Insulin Resistance and Its Associated Risk Factors in Nigerian Women with Polycystic Ovary Syndrome

Background: The etiology of polycystic ovary syndrome (PCOS) is not completely understood;however one condition that correlates closely with the pathogenesis of PCOS is insulin resistance (IR). The objective of this study was to determine the prevalence of insulin resistance (IR) and the association of such abnormality with potential risk factors in women with PCOS. Method: 116 women with confirmed PCOS attending a reproductive clinic at the University of Benin Teaching Hospital in Benin City were studied. IR was determined by homeostatic model assessment (HOMA) ≥ 2 and pre-diabetes by fasting plasma glucose between 110 and 125 mg/dl and/or plasma glucose value between 140 and 200 mg/dl at 2 hours during an oral glucose tolerance test (OGTT) after ingestion of 75 g oral glucose load. Results: Forty-two women were insulin resistant among the 116 women with PCOS. The prevalence of IR was 36.2% (95% CI 26.6 - 46.2). The prevalence of impaired fasting glucose (IFG) showed 1.7% (95% CI 0.97 - 2.03), impaired glucose tolerance (IGT) was 2.6% (95% CI 1.97 - 3.03) and diabetes mellitus (DM) was 1.7% (95% CI 0.97 - 2.03) in the 116 PCOS women. Of these 42 insulin resistant PCOS women, 23.8% (n = 10) were obese and 40.5% (n = 17) were overweight. Multivariate analysis revealed that total cholesterol (OR, 1.07;95% CI, 1.04 - 1.10), triglycerides (OR, 1.08;95% CI, 1.04 - 1.13) and LDL-cholesterol (OR, 1.08;95% CI, 1.04 - 1.12) were statistically significant independent risk factors for IR. Conclusion: The prevalence of IR was high in women with PCOS, and there was a significant association between IR, obesity, and dyslipidemia. However, the prevalence rates of impaired glucose tolerance and DM were low in women with PCOS compared to other studies. Since women with PCOS are at risk of IR and dyslipidemia, early screening, detection, intervention, and lifestyle modification would ameliorate the financial burden of DM and cardiovascular disease (CVD).

MIF May Participate in Pathogenesis of Polycystic Ovary Syndrome in Rats through MAPK Signalling pathway

The polycystic ovary syndrome (PCOS) model was established in fats and correlation between the expression of macrophage migration inhibitory factor (MIF) and cytokinesis with the MAPK signalling pathway in the rat ovary was measured. The PCOS model in rats was established by dehydroepiandrosterone (DHEA).Thirty sexually immature female Sprague-Dawley rats were randomly and equally assigned to three groups:control group,PCOS group,and PCOS with high-fat diet (HFD) group.Serum hormones were assayed by radioimmunoassay (RIA).The ovaries'were immunohistochemically stained with MIF,and the expression of MIF,p-JNK and p-p38 was detected by Western blotting in ovaries.The serum testosterone level,LH concentration,LH/FSH ratio,fasting insulin level and HOMA IR index in the PCOS group (6.077±0.478,13.809±1.701,1.820±0.404,10.83±1.123 and 1.8692±0.1096)and PCOS with HFD group (6.075±0.439,14.075±1.927,1.779±0.277,10.20±1.377 and 1.7736±0.6851)were significantly higher than those in the control group (4.949±0.337, 2.458±0.509,1.239±0.038,9.53±0.548 and 1.5329±0.7363),but there was no significant difference between the PCOS group and PCOS with HFD group.The expression levels of MIF,p-JNK,and p-p38 in the PCOS group (0.4048±0.013,0.6233±0.093 and 0.7987±0.061)and PCOS withHFD group (0.1929±0.012,0.3346±0.103 and 0.3468±0.031)were obviously higher than those in control group (0.2492±0.013, 0.3271±0.093 and 0.3393±0.061),but no Significant difference was observed between PCOS group and PCOS with HFD group.It was suggested that MIF may participate in the pathogenesis of PCOS through the MAPK signalling pathway in PCOS rats induced by DHEA.

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).

