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15 September 2011, Volume 30 Issue 5
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述评
热点问题
论著
综述
标准与指南
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述评

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The Controversies on Evaluation and Management of Polycystic Ovary Syndrome LIU Jia-yin;CHEN Zi-jiang 2011, 30 (5):  343-346.  Abstract ( 2151 )   PDF (243KB) ( 7234 )   Polycystic ovary syndrome（PCOS） has been studied and discussed as one of the hottest topics for decades since it was firstly described in 1935. Evaluation and management of PCOS have been argued for long time because of its high heterogeneity and complex mechanism. Referring to various international diagnostic criteria and consensus of PCOS， recently a new diagnostic criteria and consensus based on the data of Chinese population has been issued by Chinese Society of Obstetrics and Gynecology，although there were still so many troubles and deviations in application. This review focused on the following topics，pubertal PCOS， diagnosis and typing of PCOS， and the clinic pathway of management for PCOS with infertility. Three of the most popular problems on PCOS practices were reviewed as follows：caution on the diagnosis and management for puberty girls with symptoms like PCOS， interpretation for the Chinese criteria and consensus on typing of PCOS， and emphasis on the opportune clinical pathway of management of PCOS with infertility. Related Articles | Metrics

热点问题

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Psychological Health of Patients with Polycystic Ovary Syndrome LI Sai-jiao;YANG Jing 2011, 30 (5):  347-351.  Abstract ( 1743 )   PDF (291KB) ( 7165 )   Polycystic ovary syndrome（PCOS） is the most common endocrine disorder among women of reproductive age，with the morbidity of approximately 70% to 80% in those patients with anovulatory infertility. It is a gynecological and endocrine symptom with high heterogeneity. It’s reported that the psychological factors played a vital role in PCOS development. Compared with the normal women， PCOS patients have obvious mental disorders such as despondence，anxious，interpersonal sensitivity and so on. Those mental disorders could aggravate endocrine dysfunction of PCOS. For achieving effective treatment and higher quality of life，PCOS patients should be integrallty evaluated in the clinical diagnosis process，including the psychological health status，and be given the comprehensive treatment and prevention. Related Articles | Metrics

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How to Make the Diagnosis of Adolescent Polycystic Ovary Syndrome YANG Dong-zi;CHEN Xiao-li 2011, 30 (5):  352-354.  Abstract ( 2122 )   PDF (202KB) ( 7191 )   Polycystic ovary syndrome（PCOS） is the most common endocrine disorder in women. This syndrome often occurs in perimenarcheal girls. Some of the pathological features of adolescent PCOS are often similar to the physiological changes of puberty. How to make the diagnosis of adolescent PCOS is difficult for clinician. Related Articles | Metrics

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Difficult Problems of Treatment for Polycystic Ovary Syndrome Patients in Adolescent YANG Dong-zi 2011, 30 (5):  355-357.  Abstract ( 2345 )   PDF (284KB) ( 7181 )   Polycystic ovary syndrome（PCOS） is the most common endocrine disorder in women. This syndrome often occurs in perimenarcheal girls. Some of the pathological features of adolescent PCOS are often similar to the physiological changes of puberty. It is important to make early diagnoses and early treatment for these patients，which is helpful to prevent the long term complications of adolescent PCOS. Related Articles | Metrics

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How to Prevent Pregnancy Loss in Women with Polycystic Ovary Syndrome DENG Yu;HUANG Rui 2011, 30 (5):  358-361.  Abstract ( 2212 )   PDF (266KB) ( 7158 )   Polycystic ovary syndrome is the most common endocrine disorder in women of reproductive age. Women with PCOS， with many characteristics of pathology and pathophysiology，are considered to have the increased risk of pregnancy loss. Those women are easily complicated by gestational diabetes，pregnancy-induced hypertensive disorders and multiple pregnancy. It is important to fully understand the risk factors of the pregnancy loss and pregnancy complications in PCOS patients， to take preventive measures as soon as possible for improving the pregnancy outcome. Related Articles | Metrics

