Follicular hyperandrogenism and insulin resistance in polycystic ovary syndrome patients with normal circulating testosterone levels

Polycystic ovary syndrome（PCOS） is a common reproductive disease with high heterogeneity. The role of excess androgen in PCOS etiology remains disputed, since around 20%-50% of PCOS women do not display hyperandrogenemia. The microenvironment of the ovary critically influences follicular development. In the present study, we assessed the role of androgen in PCOS by investigating whether excessive follicular fluid androgen was present in PCOS patients with normal serum androgen levels and influenced by follicular fluid insulin resistance（IR）.Follicular fluid samples of 105 women with PCOS and 105 controls were collected. Levels of steroid hormones,glucose and insulin in the follicular fluid were examined and compared with data from serum biochemistry tests. We found that 64.9%（63/97） of PCOS patients with normal serum androgen levels displayed abnormally high follicular fluid androgen level. The follicular fluid androgen level was positively correlated with follicular fluid IR within a certain range and follicular fluid estrogen-to-testosterone（E2/T） ratio was significantly reduced in these patients.These results indicated that there existed a subgroup of PCOS patients who displayed excessive follicular fluid androgen and IR despite their normal circulating testosterone（T） levels. Our study highlights the importance of ovary hyperandrogenism and IR in the etiology of PCOS.

Effect of laparoscopic sleeve gastrectomy on related variables of obesity complicated with polycystic ovary syndrome

BACKGROUND Polycystic ovary syndrome(PCOS)is closely related to obesity,and weight loss can significantly improve the metabolic,endocrine and reproductive functions of obese individuals with PCOS.However,the efficacy of laparoscopic sleeve gastrectomy(LSG)for obesity with PCOS are unclear.AIM The purpose of the study was to investigate the effect of LSG on related variables in obese patients with PCOS.METHODS A retrospective analysis was performed on 32 obese patients with PCOS who received LSG treatment at the Third Hospital of Shanxi Medical University from 2013 to 2020.The changes in anthropometric indices,insulin,testosterone,estradiol,follicle stimulating hormone(FSH),luteinizing hormone(LH),menstrual cycle and LH/FSH ratio before and 1 mo,3 mo,6 mo and 12 mo after the operation were statistically analyzed.RESULTS At 1 mo,3 mo,6 mo and 12 mo after surgery,the anthropometric indices,such as body weight and body mass index,of all patients were lower than those before the operation.The percentage excess weight loss(EWL%)at 1 mo,3 mo,6 mo and 1 year of follow-up were 25,40,46 and 65,respectively.The PCOS-related indices,such as insulin,testosterone,estradiol,follicle stimulating hormone(FSH),luteinizing hormone(LH)and menstrual cycle,were improved to varying degrees.During the 1-year follow-up,the average serum testosterone decreased from preoperative 0.72 ng/mL to 0.43 ng/mL(P<0.05),average fasting insulin level(9.0 mIU/mL,preoperative 34.2 mil,LH level,4.4 mIU/mL,preoperative 6.1 mIU/mL).The level of FSH(3.8 U/L,4.8 U/p0.05)and the ratio of LH/FSH(0.7,1.3/p0.05)were more relieved than those before surgery.During the postoperative follow-up,it was found that the menstrual cycle of 27 patients(nasty 27)returned to normal,and 6 patients(18%)who intended to become pregnant became pregnant within 1 year after surgery.CONCLUSION The weight loss effect of LSG is obvious and affirmative,and the endocrine index of obese patients with PCOS is also improved to some extent,although the mechanism is not clear.Laparoscopic sleeve gastrectomy is expected to become a backup choice for patients with polycystic ovaries in the future.