Effects of Jiawei Buzhong Yiqi Decoction on the Endometrial Receptivity of Rats with Polycystic Ovary Syndrome

[Objectives]The study aims to discuss the effects of Jiawei Buzhong Yiqi Decoction on the endometrial receptivity of rats with polycystic ovarian syndrome(PCOS).[Methods]Adult female SD rats were selected and randomly divided into the model group and control group.In the model group,the PCOS model was established by using the method of Poretsky L.Rats in the control group were given physiological saline intervention at the same time.The successfully modeled rats were randomly divided into the PCOS group and traditional Chinese medicine group.Among them,rats in the Chinese medicine group were given Jiawei Buzhong Yiqi Decoction by gavage;rats in the model group and the control group were given normal saline for 14 d.All rats were killed by anesthesia after the last administration,and serum and uterine specimens were collected.Serum sex hormones(including T,E_(2),and P),glucose and insulin levels were detected;the equivalent diameter and area of endometrial gland and gland cavity,and the endometrial thickness of rats were measured;the expression of endometrial leukemia inhibitory factor(LIF),integrinαvβ3 protein and mRNA was detected by using Elisa and RT-PCR methods.[Results]The serum T,glucose,and insulin levels of rats in the PCOS group were significantly higher than those of the control group and the traditional Chinese medicine group,and there was no significant difference in the above indicators between the control group and the traditional Chinese medicine group;there was no significant difference in the E_(2) and P levels between the three groups.The equivalent diameter and area of endometrial gland and gland cavity,and the endometrial thickness of rats in the PCOS group were lower than those of the control group and the traditional Chinese medicine group;there was no significant difference in the above indicators between the traditional Chinese medicine group and the control group.The expression of LIF,integrinαvβ3 protein and mRNA in the endometrium of rats in various groups was basically the same.The expression of LIF and integrinαvβ3 in the endometrium of rats in the PCOS group was significantly lower than that of the control group and the traditional Chinese medicine group;there was no significant difference in the above indicators between the control group and the traditional Chinese medicine group.[Conclusions]The endometrial receptivity of PCOS rats was decreased;Jiawei Buzhong Yiqi Decoction can improve the endometrial receptivity of PCOS rats by increasing the expression of LIF and integrinαvβ3 in the endometrium.

Effect of Astragalus-hawthorn on ovarian reproductive function and inflammatory mechanism of action in rats with polycystic ovary syndrome

Objective:To investigate the effects of prophylactic administration of Astragalus-Hawthorn on ovarian reproductive function and inflammatory mechanism in rats with polycystic ovary syndrome(PCOS).Methods:Fifty 21-day-old female rats were randomly divided into five groups of 10 rats each:Normal group,Model group,Astragalus group,Hawthorn group and Astragalus-Hawthorn group.All groups,except the normal group,were fed a high-fat model diet.Each treatment group received astragalus,hawthorn and an astragalus-hawthorn solution orally during the molding period for an intervention period of 15 weeks.The estrous cycle of the rats in each group was observed under the microscope from week 8,the interference rate was calculated,changes in ovarian tissues were observed by HE staining and the levels of sex hormones,proinflammatory and anti-inflammatory factors in the serum of the rats were measured by ELISA.Results:Rate of estrous cycle disorders were more frequent in the model group than in the normal group.(P<0.01);ovarian tissue was polycystic,with few corpora lutea and sinusoids and numerous follicular ovarian cysts;Luteinising hormone/follicle-stimulating hormone(LH/FSH),testosterone(T),interleukin 6(IL-6),interleukin 17A(IL-17A)and tumour necrosis factor(TNF-α)levels were significantly higher in the model group than in the normal group;interleukin 10(IL-10)was significantly lower than in the normal group(P<0.05).Compared to the model group,rats in the Astragalus and hawthorn groups had a lower rate of estrous cycle disorders(P<0.01);the number of cystic follicles in the ovarian tissue decreased;the number of mature follicles and corpus luteum increased;LH/FSH,T,IL-6 and IL-17A levels were significantly lower in the Astragalus group,hawthorn group and the Astragalus and hawthorn groups;TNF-αlevels were significantly lower in the astragalus and hawthorn groups;IL-10 levels were significantly higher in the hawthorn and astragalus hawthorn groups(P<0.05).IL-10 levels were significantly higher in the astragalus and hawthorn groups(P<0.05).Compared to the astragalus group,T levels were significantly lower in the astragalus and hawthorn groups and IL-10 levels were significantly higher in the astragalus and hawthorn groups(P<0.05).Compared to the hawthorn group,levels of T and IL-17A were significantly lower in the astragalus-hawthorn group(P<0.05).Conclusion:Astragalus-Hawthorn prophylactic administration can improve ovarian reproductive function in rats with PCOS,and the mechanism of action may be related to reducing the levels of pro-inflammatory factors IL-6,IL-17A and TNF-α,increasing the levels of anti-inflammatory factor IL-10,and reducing the inflammatory state.