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Polycystic Ovary Syndrome and Apoptosis WEI Li-na;FANG Cong;LIANG Xiao-yan 2011, 30 (5):  362-364.  Abstract ( 1914 )   PDF (181KB) ( 7108 )   The etiology and pathogenesis of polycystic ovary syndrome（PCOS） are strongly associated with cell apoptosis. In this review，apoptosis in patients with PCOS was discussed，including its spatial and temporal characteristics，its factors and mechanisms，its effects on the oocyte quality and pregnancy outcome，as well as its potential interventions. It may be helpful to improve the etiological study and clinical therapy for PCOS. Related Articles | Metrics

论著

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Animal Model of PCOS with Type 2 Diabetes Induced by Sodium Prasterone Sulfate and Streptozotocin LI Wei;LI Sai-jiao;YIN Tai-lang;YANG Jing 2011, 30 (5):  365-367.  Abstract ( 1783 )   PDF (247KB) ( 7144 )   Objective： To develop a rat model of polycystic ovarian syndrome（PCOS） with type 2 diabetes（2-DM） induced by sodium prasterone sulfate and streptozotocin（STZ）. Methods： Female rats aged 23-day were injected daily S. C. with sodium prasterone sulfate 90 μg/（g·d） for 20 days, then intraperitoneally injected streptozotocin once in a dose of 45 mg/kg. All rats were feed with high fat and sugar feed. The ovarian weight and pathological morphology was observed. The sera levels of testosterone（T），estradiol（E2）， luteinizing hormone（LH）， follicle-stimulating hormone（FSH）， blood glucose（BG） and insulin（INS） were measured. Results： The ovaries of both PCOS group and the PCOS with 2-DM group showed multiple follicular cysts. Ovarian weight, sera T, E2 and INS of two groups were significantly higher than those of control group（P＜0.01）. BG concentration of the PCOS with 2-DM group was significantly higher than those of PCOS group and control group（P＜0.01）， while HOMA index of the PCOS with 2-DM group was higher that that of control group（P＜0.05）. Conclusions： The rat model of PCOS with 2-DM showed the morphologic and hormonal changes which were similar to patients with PCOS with 2-DM. This animal model induced by the sodium prasterone sulfate and streptozotocin is a good model of PCOS with 2-DM for studying the long?鄄term complications of PCOS. Related Articles | Metrics

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Clinical Manifestations of Polycystic Ovary Syndrome Patients with Different Phenotypes YANG Xing;XIONG Yong-lao;LIANG Xiao-yan;LI Yi 2011, 30 (5):  368-370.  Abstract ( 1794 )   PDF (188KB) ( 7080 )   Objective：Characteristic of endocrinological disturbance in PCOS subgroups were explored to provide individualized treatment options. Methods： 232 PCOS patients were recruited and divided into subgroup according to their body mass index（BMI） and luteinizing hormone/follicular stimulation hormone （LH/FSH） ratio. Basal serum sexual hormone， Anti-müllerian hormone（AMH）， markers of lipid metabolism and subacute inflammation were analyzed. Results： PCOS patients with LH/FSH＜2 were characterized by significant hypothalamus-pituitary gland-ovary（HPO） axis dysfunction， and their metabolic disturbance or subacute inflammatary response was not significant. PCOS patients with BMI≥23 kg/m2 showed typical obesity， which is accompanied by metabolic disorder， and are highly vulnerable to cardiovascular diseases. Conclusions： The introduction of BMI=23 kg/m2 and LH/FSH=2 to classify PCOS patients appears to be of great value in category of PCOS phenotype， which would greatly improve the individualized treatment in clinic practice. Related Articles | Metrics

