持动情周期、降低血清胰岛素和IGF I水平 ;卵巢囊泡体积明显缩小 ,卵泡壁颗粒细胞层及黄体数量增加。结论 :益肾健脾养血通利方具有降低血清胰岛素水平、改善多囊卵巢征象、恢复排卵的作用。

达英-35与二甲双胍联合治疗多囊卵巢综合征(PCOS)的疗效观察

目的 探讨达英-35与二甲双胍联合治疗多囊卵巢综合征（PCOS）的疗效.方法 选择2011年1月～2014年1月在我院住院治疗的PCOS患者64例作为研究对象,根据治疗方法不同分为观察组和对照组各32例,对照组予二甲双胍治疗,连用6个月,观察组同时联合达英-35,比较两组患者的疗效及两组患者治疗前后LH、FSH、T、E2的水平.结果 观察组治疗后的总有效率达93.75％,对照组治疗后的总有效率为71.88％,观察组的疗效明显优于对照组,差异具有显著性（P＜0.05）.观察组患者治疗后LH、FSH、T均较治疗前及对照组明显降低,而观察组患者治疗后的E2水平均较治疗前及对照组明显提高,差异具有显著性（P＜0.05）.结论 达英-35与二甲双胍联合治疗PCOS疗效确切,可以明显改善性激素水平,安全性好,值得推广和应用.

小檗碱对PCOS模型大鼠子宫内膜的影响

目的:探讨小檗碱对PCOS模型大鼠血清睾酮、子宫内膜相关基因及蛋白信号的影响。方法:90日龄清洁级SD雌性大鼠根据Poretsky造模方法皮下注射胰岛素及绒毛膜促性腺激素,连续22日构建PCOS模型。小檗碱灌胃治疗28日,采用ELISA法检测睾酮激素水平,采用免疫组化法检测子宫内膜组织ERα蛋白表达情况,qRT-PCR技术检测子宫内膜Kras、PTEN mRNA基因表达水平。结果:与模型组相比,小檗碱组睾酮水平显著降低(P<0.05);ERα阳性表达率下降(P<0.05);Kras、PTEN mRNA表达水平下降(P<0.05)。结论:小檗碱对PCOS模型大鼠子宫内膜有显著影响,对激素合成、细胞癌变等信号分子具有调控作用。

超排卵周期中PCOS与IGF-Ⅱ和IGFBP-3关系的研究

目的 探讨IGF Ⅱ和IGFBP 3与PCOS的关系。方法 分别采用放射免疫法 (RIA)、免疫放射测定法 (IRMA)、磁性分离酶联免疫测定法 (EIA)检测卵泡液及用药前后血清IGF Ⅱ、IGFBP 3和E2 水平。结果 用药后PCOS组血清及卵泡液IGF Ⅱ水平明显低于同期正常组血清及卵泡液IGF Ⅱ水平 (P <0 .0 1) ;用药后PCOS组血清及卵泡液IGFBP 3水平明显高于同期正常组血清及卵泡液IGFBP 3水平 (P <0 .0 1) ;正常组卵泡液IGFBP 3水平与卵泡液IGF Ⅱ水平明显呈负相关 (r=- 0 .6 79,P <0 .0 1)。结论 IGF系统的不平衡状态可能参与PCOS患者疾病的发生发展过程。

PCOS高雄激素血症患者降调节后行冻融胚胎移植的临床结局观察

目的探讨降调节对多囊卵巢综合征(PCOS)高雄激素血症患者冻融胚胎移植(FET)周期临床结局的影响。方法回顾性分析2012年1月至2016年4月在我院不孕不育科行FET的PCOS高雄激素血症患者139例的临床资料,根据内膜准备方案不同分为常规雌孕激素替代组(HRT组,n=76)和降调节雌孕激素替代组(降调节HRT组,n=63),观察两组患者雌激素使用时间和剂量、子宫内膜厚度及分型、血清激素水平及临床妊娠结局等。结果两组患者的胚胎移植(ET)日子宫内膜厚度、移植胚胎数、优质胚胎率、早期流产率、异位妊娠率比较均无显著性差异(P>0.05);降调节HRT组补佳乐使用时间[(13.67±1.91)d]及总剂量[(81.55±10.80)mg]显著小于HRT组[分别为(15.28±2.47)d和(94.25±14.17)mg](P<0.01);降调节HRT组的ET日A型内膜占比(77.78%)、临床妊娠率(69.84%)及胚胎种植率(47.29%)均显著高于HRT组(分别为57.89%、51.31%、32.47%)(P<0.05)。结论对于PCOS高雄激素血症患者,降调节后雌孕激素替代法准备内膜可以减少雌激素使用时间及用量,改善子宫内膜分型,有效提高胚胎种植率和临床妊娠率。