Logistic Regression Analysis of Risk Factors Associated with Spontaneous Abortion after In Vitro Fertilization/Intracytoplasmic Sperm Injection-Embryo Transfer in Polycystic Ovary Syndrome Patients

Objective:To analyze spontaneous abortion rate and its associated risk factors in patients with polycystic ovary syndrome(PCOS)after in vitro fertilization/intracytoplasmic sperm injection-embryo transfer(IVF/ICSI-ET).Methods:This was a retrospective cohort study on 2,231 PCOS patients undergoing IVF/ICSI treatment.For comparison,we enrolled another 2,231 patients with tubular factors in control group.Spontaneous abortion rate and chromosomal abnormality rate were compared between the two groups.Furthermore,clinical data were compared between the patients with spontaneous abortion and those with ongoing pregnancy using univariate and multivariate analysis for risk factors of spontaneous abortion in PCOS patients.Results:Patients in the PCOS group had significantly higher spontaneous abortion rate(24.15%)than that in the control group(12.75%,P<0.001).Chromosomal abnormality rate was significantly lower in the PCOS group(36.05%,31/86)than in the control group(55.56%,50/90,P=0.009).In the PCOS group,patients with spontaneous abortion had significantly elder age,higher body mass index(BMI),and homeostasis model assessment for insulin resistance(HOMA-IR)than those with ongoing pregnancy.The logistic regression analysis confirmed that the age,BMI,and HOMA-IR were the risk factors of spontaneous abortion in the PCOS patients.There were no significant differences between groups in the type of cycles,the quality of embryos transferred,the number of embryos transferred,fasting blood glucose,fasting insulin,and so on.Conclusions:Compared with non-PCOS patients,PCOS patients had higher spontaneous abortion rate,but the chromosomal abnormality was not a major factor for the high spontaneous abortion rate in the PCOS patients.Age,BMI,and HOMA-IR were risk factors for spontaneous abortion after IVF/ICSI-ET in PCOS patients.

Effect of Acupuncture on Ovary Morphology and Function in DHEA-Induced Polycystic Ovary Syndrome Model Rats

Objective To investigate the effects of acupuncture on ovary morphology and function in dehydroepiandrosterone(DHEA)-induced polycystic ovary syndrome(PCOS)model rats.Methods A total of 40 adult female Wistar rats were randomly allocated to 4 groups by a random number table,including control,model,metformin and acupuncture groups,10 rats in each group.PCOS rat model was developed by injecting with DHEA(6 mg/100 g body weight)in 0.2 mL of oil subcutaneously.Electrical stimulation(2 Hz,3 mA)was applied to Guanyuan(CV 4),Zigong(EX-CA1)and Qihai(CV 6)acupoints for 30 min daily in the acupuncture group,and metformin(200 mg/kg)was given to rats in the metformin group,both once per day for 21 consecutive days,and rats in the normal group was fed with normal saline and fed regularly.After 21 days of administration,the rat blood samples were collected for detecting the reproductive hormonal levels[luteinizing hormone(LH),follicle stimulating hormone(FSH),estradiol(E2),progesterone(P),testosterone(T)]and inflammatory factors(visfatin,IL-6)analysis.Ovary tissue was used for histopathological analysis.Results Compared with the model group,rats in the acupuncture and metformin groups were significantly lower in weight gain,FSH,LH and T levels,and E2 and P levels significantly increased(alll P<0.05).Meanwhile,LH and FSH levels were significantly decreased,and P,T and E2 levels significantly increased in the acupuncture group,compared with the metformin group(P<0.05).Compared with the model group,IL-6 and visfatin levels were significantly decreased in the acupuncture and metformin groups(P<0.05).There were no significant differences in IL-6 and visfatin levels between the acupuncture and metformin groups(P>0.05).Ovarian diameter in the acupuncture and metformin groups were smaller than the model group(P<0.05).However,there were no significant differences in ovarian diameters between the acupuncture and metformin groups(P>0.05).Conclusion Acupuncture might improve ovary morphology and its function in DHEA-induced PCOS model rats.

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.