综述

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Impact of Polycystic Ovary Syndrome on Pregnancy Outcome YAN Xue YAN Xue;XU Xing-hua;CHEN Zi-jiang 2011, 30 (5):  371-374.  Abstract ( 2153 )   PDF (251KB) ( 7126 )   Polycystic ovary syndrome（PCOS） which mainly affect women of reproductive age can cause endocrine and metabolic disorders. Its clinical manifestations are multifarious and heterogeneous. obesity， peripheral insulin resistance and impaired beta cell function are common in patients with PCOS， which increase the incidence of glucose intolerance and diabetes. Moreover， PCOS often accompany with dyslipidemia and hypertension. All these amplify the risk of pregnancy complication such as gestational diabetes and pregnancy induced hypertension syndrome. This paper reviewed the impact of PCOS on pregnancy complication and newborn outcome. Related Articles | Metrics

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Ovulation Induction Strategy in Polycystic Ovary Syndrome MA Wen-hong. LIANG Xiao-yan 2011, 30 (5):  375-379.  Abstract ( 2549 )   PDF (241KB) ( 7086 )   PCOS， with the prevalence rate 4% to 12%， is one of the most common disorder of reproductive and endocrine systems in fertile women. The principal clinical manifestations are hyperandrogenism， irregular menstruation and infertility. The metabolic dysfunction includes insulin resistance，dyslipidemia and obesity. Those metabolic disorders are involved with the dysfunction of hypothalamic pituitary ovary axis and adrenal gland. All of these disorders may contribute to the chronic complication，such as hypertension， DM， CVD. So， doctors should closely monitoring and positively prevent those metabolic disorders.Anovulation in obese women with PCOS could be successfully treated with weight loss. Clomiphene， clomiphene plus glucocorticoid， clomiphene and estrogen?-progestin pretreatment， clomiphene and metformin，aromatase inhibitors，gonadotropin and ovarian surgery could be used for induction of ovulation in PCOS. GnRH antagonist and GnRH agonist could be used for PCOS during IVF to prevent OHSS. In vitro maturation of oocytes also is plausible. Related Articles | Metrics

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The Clinical Application of In-vitro Maturation of Occytes XU Yu-ping;CAO Yun-xia 2011, 30 (5):  380-383.  Abstract ( 1635 )   PDF (265KB) ( 7114 )   In-vitro maturation of occytes（IVM） is a new method for infertility treatment. It is characterized by the simple proceed，the decreased drug use and medical fee，and the avoided OHSS. It also provides a new approach for oocytes donation and fertility preservation. So， IVM is one of the hottest focal points of reproductive medicine. In this paper， we reviewed the clinical application of IVM， and its safety and pregnant rate， as well as its new progress. Related Articles | Metrics

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Factors Influencing the Endometrial Blood Flow in Polycystic Ovary Syndrome TANG Hong-juan;LI Xiao-dong 2011, 30 (5):  384-387.  Abstract ( 2264 )   PDF (236KB) ( 7161 )   Uterine artery pulsatility index（PI） and resistance index（RI） by the transvaginal color Doppler ultrasound can reflect the changes of endometrial blood flow，which showed the status of endometrial development and endometrial function. In patients with polycystic ovary syndrome（PCOS）， the factors influencing the endometrial blood flow include hyperinsulinemia，hyperandrogenism，the increased luteinizing hormone， obesity，hyperlipidemia and hyperactivity of renin-angiotensin system. These factors induce the impaired endometrial function and lowed endometrial receptivity. Endometrial function can be improved by medical treatment. Related Articles | Metrics

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Ultrasound-guided Minimally Invasive Puncture in the Treatment of Polycystic Ovary Syndrome WANG Pei-yu;ZHAO Jun-zhao 2011, 30 (5):  388-390.  Abstract ( 1851 )   PDF (216KB) ( 7090 )   The trans-vaginal ultrasound-guided immature follicle puncture（IMFP） is a new minimally invasive operative method to treat polycystic ovary syndrome， following ovarian wedge resection and laparoscopic ovarian drilling. IMFP can ameliorate the endocrine environment， promote ovulation， reestablish regular menstrual cycle， and increase the sensibility to ovarian stimulation medicine. Compared with the traditional operations，IMFP has simpler procedure，more minimal surgical invasion and fewer complications. However， the detailed mechanism of IMFP is still unclear， and the standard protocol also needs more discussion. Related Articles | Metrics