来曲唑联合HMG治疗不同体质量指数PCOS不孕患者的促排卵效果及妊娠结局分析

目的分析不同体质量指数(BMI)多囊卵巢综合征(PCOS)不孕患者应用来曲唑(LE)联合人绝经期促性腺激素(HMG)治疗的促排卵效果及妊娠结局。方法回顾性分析2016年10月至2019年1月在汉中市中心医院妇科治疗的300例PCOS不孕患者的诊疗情况,按照BMI将其分为体质量过低组72例、正常体质量组75例、超重组74例和肥胖组79例。检测所有患者的激素水平后,应用来曲唑联合HMG促进排卵,比较四组患者的激素水平、排卵率及妊娠结局。结果四组患者的雌二醇(E2)值比较差异无统计学意义(P>0.05);BMI指数越大,睾酮(T)值越大,超重组和肥胖组的T值为(0.73±0.42)ng/mL和(0.88±0.51)ng/mL,明显高于正常体质量组的(0.45±0.21)ng/mL,差异均具有统计学意义(P<0.05);BMI指数越大,卵泡刺激素/黄体生成素(LH/FSH)值越小,超重组和肥胖组的LH/FSH值为1.14±0.58和1.12±0.62,明显低于正常体质量组的1.37±0.80,差异具有统计学意义(P<0.05),体质量过低组患者的T值和LH/FSH值分别为(0.44±0.18)ng/mL和1.62±0.93,与正常体质量组比较差异均无统计学意义(P>0.05);四组患者的排卵率比较差异无统计学意义(P>0.05);超重组和肥胖组的临床妊娠率分别为9.46%和8.46%,明显低于正常体质量组的21.33%;超重组和肥胖组的流产率为5.41%和6.33%,明显高于正常体质量组的0;超重组和肥胖组的生化妊娠率为6.76%和6.33%,明显高于正常体质量组的0,差异均具有统计学意义(P<0.05);体质量过低组的临床妊娠率、流产率和生化妊娠率分别为11.11%、1.39%和2.78%,与正常体质量组比较差异均无统计学意义(P>0.05)。结论不同BMI的PCOS不孕患者进行来曲唑联合HMG促排后的效果和妊娠结局不同,BMI指数越高,睾酮水平越高,临床妊娠率越低,流产率和生化妊娠率越高。低体质量的妊娠结局在本次研究中并未得出有影响的结论,可能是由于样本数量不够,有待进一步研究确定。

瘦素和多囊卵巢综合征(PCOS)伴非酒精性脂肪肝(NAFLD)相关性的临床观察

目的通过对多囊卵巢综合征(polycystic ovary syndrome,PCOS)人群中伴非酒精性脂肪肝(non-acoholic fatty liver disease,NAFLD)的分析,探讨瘦素与PCOS伴NAFLD之间的关系。方法收集35例PCOS伴有NAFLD的患者为脂肪肝组,同期选择35例PCOS不伴NAFLD的患者为非脂肪肝组,健康女性志愿者20例为对照组。所有受试者进行相关问卷调查建立个人病例档案,测量身高(height,H)、体重(weight,W)、体重指数(body mass index,BMI)、腰围(waist circumference,WC)、臀围(hip circumference,HC)及腰臀比(wasit hip ratio,WHR);检测血清睾酮(testosterone,T)、泌乳素(prolactin,PRL)、卵泡刺激素(folliclestimulating hormone,FSH)、黄体生成素(luteinizing hormone,LH)、雌二醇(estradiol,E2)、瘦素、空腹血糖(fasting blood sugar,FBG)、空腹胰岛素(fasting insulin,FINS)、餐后2h血糖(2hpostprandial blood glucose,2hPBG)、稳态模型胰岛素抵抗指数(homeostatic model assessment for insulin resistance,HOMA-IR)、总胆固醇(total cholesterol,TC)、三酰甘油(triglyceride,TG)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)及丙氨酸转氨酶(alaninetransaminase,ALT)等指标。结果两组PCOS的瘦素、W、BMI、WHR、T、LH、LH/FSH、FINS、PBG、HOMA-IR、LDL-C各项指标均高于对照组(P<0.05),FSH显著低于对照组(P<0.05);而PCOS伴NAFLD的瘦素、W、BMI、WC、HC、WHR、FINS、PBG、HOMA-IR、TG、LDL-C、ALT较不伴NAFLD显著升高(P<0.05),HDL-C显著降低(P<0.05)。脂肪肝组的瘦素水平与年龄、W、BMI、WC、HC、WHR、FINS、HOMA-IR及TG呈均显著正相关性(P<0.01),与HDL-C呈显著负相关性(P<0.01),控制与体脂有关的如W、BMI、WC、HC、WHR,脂肪肝组的瘦素水平与HOMA-IR、TG仍有显著正相关性(P<0.01)。结论瘦素水平异常与PCOS伴NAFLD的形成密切相关,及早重视瘦素干预,对于防治PCOS伴NAFLD有重要意义。