Observation on Therapeutic Effects of Electroacupuncture on Polycystic Ovary Syndrome of Kidney Deficiency and Phlegm Dampness Type and Oxidative Stress Level

Objective:To observe the clinical effect of electroacupuncture on improving polycystic ovary syndrome(PCOS)of kidney deficiency and phlegm dampness type and serum oxidative stress level.Methods:There were 68 patients with polycystic ovary syndrome were randomly divided into observation group(34 cases)and the control group(34 cases),The observation group was treated by electroacupuncture,while the control group was treated by placebo electroacupuncture.Combined with the evaluation of menstrual cycle,menstrual color,quality,quantity and TCM symptom integral index,the difference of curative effect between the two groups was observed,and the levels of peripheral blood,sex hormones,insulin resistance and oxidative stress were detected before and after treatment for 3 months.Results:The total effective rate in the observation group was better than that in the control group(P<0.01);After intervention,serum LH,FSH,E_(2) and LH/FSH in the observation group were significantly different from those before intervention.The D values of serum LH,FSH,LH/FSH and E_(2) before and after intervention were significantly different between the two groups(P<0.01);Comparing the level of androgen,the serum A4 and T in the observation group were significantly different from those before intervention(P<0.01);After intervention,there was a significant difference in serum A4 and T between the two groups(P<0.01),and there was a significant difference in D value between the two groups before and after intervention;There was a difference in insulin resistance in the observation group before and after intervention(P<0.05),and there was a significant difference in D value between the two groups before and after intervention(P<0.01);After the intervention,the serum SOD,MDA,ROS in the observation group were significantly different from those before the intervention;After intervention,the results of serum SOD and ROS in the observation group were significantly different from those in the control group;There was no significant difference in serum MDA results.There were significant differences in SOD,MDA,ROS between the two groups before and after intervention.Conclusion:Electroacupuncture can improve oxidative stress injury,insulin resistance and hyperandrogenism in PCOS patients.

Nonalcoholic fatty liver disease and polycystic ovary syndrome

Nonalcoholic fatty liver disease(NAFLD)is the most common cause of chronic liver disease in the Western world comprising a spectrum of liver damage from fatty liver infiltration to end-stage liver disease,in patients without significant alcohol consumption.Increased prevalence of NAFLD has been reported in patients with polycystic ovary syndrome(PCOS),one of the most common endocrinopathies in premenopausal women,which has been redefined as a reproductive and metabolic disorder after the recognition of the important role of insulin resistance in the pathophysiology of the syndrome.Obesity,in particular central adiposity and insulin resistance are considered as the main factors related to NAFLD in PCOS.Moreover,existing data support that androgen excess,which is the main feature of PCOS and is interrelated to insulin resistance,may be an additional contributing factor to the development of NAFLD.Although the natural history of NAFLD remains unclear and hepatic steatosis seems to be a relatively benign condition in most patients,limited data imply that advanced stage of liver disease is possibly more frequent in obese PCOS patients with NAFLD.PCOS patients,particularly obese patients with features of the metabolic syndrome,should be submitted to screening for NAFLD comprising assessment of serum aminotransferase levels and of hepatic steatosis by abdominal ultrasound.Lifestyle modifications including diet,weight loss and exercise are the most appropriate initial therapeutic interventions for PCOS patients with NAFLD.When pharmacologic therapy is considered,metformin may be used,although currently there is no medical therapy of proven benefit for NAFLD.Long-term follow up studies are needed to clarify clinical implications and guide appropriate diagnostic evaluation,follow-up protocol and optimal treatment for PCOS patients with NAFLD.

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.

Identification of Differentially Expressed MicroRNAs in the Ovary of Polycystic Ovary Syndrome with Hyperandrogenism and Insulin Resistance

Background：Polycystic ovary syndrome （PCOS） is the commonest endocrinopathy in women of reproductive age.The patients often develop insulin resistance （IR） or hyperinsulinemia despite manifesting anovulation and signs of hyperandrogenism.The cause and effect relationship of hyperinsulinemia and hyperandrogenemia （HA） is still debated.Micro-ribonucleic acids （miRNAs） have recently been shown to play a role in regulation of ovarian function.Our current study focused on the altered expression of miRNAs with PCOS.Methods：Ovarian theca intema tissues were obtained from 10 PCOS patients and 8 controls that were non-PCOS and had normal insulin sensitivity undergoing laparoscopy and/or ovarian wedge resection.Total RNA of all samples was extracted.We studied the repertoire of miRNAs in both PCOS and non-PCOS women by microarray hybridization.Bioinformatic analysis was performed for predicting targets of the differentially expressed miRNAs.Furthermore,selected miRNAs were validated by quantitative reverse transcriptase polymerase chain reaction （qRT-PCR）.Results：A total of 27 miRNAs were differentially expressed in PCOS patients with respect to the controls in our discovery evaluationand two （miR-92a and miR-92b） of them were significantly downregulated in PCOS women in followed validation （P 〈 0.05）.Targets prediction revealed that miR-92a targeted both GATA family of zinc finger transcription factor GATA-binding factor 6 （GATA6） and insulin receptor substrate proteins 2 （IRS-2）.Conclusions：MiRNAs are differentially expressed between PCOS patients and controls.We identified and validated two miRNAs-miR-92a and miR-92b.They are significantly downregulated and may be involved in the pathogenesis of PCOS.