班氏促卵助孕汤改善多囊卵巢综合征小鼠卵母细胞的质量

背景:班氏促卵助孕汤改善多囊卵巢综合征卵母细胞质量的分子机制亟待完善补充。目的:探讨班氏促卵助孕汤对多囊卵巢综合征小鼠卵母细胞质量的影响和分子机制。方法:21 d龄雌性昆明小鼠颈部皮下注射硫酸脱氢表雄酮构建多囊卵巢综合征模型,连续给药21 d,记录动情周期及妊娠情况,ELISA检测血清性激素水平,Annexin V染色检测卵母细胞凋亡率,DCFH-DA荧光探针检测卵母细胞内活性氧水平,免疫荧光法观察卵母细胞纺锤体及染色体情况,网络药理学及分子对接验证班氏促卵助孕汤核心有效成分与卵母细胞成熟相关因子(生长分化因子9和骨形态发生蛋白15)结合活性,实时荧光定量PCR和Western blot检测卵母细胞中生长分化因子9和骨形态发生蛋白15的mRNA及蛋白表达水平。结果与结论:①班氏促卵助孕汤中的成分(槲皮素、山奈酚、β-谷甾醇)与生长分化因子9、骨形态发生蛋白15具有良好的结合活性;②班氏促卵助孕汤能恢复小鼠动情期,改善性激素紊乱和妊娠情况,降低细胞凋亡率、活性氧水平、纺锤体组装异常率、染色体丢失率(P<0.01,P<0.05),促进生长分化因子9、骨形态发生蛋白15 mRNA和蛋白表达(P<0.01,P<0.05)。结果表明,班氏促卵助孕汤可能通过调控生长分化因子9和骨形态发生蛋白15的基因表达,改善多囊卵巢综合征小鼠卵母细胞质量,提高生育力。

血清CTRP9、Asprosin、PTX3水平单项及联合检测诊断多囊卵巢综合征的效能

目的:分析血清C1q肿瘤坏死因子相关蛋白9(CTRP9)、白脂素(Asprosin)、正五聚蛋白3(PTX3)水平单项及联合检测诊断多囊卵巢综合征的效能。方法:回顾性分析2021年7月至2023年4月该院收治的69例多囊卵巢综合征患者的临床资料,设为研究组,另选取同期该院138名健康体检者为对照组。比较两组血清CTRP9、Asprosin、PTX3水平,采用Spearman相关性分析血清CTRP9、Asprosin、PTX3水平与疾病的相关性,绘制受试者工作(ROC)曲线分析血清CTRP9、Asprosin、PTX3水平单项及联合检测诊断多囊卵巢综合征的效能。结果:研究组血清CTRP9、PTX3水平均低于对照组,Asprosin水平高于对照组,差异有统计学意义(P<0.05);经Spearman相关性分析结果显示,血清CTRP9、PTX3表达与疾病均呈负相关(r<0,P<0.05),血清Asprosin水平与疾病呈正相关(r>0,P<0.05);绘制ROC曲线结果显示,入院时血清CTRP9、Asprosin、PTX3水平单项及联合检测诊断多囊卵巢综合征的曲线下面积分别为0.649、0.700、0.606、0.873,均具有一定诊断价值,且联合检测的诊断效能高于三者单项检测。结论:血清CTRP9、Asprosin、PTX3水平联合检测诊断多囊卵巢综合征的效能高于三者单项检测。