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The Epigenetic Research on Polycystic Ovary Syndrome WANG Ting;HUA Ke-qin 2011, 30 (5):  391-393.  Abstract ( 1983 )   PDF (229KB) ( 7134 )   The etiology of polycystic ovary syndrome（PCOS） is not well known so far. Genetics and environment factors can not completely explain its pathogenesis. At present， it has been accepted that epigenetics is involved in the development and inheritance of PCOS. Epigenetic refers to change in gene expression other than in DNA sequence. Epigenetic modification involves DNA methylation， histone modification， X?-chromosone inactivation，genomic imprinting， and so on. DNA methylation status and X chromosome inactivation affect the expression of androgen receptor gene and insulin gene， which could change androgen activity. Histone deacetylase inhibitors increase the accumulation of CYP17 and P450scc mRNA， and further increase androgen level. All of them will eventually lead to PCOS pathogenesis. Related Articles | Metrics

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Progress in the Mechanism of Polycystic Ovary Syndrome ZHENG Ruo-heng;DING Cai-fei 2011, 30 (5):  394-396.  Abstract ( 1806 )   PDF (255KB) ( 7124 )   Polycystic ovary syndrome（PCOS） is the major cause of ovulation failure induced infertility， which is characterized by continuous ovulation obstacles，hyperandrogenemia and insulin resistance. The prevalence of PCOS is approximately 5%~10%. The etiology and pathogenesis of PCOS are still unknown. With the technique development，especially the emergence of high throughout sequence platform，research on PCOS has been revolutionized. We reviewed the progress of PCOS， including heredity， predisposing genes，environmental and psychologic factors，and metabolic syndrome. Related Articles | Metrics

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Evolution of Anti-müllerian Hormone in Female Dysgenesia and Precocious Puberty TIAN Chun-hua;HU Rong 2011, 30 (5):  397-399.  Abstract ( 2420 )   PDF (248KB) ( 7255 )   Anti-Müllerian hormone（AMH）， a member of the transforming growth factor（TGF-β） superfamily，mainly expressed in the granulosa cells of ovarian in women，which can be used as a marker to evaluate the ovarian reserve. There are three types of AMH receptor，Ⅰ，Ⅱ and Ⅲ type. In human， AMH acts via receptor Ⅱ. PCOS and POF are the main reason of infertility. It was found that sera AMH was at high level in PCOS， at low level in POF， but at almost normal level in precocious puberty. AMH， as well as its receptor Ⅱ， gene polymorphisms are related with PCOS and POF. AMH may be an important marker for the diagnosis of PCOS， POF， PA， and it also be a guided marker for PCOS treatment. Related Articles | Metrics

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Differences and Similarities Between Abnormal Glucose Tolerance of PCOS and T2DM ZHANG Yang-yang;XU Yang 2011, 30 (5):  401-404.  Abstract ( 1791 )   PDF (226KB) ( 7042 )   Polycystic ovary syndrome（PCOS） is the most common endocrine disorder， leading to paramenia and infertility in women. The incidence of the impaired glucose tolerance is high in PCOS population and it is closely related to type 2 diabetes mellitus（T2DM）. Insulin resistance（IR） is the common pathophysiological basis in both PCOS and T2DM， but the pathogenesis and tissue?-speciality of IR are different. It could offer the reliable evidence for preventing long?-term complications of PCOS， to compare abnormal glucose tolerance in PCOS and T2DM. Related Articles | Metrics