内质网应激在多囊卵巢综合征中的研究进展

多囊卵巢综合征(polycystic ovary syndrome,PCOS)是一种常见的妇科内分泌疾病,患者通常伴有月经失调、不孕、多毛、痤疮和肥胖等临床表现,目前确切的发病机制尚不清楚。近年越来越多的证据显示内质网应激(endoplasmic reticulum stress)参与了PCOS的病理过程,有望成为治疗PCOS的新靶点。内质网应激是内质网的稳态失衡,未折叠或错误折叠的蛋白质在内质网中积累的状态。一定程度的内质网应激有助于卵泡的发育成熟,但持续的内质网应激会诱导颗粒细胞凋亡,并且通过影响类固醇激素代谢、糖代谢和脂质代谢等过程导致PCOS患者卵泡发育异常、性激素及胰岛素合成分泌紊乱,从而对女性生育能力造成不利影响。综述内质网应激与PCOS各种致病因素之间的关系,以期为PCOS的病因学研究和治疗提供新思路。

单核苷酸多态性与多囊卵巢综合征发生发展的研究进展

多囊卵巢综合征(PCOS)是女性一种常见的异质性、复杂性和多基因性疾病,其临床特征为高雄激素血症、胰岛素抵抗、肥胖和稀发/无排卵等。PCOS病因及发病机制尚未阐明,主要涉及遗传、环境、精神及心理因素等。目前,越来越多的研究表明,遗传因素在PCOS发生发展中占据重要作用。单核苷酸多态性(SNP)是由单个碱基的转换、颠换、插入或缺失引起的单个核苷酸变异形成的脱氧核糖核酸序列多态性。因此,研究PCOS的易感性基因对未来阐明该病的病因和发病机制具有重要意义。本文综述近年来基因多态性与PCOS发生发展关系的最新研究成果,主要从雄激素的生物合成、结合和转化,胰岛素抵抗,脂代谢和炎症等相关易感基因位点上的SNP,如rs743572、rs35785886、rs2414096、rs2059807、rs9939609、rs361525、rs2275913等进行论述,以期为PCOS的病因、病理机制研究及精准防治提供新思路。

高雄激素和胰岛素抵抗对多囊卵巢综合征孕妇胎盘病理影响的研究进展

多囊卵巢综合征(PCOS)是育龄期女性常见的内分泌疾病,可影响患者的生殖、代谢等。胎盘是影响妊娠和分娩结局及子代发育状况的关键介质,PCOS患者产前高雄激素和胰岛素抵抗所致糖脂代谢异常引起的胎盘结构和功能异常,可能是其子代出现低体质量出生儿、巨大儿甚至成年后发生内分泌及代谢系统疾病的主要原因。本文综述高雄激素和胰岛素抵抗对PCOS患者胎盘的病理影响,总结PCOS相关胎盘功能障碍的研究现状,探讨PCOS患者妊娠期胎盘结构和功能异常的原因及相应胎盘病理学特征,以期为预防PCOS相关妊娠并发症以及PCOS患者子代相关疾病的发生提供参考依据。

肠道微生物群失调对多囊卵巢综合征的影响

肠道微生物群被认为是人体的一种内分泌器官,肠道微生物及其代谢产物可通过影响远处器官和相关生物途径参与人体代谢、免疫及生殖,肠道微生物群失衡对疾病的发生、发展起着重要作用。多囊卵巢综合征(polycystic ovary syndrome,PCOS)存在高雄激素血症、下丘脑-垂体-卵巢轴紊乱以及胰岛素抵抗等复杂的病理生理过程。研究表明,PCOS患者和PCOS啮齿动物模型的肠道微生物群发生了改变,肠道微生物群失调可以通过介导糖皮质激素代谢、胆汁酸代谢及慢性炎症等导致性激素合成及胰岛素分泌紊乱、卵泡发育异常,提示肠道微生物失调可能在PCOS的发展和病理学中发挥相应作用。综述肠道微生物失调在PCOS发病机制中作用的研究进展。