穴位埋线对两种肥胖类型PCOS患者生殖指标及炎症因子的影响

目的探究穴位埋线对两种肥胖类型PCOS患者炎性因子及生殖指标的影响。方法将2020年1月—2021年1月于山东中医药大学附属医院妇科门诊诊断为多囊卵巢综合征(肾虚痰湿证)肥胖患者63例作为研究对象。将患者按照不同肥胖类型分为均匀性肥胖组(A组,WC<80cm,n=33)和腹型肥胖组(B组,WC≥80,n=31)。两组均给予穴位埋线配合炔雌醇环丙孕酮治疗,对比3个月后两组的性激素(E_(2)、T、FSH、LH),炎症因子(TNF-α、hs-CRP、APN、IL-6),卵巢功能(卵巢体积、AMH、INHB),子宫内膜容受性(子宫内膜厚度、PI、RI),并统计治疗后患者的体质量、BMI、治疗后2个月排卵率、妊娠率。结果治疗后,均匀性肥胖组(A组)和腹型肥胖组(B)组T(0.74±0.07 VS 1.05±0.13)ng/mL,LH(10.43±1.07 VS 14.08±0.95)mIU/mL,IL-6(17.84±0.36 VS 21.06±1.34)ng/L,TNF-α(16.19±1.61 VS 19.95±0.95)ng/L,hs-CRP(4.75±0.35 VS 6.66±0.27)ng/L,卵巢体积(10.7±0.64 VS 11.31±0.62)cm^(3),PI(2.33±0.10 VS 2.55±0.13),RI(0.62±0.04 VS 0.74±0.03),体质量(63.83±2.87 VS 69.47±3.29)kg,BMI(24.23±1.46 VS 26.35±1.31)kg/m^(2)均显著降低(P<0.05),且均匀性肥胖组(A组)降低明显(P<0.05)。均匀性肥胖组(A组)和腹型肥胖组(B)组APN(57.15±3.6 VS 48.16±1.52)pg/L,FSH(7.24±0.86 VS 6.66±0.81)mIU/mL,E_(2)(98.75±4.63 VS 70.19±23.61)pg/mL,子宫内膜厚度(8.95±0.22 VS 8.29±0.29)cm,AMH(8.60±0.54 VS 7.56±0.55)ng/dL均显著提高(P<0.05),且A组(均匀性肥胖组)提高明显(P<0.05)。A组(均匀性肥胖组)的排卵率为80%,高于B组(腹型肥胖组)的40%(χ^(2)=10.00,P=0.000)。A组(腹型肥胖)的妊娠率60%,高于B组(腹型肥胖组)的33.3%(χ^(2)=4.29,P=0.04)。结论穴位埋线联合炔雌醇环丙孕酮能够改善PCOS(肾虚痰湿证)肥胖患者的性激素、卵巢功能、子宫内膜容受性,其机制可能与改善机体炎症状态相关。均匀性肥胖组改善更明显。提示,穴位埋线治疗均匀性肥胖PCOS效果更好,临床应针对腹型肥胖PCOS患者特点,采取更精准的治疗措施。

苍附导痰汤对肥胖型PCOS大鼠内分泌激素及miRNA-16和PDCD-4表达的影响

目的:探讨苍附导痰汤对肥胖型多囊卵巢综合征(PCOS)大鼠内分泌激素及微小RNA(miRNA)-16和程序性细胞死亡因子4(PDCD-4)表达的影响。方法:将50只SPF级雌性SD大鼠随机分为5组,每组10只。阳性对照组大鼠灌胃格华止(0.43 g/kg),低剂量组大鼠灌胃低剂量苍附导痰汤(1.42 g/kg),高剂量组大鼠灌胃高剂量苍附导痰汤(5.68 g/kg),模型组和正常组大鼠灌胃等量生理盐水,各组均持续给药14 d。比较各组大鼠体质量,内分泌激素水平,miRNA-16和PDCD-4 mRNA表达,以及PDCD-4蛋白表达。结果:模型组、阳性对照组、低剂量组和高剂量组大鼠体质量均高于正常组(P<0.05);阳性对照组、低剂量组和高剂量组大鼠体质量均低于模型组(P<0.05),且呈剂量依赖性。模型组、阳性对照组、低剂量组和高剂量组大鼠血清E_(2)均水平低于正常组,而血清T、FSH和LH水平均高于正常组(P<0.05);阳性对照组、低剂量组和高剂量组大鼠血清E_(2)水平均高于模型组,而血清T、FSH和LH水平均低于模型组(P<0.05),且呈剂量依赖性。模型组、阳性对照组、低剂量组和高剂量组大鼠卵巢miRNA-16表达均低于正常组,而PDCD-4 mRNA表达高于正常组(P<0.05);阳性对照组、低剂量组和高剂量组大鼠卵巢miRNA-16表达均高于模型组,而PDCD-4 mRNA表达低于模型组(P<0.05),且呈剂量依赖性。模型组、阳性对照组、低剂量组和高剂量组大鼠卵巢PDCD-4蛋白相对表达量均高于正常组(P<0.05);阳性对照组、低剂量组和高剂量组大鼠卵巢PDCD-4蛋白相对表达量均低于模型组(P<0.05),且呈剂量依赖性。结论:苍附导痰汤可调节肥胖型PCOS大鼠内分泌激素水平,其机制可能与上调miRNA-16表达及下调PDCD-4表达有关。

