目的 探讨多囊卵巢综合征(PCOS)合并亚临床甲状腺功能减低(SCH)患者胰岛素水平及血脂的变化.方法 采用病例-对照的研究方法,收集2011年10月至2012年6月海军总医院生殖中心就诊的育龄期妇女,年龄在25～35周岁,选取PCOS合并SCH患者54例作为观察组,PCOS不伴有甲状腺疾病功能异常者52例作为对照组,分别测定体重、血压、静息心率、血脂,并进行糖耐量及胰岛素释放试验.采用独立样本t检验及相关分析评价PCOS合并SCH患者血脂及胰岛素变化情况. 结果 (1)PCOS合并SCH组静息心率、空腹胰岛素(FINS)高于PCOS组(P＜0.05),促甲状腺激素(TSH)、甘油三酯(TG)、餐后1h胰岛素(INS-1h)均显著高于PCOS组(P＜0.01)；(2)两组中按照体重指数(BMI)比较分析:PCOS+ SCH组中BMI≥23亚组与PCOS组BMI≥23亚组相比,心率明显增快,TSH与TG显著升高,INS-1h也有明显的升高.PCOS+ SCH组中BMI＜23亚组与PCOS组BMI＜23亚组相比,除TSH有显著升高外,其余指标无显著差异；(3)相关分析显示:TSH与TG、高密度脂蛋白(HDL)、FINS、INS-1h有相关性(r分别为0.360、-0.259、0.408、0.255,P均＜0.01). 结论 PCOS合并SCH患者可能存在更严重的血脂异常及胰岛素水平的改变,TG水平的升高、HDL及胰岛素水平的改变可能成为PCOS合并SCH患者的独立危险因素.

目的 探讨整合素αvβ3和骨桥蛋白(OPN)在多囊卵巢综合征(PCOS)患者植入窗期子宫内膜的表达. 方法 选取15名典型PCOS患者(其中7例为自主排卵,8例为促排卵)为PCOS组,同期选择15例月经周期规律妇女为对照组.阴道超声监测排卵,排卵日测定子宫内膜分型及厚度;免疫组织化学技术测定植入窗期的子宫内膜整合素αvβ3和骨桥蛋白的表达;放射免疫法测定内膜活检当天的血清雌二醇(E2)和孕酮(P)的浓度. 结果 与对照组比较,PCOS组植入窗期子宫内膜整合素αvβ3和OPN表达均显著下调(P＜0.01),两者之间不伴有比例的失调;排卵日子宫内膜厚度两组无显著差异(P>0.05);子宫内膜分型有显著性差异(P＜0.05);血清E2水平显著高于对照组(P<0.01),E2/P比值亦显著高于对照组(P<0.05),而P显著低于对照组(P<0.01). 结论 PCOS患者植入窗期子宫内膜整合素αvβ3和OPN表达均下调,子宫内膜容受性降低,影响了胚泡着床.

Objective To study the relationship of serum adiponectin(APN) and insulin resistance of young polycystic ovary syndrome(PCOS) patients.Methods Thirty eight young PCOS patients and 27 healthy young females were assigned as experiment group and control group.Each group was divided into obesity group[body mass index(BMI) ≥25 kg/m2 ]and non-obesity group(BMI25 kg/m2).Serum APN levels of the four groups were detected by Enzyme Linked Immuno Sorbent Assay(ELISA).Blood glucose concentration was detected by glucose oxidase method,and insulin concentration was detected by chemiluminescence method,and the Insulin Sensitivity Indexes(ISI) were calculated.Results ①The concentration of fasting blood glucose of experiment group was equal to the control group(P0.05).②The concentration of fasting insulin of experiment group was statistically higher than the control group(P0.01).③The serum APN concentration and ISI of experiment group were statistically lower than that of control group(P0.01).④The serum APN concentrations and ISI were statistically increased progressively,and the insulin concentrations were statistically decreased progressively(P0.01) in obesity group of experiment group,non-obesity group of experiment group,obesity group of control group and non-obesity group of control group successively.Conclusion Serum APN level of experiment group is lower than control group,and the tendency is more obvious in obesity group,which may be related to insulin sensitivity and insulin resistance.