PCOS患者血清IGF-1水平与胰岛素抵抗及脂代谢的相关性研究

目的探讨多囊卵巢综合征(PCOS)患者胰岛素样生长因子1(IGF-1)与胰岛素抵抗(IR)及脂代谢的相关性。方法150例PCOS患者作为研究对象,依据体质量指数(BMI)分为超重组(BMI≥25 kg/m^(2),82例)和常重组(BMI<25 kg/m^(2),68例)。检测并比较两组患者IGF-1、空腹血糖(FPG)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)、甘油三酯(TG)、总胆固醇(CHOL)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)水平,分析PCOS患者IGF-1与IR及脂代谢的相关性。结果超重组IGF-1(169.29±9.18)ng/ml、FINS(15.01±2.82)μU/ml、HOMA-IR(3.26±0.64)和BMI(25.86±0.76)kg/m^(2)、TG(1.79±0.09)mmol/L、CHOL(6.43±0.42)mmol/L、LDL-C(4.08±0.55)mmol/L明显高于常重组的(136.05±18.97)ng/ml、(11.55±1.84)μU/ml、(2.55±0.39)、(23.32±1.19)kg/m^(2)、(1.08±0.30)mmol/L、(4.12±0.75)mmol/L、(2.43±0.39)mmol/L,差异均有统计学意义(P<0.05);Pearson相关分析显示,PCOS患者的IGF-1水平与FINS、HOMA-IR、TG、CHOL、LDL-C呈正相关(P<0.05),与FPG、HDL-C无相关性(P>0.05)。结论超重组PCOS患者血清IGF-1、FINS、HOMA-IR、TG、CHOL、LDL-C明显升高,且IGF-1与FINS、HOMA-IR和TG、CHOL、LDL-C之间具有相关性。

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 orlistat on obese women with polycystic ovary syndrome

Polycystic ovary syndrome(PCOS)is a common gynecological endocrine syndrome characterized by metabolic abnormality and reproductive dysfunction,including ovulation abnormality,hyperandrogenism and polycystic ovarian manifestations.Most PCOS patients are overweight or obese,particularly the central type.This aggravates the clinical manifestations of PCOS and ultimately increases the risk of infertility.Orlistat is the only weight loss drug approved by the US Food and Drug Administration.As a long-lasting gastrointestinal lipase inhibitor,orlistat can effectively reduce the absorption of lipid and increase lipid excretion,thereby achieving weight loss.In obese PCOS patients,orlistat can reduce weight,improve lipid metabolism and insulin resistance,improve sex hormone disorder,and have a positive effect on pregnancy outcome.This review summarizes the impact of orlistat treatment on metabolism and fertility in obese women with PCOS.

内脏脂肪素和二甲双胍对多囊卵巢综合征大鼠胰岛素抵抗和生殖内分泌的治疗作用

目的比较内脏脂肪素(visfatin)和二甲双胍对多囊卵巢综合征(PCOS)大鼠胰岛素抵抗及生殖内分泌紊乱的治疗作用,为visfatin进一步应用于PCOS治疗的临床研究提供理论依据。方法 40只SD大鼠随机平均分为A、B、C、D组4组,A、B、C三组采用DHEA造模法建模,通过连续阴道液涂片及血清学检测判断建模成功与否,A、B组为实验组,C组为PCOS建模对照组,D组为空白对照组。建模成功后,A组大鼠予visfatin 10μg/只单次给药,B组大鼠予二甲双胍14 mg/100 g体质量连续灌胃15 d。干预前后采血测定T、LH、FSH、FINS及OGTT各时段血糖,并计算HOMA-IR指数及LH/FSH比值,最后剖取卵巢行病理切片。结果(1)干预前后对比,A、B组大鼠血FINS、FPG、T、HOMA-IR及OGTT各时段血糖均显著降低(P<0.05);(2)干预后,A组和B组中分别有8只(80%)及7只(77.8%)大鼠恢复规律的发情周期,均可见正常卵泡的发育;(3)visfatin与二甲双胍在改善PCOS大鼠胰岛素抵抗及高雄激素血症方面的疗效相同。结论 visfatin和二甲双胍均能改善PCOS大鼠的胰岛素抵抗及高雄激素血症,并能促进其规律动情周期的建立及正常卵泡的发育,且两者疗效相同。