标准与指南

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Diagnosis Criteria and Guidelines for the Diagnosis and Treatment of PCOS CUI Lin-lin;CHEN Zi-jiang 2011, 30 (5):  405-408.  Abstract ( 2804 )   PDF (247KB) ( 7421 )   Polycystic ovary syndrome（PCOS） is one of the most common endocrinal and metabolic diseases in fertile woman. There are many controversies on PCOS diagnosis because of its diversity and heterogeneity in clinical manifestations， and the phenotypes overlapping with normal individuals. Since PCOS was described for the first time in 1935， three consensuses have been proposed successively. They are NIH criteria by National Institutes of Health，Rotterdam criteria by both European Society for Human Reproduction and Embryology（ESHRE） and American Society for Reproductive Medicine（ASRM）， and AES criteria by Androgen Excess Society. In 2011，“Diagnosis criteria for Polycystic Ovary Syndrome” was established by Chinese Medical Association， which was supported by Ministry of Health of China. This Chinese criteria was based on the currently available evidences in Han Chinese. The contradictions of diagnosis have influence on the standardized treatment. So far， the consensus，reached by PCOS Consensus Workshop Group，on the treatment of PCOS infertility， has been well-accepted. This paper described the main criteria of PCOS and the consensus on the treatment of PCOS infertility. Related Articles | Metrics