两种剂量LE和CC对PCOS不孕患者促排卵效果比较

目的比较两种不同剂量来曲唑（LE）和克罗米芬（CC）对多囊卵巢综合征（PCOS）不孕患者促排卵的效果。方法选择PCOS不孕症患者179例，于月经第5天A组80例给LE2．5mg／d，B组50例给LE5．0mg／d，C组49例给CC100mg／d，共5天，阴道超声监测排卵，排卵后指导同房。观察人绒毛膜性腺激素（hCG）注射日血雌二醇（E2）水平、子宫内膜厚度、优势卵泡个数、单优势卵泡发生率、排卵率、周期妊娠率、未破裂卵泡黄素化综合征（LUFS）的发生率。结果hCG注射日3组宫内膜厚度、B水平和单优势卵泡发生率比较，差异有统计学意义，子宫内膜厚度F=6．650，P=0．002〈0．01；E2水平F：89．533，P=0．000〈0．01；单优势卵泡发生率χ^2=7．585，P=0．023〈0．05；各组间卵泡成熟天数、排卵率、每周期妊娠率和LUFS发生率，差异均无统计学意义（均P〉0．05）。结论对于PCOS不孕症患者，两种剂量LE促排卵效果与CC相似，5．0mg／d的LE并不明显优于2．5mg／d，尚需加大样本量进一步研究。

经阴道超声检测参数对PCOS不孕症患者子宫内膜容受性的评估研究

目的探讨经阴道超声检测参数对多囊卵巢综合征(PCOS)不孕症患者子宫内膜容受性的评估价值。方法选取2016年10月至2018年9月重庆三峡中心医院收治的162例PCOS不孕症患者作为研究对象。均行子宫内膜胞饮突检查及阴道超声检测,观察子宫内膜胞饮突情况、子宫内膜厚度、容积与子宫螺旋动脉搏动指数(PI)、阻力指数(RI)、S/D(收缩期峰值血流速度/舒张末期血流速度)。根据子宫内膜胞饮突将162例患者分为容受性良好组与不良组,对比两组患者阴道超声检测参数,且采用Logistic回归分析法分析其对子宫内膜容受性的影响。结果162例患者经阴道超声检查,其中子宫内膜厚度(6.42±0.71)mm,子宫内膜容积(1.56±0.38)mL,PI(1.78±0.29),RI(0.79±0.03),S/D(3.84±0.41);子宫内膜容受性良好组患者子宫内膜厚度、子宫内膜容积均大于不良组患者,良好组患者PI、RI、S/D均小于不良组患者,差异均具有统计学意义(均P<0.05);良好组患者子宫内膜厚度≤7.0mm、子宫内膜容积≤2mL、PI≥1.6、RI≥0.72、S/D≥3.6、高雄激素血症、高胰岛素血症构成比占比均明显低于不良组患者,差异均具有统计学意义(均P<0.05),且经Logistic回归分析发现,其均是影响PCOS不孕症患者子宫内膜容受性的危险因素,差异均具有统计学意义(OR=5.223、4.080、2.591、2.998、3.522、2.930、3.684,均P<0.05)。结论经阴道超声检查可观察PCOS不孕症患者子宫内膜及子宫螺旋动脉血流动力学变化情况,且当检测参数显示为子宫内膜厚度≤7.0mm、子宫内膜容积≤2mL、PI≥1.6、RI≥0.72、S/D≥3.6时,此类患者子宫内膜容受性不良的风险增加,可指导临床工作。

CYP19基因多态性与PCOS发病相关性

目的研究芳香化酶基因(C YP19)第4内含子△3(TTTA)n微卫星多态性与多囊卵巢综合征(PCOS)发病、PCOS患者体重指数(BMI)和血清生殖激素之间的关系。方法收集PCOS和非PCOS人群的血液标本。记录临床数据并检测血清中的生殖激素。采用Chelex-100提取法从180例PCOS患者和127名非PCOS对照者的外周血标本中提取DNA。特异引物聚合酶链反应,产物经6%变性聚丙烯酰胺凝胶电泳分离,银染检测。结果正常对照和PCOS患者之间的△3(TTTA)n频率分布差异无统计学意义。二者均没有(TTTA)9。PCOS患者中各基因型个体之间的BMI和血清生殖激素差异无统计学意义。结论C YP19基因第4内含子的多态性与PCOS发病之间没有直接相关性,PCOS的雄激素升高不是其代谢下降,而是合成过多;同时C YP19基因第4内含子的多态性对PCOS患者的BMI和生殖激素也无影响。