瓜石汤联合当归芍药散对多囊卵巢综合征合并胰岛素抵抗小鼠的影响

目的:探讨瓜石汤联合当归芍药散对多囊卵巢综合征联合胰岛素抵抗(PCOS-IR)小鼠模型性激素和内膜炎症介质的影响。方法:用来曲唑和高脂饮食构建PCOS-IR模型小鼠,观察小鼠动情周期变化及检测小鼠空腹血糖、空腹胰岛素评价模型成功是否。将小鼠随机分为对照组、模型组、中药组,中药组造模成功后给予瓜石汤联合当归芍药散中药方灌胃,对照组及模型组给予等体积纯净水。干预21 d后用酶联免疫吸附试验(ELISA)法测定血清卵泡刺激素(FSH)、促黄体生成素(LH)、总睾酮(T)水平,检测内膜组织肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)的水平。结果:造模后对照组小鼠动情周期正常,模型组小鼠动情周期紊乱,多数位于动情间期;对照组小鼠胰岛素抵抗指数(HOMA-IR)均小于2.69,而模型组均大于2.69。给药21 d后,中药组小鼠血清LH、T、LH/FSH较模型组低(P<0.05),内膜组织TNF-α、IL-1β、IL-6 mRNA和蛋白表达水平较模型组低(P<0.05)。结论:瓜石汤联合当归芍药散能改善PCOS-IR小鼠血清激素水平,降低内膜炎症介质水平,改善内膜炎症。

免疫因素与多囊卵巢综合征相关性的中西医研究进展

通过回顾PCOS的免疫病理学发病机制,探讨各类免疫因素如免疫细胞、肠道菌群、慢性低度炎症中炎症介质及表观遗传学等与PCOS的相关性;并从中医学角度,通过分析痰湿体质PCOS患者和肾虚型PCOS患者的免疫特征和治疗方案,探讨免疫因素与PCOS的相关性。参考文献37篇。

基于PT和APTT相关凝血指标分析多囊卵巢综合征危险因素并建立列线图预测模型

目的:基于凝血酶原时间(PT)和活化部分凝血酶原时间(APTT)相关凝血指标分析多囊卵巢综合征(PCOS)危险因素并建立列线图预测模型。方法:选择2021年9月—2022年10月江西中医药大学附属医院中医妇科门诊就诊的PCOS患者199例作为PCOS组,同期在该院进行孕前检查的248例正常女性作为对照组。比较两组各项指标,行单因素和多因素Logistics回归分析,筛选PCOS独立危险因素,并建立列线图预测模型,受试者工作持证曲线(ROC)评估该模型的区分度与准确度,P<0.05为差异有统计学意义。结果:单因素结果分析显示,年龄、抗缪勒氏管激素(AMH)、PT、APTT、凝血酶时间(TT)、纤维蛋白原(Fib)是PCOS危险因素,也是PCOS独立危险因素;构建的Nomogram模型预测PCOS的发生风险阈值为0.07~0.86时,适用性最佳。结论:年龄和AMH,PT,APTT,TT,Fib是PCOS危险因素,同时也提示抗凝治疗可能会改善生殖结局。PCOS的早期筛查和干预对患者长期健康和生命质量具有重要意义,对临床治疗方案的实施具有一定指导意义。