PCOS患者AMH水平与内分泌代谢异常间关系的研究

目的分析多囊卵巢综合征(PCOS)患者抗苗勒管激素(AMH)水平与内分泌代谢异常之间的关系,比较高雄激素和非高雄激素型患者AMH及其它指标的差异。方法 210例PCOS患者,据AMH水平分为高AMH组(AMH≥10ng/ml,86例)和低AMH组(AMH<10ng/ml,124例);根据高雄激素临床表现或高雄激素血症分为高雄组(58例)和非高雄组(152例)。测定血清AMH、卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇、睾酮(T)、空腹血糖和空腹胰岛素、总胆固醇、甘油三酯和低密度脂蛋白,计算稳态模型胰岛素抵抗指数(HOMA-IR),比较各组AMH及内分泌代谢指标差异,分析AMH水平的影响因素。结果 (1)低AMH组与高AMH组比较,BMI(24.73±5.02kg/m2 vs.23.08±4.34kg/m2)、空腹胰岛素(93.26±57.64pmol/L vs.73.81±42.62pmol/L)、HOMA-IR(3.23±2.20vs.2.51±1.64)均显著增高(P<0.05);(2)高雄组与非高雄组比较,AMH水平(11.71±5.86ng/ml vs.9.64±4.91ng/ml)、LH/FSH比值(1.94±0.93vs.1.54±0.80)、总胆固醇水平(4.94±1.38 mmol/L vs.4.36±0.83 mmol/L)、低密度脂蛋白水平(3.06±1.22 mmol/L vs.2.63±0.68mmol/L)均显著增高(P<0.05);(3)多元线性回归分析显示AMH水平与睾酮水平正相关(β=0.281,P<0.05),与BMI负相关(β=-0.264,P<0.05)。结论 PCOS患者BMI、空腹胰岛素和HOMA-IR升高导致AMH水平降低,而高雄激素型患者AMH水平和LH/FSH显著升高,并增加脂质代谢异常的风险。

青春期多囊卵巢综合征患者临床特征分析

目的探讨青春期多囊卵巢综合征(PCOS)患者的临床特征。方法回顾性分析2003年1月～2006年5月我院收治的青春期PCOS患者58例的临床资料。结果青春期PCOS患者中,超重者占39.7%,肥胖者占31.0%,月经异常、痤疮、多毛和黑棘皮症发生率分别为87.9%、65.5%、56.9%和6.9%,痤疮和多毛评分明显增高(分别为1.60±1.36和2.16±1.98),胰岛素抵抗发生率为12.7%。青春中期组与晚期组各项指标比较,差异无显著性(P>0.05)。结论肥胖、高雄激素血症和胰岛素抵抗是青春期PCOS患者的主要临床特征,应作为青春期PCOS的高危因素在临床上引起重视。

多囊卵巢综合征对妊娠结局的影响研究进展

多囊卵巢综合征(polycystic ovary syndrome,PCOS)是育龄期女性最常见的内分泌及代谢紊乱性疾病之一。大多数研究认为,胰岛素抵抗、高雄激素血症和肥胖在PCOS发病过程中起重要作用。临床上观察到PCOS患者常出现妊娠期糖尿病、妊娠高血压疾病等妊娠期合并症。为此,本文对PCOS不良妊娠结局相关因素如PCOS患者卵泡和胚胎发育、子宫内膜容受性的改变以及PCOS与妊娠期合并症的关系做一综述,探讨PCOS患者孕前抗雄激素治疗对其妊娠结局的影响。