论著

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Clinical Study of Patient-controlled Epidural Analgesia with Pentazocine Combined with Ropivacaine After Abdominal Hysterectomy LV Dong-ong;YUAN Feng 2011, 30 (5):  417-419.  Abstract ( 2417 )   PDF (193KB) ( 7115 )   Objective： To observe the analgesia and side-effects of patient-controled epidural analgesia（PCEA） with different doses of pentazocine combined with ropivacaine after abdominal hysterectomy，so as to find appropriate analgesic dose of pentazocine. Methods： 120 patients selected ASA Ⅰ~Ⅱ having abdominal hysterectomy were randomly divided into 4 groups. Each group included 30 patients. P1 Group：pentazocine 90 mg； P2 Group：pentazocine 150 mg； P3 Group： pentazocine 180 mg； F group： fentanyl 0.4 mg. Above treatment in four groups were combined with 0.2% ropivacaine for epudiral analgesia. The VAS score，Ramsay sedation score， PCA pumps push the number of patients（D1） and the actual entry number（D2）， the ratio of nausea and vomitting，were recorded. Results： The VAS score of P1 group at each time point was higher than those of P2， P3 and F group（P＜0.05）. The VAS scores of P2 and P3 group at each time point were higher than that of F group（although P＞0.05）. The Ramsay sedation scores of P2 group at 4 h，8 h and 12 h after operation were higher than that of P1 group（P＜0.05）. The Ramsay sedation score of P3 and F group at each time point were higher than that of P1 group（P＜0.05）. The Ramsay sedation score of P3 and F group at 8 h，12 h and 24 h after operation were higher than that of P2 group（P＜0.05）. The D1/D2 ratios of P1 group at 8 h，12 h and 24 h after operation were higher than those of P2， P3 and F group（P＜0.05）. The ratio of nausea and vomiting of F group were higher than that of P2 and P3 group（P＜0.05）. Conclusions： 150 mg pentazocine combined with 0.2% ropivacaine for epudiral analgesia after abdominal hysterectomy is more effective， with lower incidence of adverse reactions， suggesting that it is relatively safe and effective technique for epidural analgesia.Objective： To observe the analgesia and side?鄄effects of patient?鄄controled epidural analgesia（PCEA） with different doses of pentazocine combined with ropivacaine after abdominal hysterectomy，so as to find appropriate analgesic dose of pentazocine. Methods： 120 patients selected ASA Ⅰ~Ⅱ having abdominal hysterectomy were randomly divided into 4 groups. Each group included 30 patients. P1 Group：pentazocine 90 mg； P2 Group：pentazocine 150 mg； P3 Group： pentazocine 180 mg； F group： fentanyl 0.4 mg. Above treatment in four groups were combined with 0.2% ropivacaine for epudiral analgesia. The VAS score，Ramsay sedation score， PCA pumps push the number of patients（D1） and the actual entry number（D2）， the ratio of nausea and vomitting，were recorded. Results： The VAS score of P1 group at each time point was higher than those of P2， P3 and F group（P＜0.05）. The VAS scores of P2 and P3 group at each time point were higher than that of F group（although P＞0.05）. The Ramsay sedation scores of P2 group at 4 h，8 h and 12 h after operation were higher than that of P1 group（P＜0.05）. The Ramsay sedation score of P3 and F group at each time point were higher than that of P1 group（P＜0.05）. The Ramsay sedation score of P3 and F group at 8 h，12 h and 24 h after operation were higher than that of P2 group（P＜0.05）. The D1/D2 ratios of P1 group at 8 h，12 h and 24 h after operation were higher than those of P2， P3 and F group（P＜0.05）. The ratio of nausea and vomiting of F group were higher than that of P2 and P3 group（P＜0.05）. Conclusions： 150 mg pentazocine combined with 0.2% ropivacaine for epudiral analgesia after abdominal hysterectomy is more effective， with lower incidence of adverse reactions， suggesting that it is relatively safe and effective technique for epidural analgesia.Objective： To observe the analgesia and side?鄄effects of patient?鄄controled epidural analgesia（PCEA） with different doses of pentazocine combined with ropivacaine after abdominal hysterectomy，so as to find appropriate analgesic dose of pentazocine. Methods： 120 patients selected ASA Ⅰ~Ⅱ having abdominal hysterectomy were randomly divided into 4 groups. Each group included 30 patients. P1 Group：pentazocine 90 mg； P2 Group：pentazocine 150 mg； P3 Group： pentazocine 180 mg； F group： fentanyl 0.4 mg. Above treatment in four groups were combined with 0.2% ropivacaine for epudiral analgesia. The VAS score，Ramsay sedation score， PCA pumps push the number of patients（D1） and the actual entry number（D2）， the ratio of nausea and vomitting，were recorded. Results： The VAS score of P1 group at each time point was higher than those of P2， P3 and F group（P＜0.05）. The VAS scores of P2 and P3 group at each time point were higher than that of F group（although P＞0.05）. The Ramsay sedation scores of P2 group at 4 h，8 h and 12 h after operation were higher than that of P1 group（P＜0.05）. The Ramsay sedation score of P3 and F group at each time point were higher than that of P1 group（P＜0.05）. The Ramsay sedation score of P3 and F group at 8 h，12 h and 24 h after operation were higher than that of P2 group（P＜0.05）. The D1/D2 ratios of P1 group at 8 h，12 h and 24 h after operation were higher than those of P2， P3 and F group（P＜0.05）. The ratio of nausea and vomiting of F group were higher than that of P2 and P3 group（P＜0.05）. Conclusions： 150 mg pentazocine combined with 0.2% ropivacaine for epudiral analgesia after abdominal hysterectomy is more effective， with lower incidence of adverse reactions， suggesting that it is relatively safe and effective technique for epidural analgesia. Related Articles | Metrics

综述

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CXCL12， CCL2， RANTES and Their Receptors with Pregnancy Immune Tolerance ZHANG Yu;LI Yi 2011, 30 (5):  420-424.  Abstract ( 1784 )   PDF (279KB) ( 7091 )   Pregnancy immune tolerance is a special type of immunological tolerance formed by maternal immune system during pregnancy. The status of immunological tolerance within maternal?-fetal interface is very important for maintaining pregnancy. The chemokines and their receptors expressed in maternal?fetal interface play important roles in the induced immune tolerance， participating in the invasion of trophoblasts，activation and migration of immunocytes. Stromal cell-derived factor-1（CXCL12）， monocyte chemotactic protein-1（CCL2）， and the regulated upon activation normal T cell expressed and secreted（RANTES）， belong to the super family of chemokines. In this article， we reviewed the effects of those chemokines and their receptors in the pregnancy immune tolerance. Related Articles | Metrics