两类不孕女性行IVF/ICSI-ET术后妊娠结局的影响因素

目的探讨输卵管性不孕(TFI)与多囊卵巢综合征(PCOS)不孕症患者行体外受精(IVF)/卵胞浆内单精子注射(ICSI)-胚胎移植(ET)后妊娠结局的相关影响因素。方法选取行IVF/ICSI助孕的TFI和PCOS不孕症患者77例为研究对象,分为TFI组(n=45)和PCOS组(n=32),根据是否发生妊娠分为TFI组妊娠者(n=21)和未妊娠者(n=24)、PCOS组妊娠者(n=10)及未妊娠者(n=22),收集各组不孕症患者的一般临床资料[年龄、文化水平、体质量指数(BMI)、月经周期、既往阴道炎史、不孕类型、不孕年限及既往孕产史];采集各组不孕症患者月经第2~3天静脉血,检测血清中抗苗勒氏管激素(AMH)及基础性激素水平[促卵泡生成素(FSH)、黄体生成素(LH)、雌二醇(E2)、孕酮(P)、催乳素(PRL)及睾酮(T)],并计算FSH/LH;收集各组患者进入IVF/ICSI周期后的促排卵资料[控制性超促排卵(COH)方案、促性腺激素(Gn)总剂量、Gn总天数]及注射人绒毛膜促性腺激素(HCG)日血清FSH、LH、E2、P水平;各组不孕症患者卵泡成熟后取卵,收集实验室相关资料(总获卵数、成熟卵数、受精方式及优质卵数)及移植情况(移植胚胎数量、移植胚胎类型及移植日子宫内膜厚度),并计算成熟卵数占卵子总数比例;行IVF/ICSI助孕4~6周,收集各组ET后的妊娠结局,采用单因素和多因素logistic回归分析影响两类患者妊娠结局的因素。结果PCOS组不孕症患者年龄、Gn总剂量低于TFI组(P<0.05),月经稀发、原发性不孕、孕产史、异位妊娠史、总获卵数及成熟卵数高于TFI组(P<0.05);TFI组不孕症患者中未妊娠者基础P水平低于妊娠者(P<0.05),Gn总剂量、Gn总天数及卵裂期ET比例高于妊娠者(P<0.05);PCOS组不孕症患者中妊娠者的年龄、月经周期正常比例低于TFI妊娠者(P<0.05),基础FSH激素水平、总获卵数及成熟卵数高于TFI组妊娠者(P<0.05);PCOS组不孕症患者中未妊娠者月经周期正常、继发性不孕患者比例低于TFI组未妊娠者(P<0.05),基础LH激素水平、Gn总剂量、注射HCG日LH水平、总获卵数及成熟卵数高于TFI组未妊娠者(P<0.05);TFI组不孕症患者妊娠结局的logistic回归分析结果未筛选出有统计学意义的指标。结论一般临床资料、血清激素水平、促排卵及卵细胞实验室培养情况等指标未对行IVF/ICSI-ET的TFI及PCOS不孕症患者妊娠结局产生影响。

多囊卵巢综合征(肾虚痰湿型)患者胰岛素抵抗的临床特征及危险因素分析

目的通过临床横断面研究分析肾虚痰湿型PCOS伴胰岛素抵抗(IR)患者的临床特征和危险因素,以早期识别肾虚痰湿证患者PCOS-IR,为其临床诊疗及预后管理提供依据。方法收集2021年8月至2023年1月就诊于北京中医药大学东方医院妇科、妇科内分泌门诊及住院的肾虚痰湿型PCOS患者,依据纳排标准进行纳入,依据是否伴有IR进行分类,通过单因素差异性分析探讨与年龄、性激素水平、血脂等因素是否相关,通过二元Logistic回归分析探讨独立危险因素。结果共纳入90名PCOS肾虚痰湿证患者。对IR的不同影响因素中,单因素分析具有统计学意义的变量为LH/FSH、TG、LDL(LH/FSH P<0.05,TG P<0.01,LDL P<0.05),纳入二分类Logistic回归分析,对IR未发生赋值为0,IR发生赋值为1,其阳性事件为IR。结果显示,PCOS肾虚痰湿证患者TG越高,IR风险越高,具有统计学意义(OR=8.475,95%CI 2.920-24.601,P=0.000<0.01)。结论在肾虚痰湿型PCOS患者中,PCOS-IR发生与低LH/FSH、高TG和高LDL水平相关,高TG是PCOS-IR的独立危险因素,即肾虚痰湿型PCOS患者TG越高,IR风险越高。