育龄期伴高雄激素多囊卵巢综合征临床特征及代谢异常相关因素分析

目的总结育龄期伴高雄激素多囊卵巢综合征(PCOS)的临床特征,探讨其代谢异常的影响因素。方法采用横断面研究方法,收集我院门诊诊断为PCOS的育龄期患者342例(所有患者均稀发排卵或无排卵),年龄19~34岁,纳入一般临床资料、检测性激素、血脂、血糖、胰岛素释放等代谢指标,根据是否有高雄激素血症和(或)体征分为高雄激素组和非高雄激素组,采用t检验或χ2检验,比较2组一般资料及代谢指标的差异。以年龄、体质量指数(BMI)、腰围等为自变量,采用Logistic回归分析代谢异常的影响因素。结果 342例PCOS患者高雄激素血症/体征检出率分别为46.8%(160/342)、26.3%(90/342),高雄激素组与非高雄激素组胰岛素抵抗检出率分别为97.6%、99.2%,2组腰围、黄体生成素/卵泡刺激素(LH/FSH)比值、低密度脂蛋白胆固醇(LDLC)、FSH比较差异有统计学意义(P<0.05)。相关因素分提示腰围是血脂异常的危险因素,OR值为2.968;体质量指数、腰围是胰岛素抵抗的危险因素,OR值分别为29.424,0.068。结论 PCOS患者胰岛素抵抗检出率几乎100%,伴高雄激素PCOS患者腹型肥胖风险增加,排卵障碍风险增加可能与LH/FSH比值增加有关,而代谢异常与雄激素水平关系不密切。伴高雄激素PCOS胰岛素抵抗与腹型肥胖、肥胖有关。

育龄期肥胖多囊卵巢综合征患者特异性临床代谢特征分析

目的多囊卵巢综合征(polycystic ovary syndrome,PCOS)是遗传异质性、发病多因性、临床表现多样性的疾病,发病机制尚不明确。对年龄及肥胖与PCOS关系的研究报道较少。文中比较育龄期和青春期肥胖与非肥胖PCOS患者的病史、临床特征及实验室指标的差异,探讨PCOS发生的危险因素和发病机制。方法按年龄及体质指数(body mass index,BMI)将PCOS患者分为育龄期肥胖组、育龄期非肥胖组和青春期肥胖组3组。记录各组患者病史、体征,检测并比较血脂、血糖、胰岛素、性激素等实验室检查结果。结果肥胖PCOS患者中,青春期患者紫纹发生率显著高于育龄期患者(P<0.05),育龄期患者三酰甘油(triglyceride,TG)、总胆固醇(total cholesterol,TC)异常发生率与青春期患者相比有升高趋势,但差异无统计学意义。育龄期PCOS患者中,肥胖者黑棘皮、紫纹、痤疮、腹型肥胖、黄体生成素/卵泡刺激素(luteinizinghormone/follicule-stimulating hormone,LH/FSH)≥2.0、高胰岛素血症及胰岛素抵抗(insulin resistance,IR)、空腹血糖受损/糖耐量受损、糖尿病(diabetes mellitus,DM)、代谢综合征(metabolic syndrome,MS)发生率均较非肥胖者显著升高,而胰岛素敏感指数(intermediate-acting insulin,IAI)及血高密度脂蛋白胆固醇(HDL-C)水平显著低于非肥胖者。高雄激素血症(hyperandro-genism)发生率以及血LH、TC、TG水平与非肥胖者比较呈升高趋势,但差异无统计学意义。PCOS患者的肥胖程度与腰臀比(waist-to-hip ratio,WHR)和IR呈正相关。青春期肥胖PCOS患者的肥胖程度与TG水平呈正相关。肥胖PCOS患者的年龄与血FSH水平呈负相关,TG/HDL-C与腰围、WHR呈正相关。结论 PCOS患者中普遍存在IR及LH/FSH倒置,育龄期肥胖PCOS患者糖脂代谢异常较为常见。PCOS发生与肥胖相关,与家族史、月经史无明显相关。

miRNA与多囊卵巢综合征发病机制相关性的研究进展

多囊卵巢综合征（PCOS）是育龄女性最常见的生殖内分泌疾病,目前多项研究认为PCOS是由遗传基因、环境等多种因素共同作用的结果。miRNA是一类长度为18~22个核苷酸的非蛋白编码的单链小分子,广泛参与卵泡发育、受精、胚胎着床及早期胚胎发育等过程,miRNA表达异常直接影响卵巢的正常生理功能、卵泡和卵母细胞的生长发育。现对miRNA如何调控卵巢细胞增殖和（或）凋亡、卵泡异常形成、胆固醇合成改变和脂肪细胞功能障碍等具体机制尚不清楚,后续对PCOS的深入了解以及对与其表型相关路径的识别,可能改善PCOS患者的临床管理和个性化治疗的实施。