β细胞营养因子及核因子κB在多囊卵巢综合征患者治疗中的表达及对妊娠结局的预测价值

目的探讨多囊卵巢综合征(polycystic ovary syndrome,PCOS)患者β细胞营养因子(Betatrophin)和核因子κB(nuclear factor-κB,NF-κB)的表达及对妊娠结局的预测价值。方法选取PCOS患者110例作为研究对象,另选同期进行健康体检的健康育龄女性40例作为对照组,比较2组相关血清指标,观察PCOS患者治疗前后相关血清指标变化及排卵率和妊娠率,分析影响妊娠的危险因素,评估联合检测Betatrophin与NF-κB对患者治疗后妊娠结局的预测价值。结果治疗前PCOS患者血清空腹血糖(fasting blood-glucose,FBG)、空腹胰岛素水平(fasting insulin,FINS)、胰岛素抵抗指数(homeostasis model assessment of insulin resistance,HOMA-IR)、胰岛β细胞功能指数(homeostatic model assessmentβcell function,HOMA-β)、促黄体生成素(luteinizing hormone,LH)、LH/促卵泡生成素(follicle stimulating hormone,FSH)、抗缪勒管激素(anti-mullerian hormone,AMH)、NF-κB、Betatrophin水平均高于对照组(P<0.05);治疗后上述指标均下降,随访1年,PCOS患者的排卵率为77.27%,妊娠率为61.82%。多因素Logistic回归分析显示HOMA-IR、HOMA-β、LH/FSH、AMH、Betatrophin、NF-κB是影响妊娠成功的危险因素,治疗后Betatrophin与HOMA-IR、HOMA-β、LH/FSH、AMH呈正相关(P<0.05);NF-κB与FBG、HOMA-IR、LH/FSH、AMH呈正相关(P<0.05)。ROC曲线显示,Betatrophin、NF-κB联合检测预测PCOS妊娠结局的AUC为0.978(0.961~0.998),敏感度为86.75%,特异度为90.12%。结论Betatrophin、NF-κB水平在PCOS患者中升高,治疗后显著降低,两者血清水平与HOMA-IR、LH/FSH、AMH等呈正相关,联合检测Betatrophin、NF-κB对PCOS妊娠结局有一定预测价值。

超声联合AMH对PCOS不孕患者卵巢储备功能的评估价值

目的:探究彩色多普勒超声检查联合血清抗苗勒氏管激素(AMH)对多囊卵巢综合征(PCOS)不孕患者卵巢储备功能的评估价值。方法:回顾性选取2021年1月-2024年3月本院就诊的PCOS不孕患者82例,根据卵巢储备功能情况分为正常组和异常组。两组均接受阴道超声检查,观察卵巢体积(OV)、卵泡计数(AFC),采用化学发光法测定血清AMH和雌二醇(E_(2))水平,采用受试者工作特征(ROC)曲线分析超声指标和血清指标对卵巢储备功能的评估价值,采用多因素logistic回归分析患者卵巢储备功能影响因素。结果:卵巢储备功能异常43例(52.4%)纳入异常组,余患者39例纳入正常组。正常组年龄、体质指数(BMI)、流产次数和盆腔手术史均少于异常组,运动频率高于异常组,OV、AFC和AMH水平高于异常组(均P<0.05),E_(2)水平与异常组无差异(P>0.05)。ROC曲线分析,OV、AFC、AMH联合检测评估PCOS不孕患者卵巢储备功能异常效能提高,其曲线下面积为0.877,评估灵敏度达97.4%。多因素logistic回归分析,年龄大、BMI高、流产次数多、盆腔手术史均是PCOS不孕患者卵巢储备功能异常的影响因素,每周运动频率≥2次/周为保护因素(均P<0.05)。结论:超声检查联合血清AMH水平对PCOS不孕患者卵巢储备功能评估价值较好,年龄大、BMI高、流产次数多、盆腔手术史均能影响患者卵巢储备功能。

多囊卵巢综合征高雄激素血症与凝血功能的关系探讨

目的探讨多囊卵巢综合征患者合并高雄激素血症的影响因素及高雄激素血症与凝血指标的关系。方法通过收集274例多囊卵巢综合征患者一般资料,测定内分泌相关指标(FSH、LH、AMH、雄激素)、代谢指标(空腹血糖、胰岛素)、凝血相关指标(FIB、PT、INR、PA、TT、APTT、D-Dimer、PLT),采用单因素分析及Logistics回归分析探讨多囊卵巢综合征患者合并高雄激素血症的影响因素,进一步分析高雄激素血症与凝血指标的可能关系。结果274例多囊卵巢综合征患者合并高雄激素血症比例为52.55%(144/274),非高雄激素血症比例为47.45%(130/274),两组在年龄、超重或肥胖分布比例及AMH、PT、INR、PA、TT、APTT水平差异无统计学意义(P>0.05),高雄激素血症组月经稀发、LH/FSH≥2.5、胰岛素抵抗分布比例及FIB、D-Dimer、PLT水平均高于非高雄激素血症组(P<0.05);Logistics回归分析结果提示,月经稀发、LH/FSH≥2.5、FIB是PCOS合并高雄激素血症的独立危险因素(OR值分别为2.286、3.105、1.615,P<0.05)。结论多囊卵巢综合征合并高雄激素血症的概率较高,与月经稀发、内分泌及凝血指标相关,高雄激素血症较非高雄激素血症患者具有更显著的高凝风险。