多囊卵巢综合征的流行病学调查及相关基础研究
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摘要
多囊卵巢综合征(polycystic ovarian syndrome，PCOS)是育龄期常见的妇科内分泌疾病，发病机理尚不清楚，新的观点不断出现，已成为妇科内分泌学研究的热点和难点。PCOS可影响妇女从青春期-绝经后整个过程的身心健康，远期糖尿病并发症的发生明显早于和高于对照群体。PCOS的临床表现高度异质性，因此诊断标准问题也长期受到争议。2003年ESHRE／ASRM对其联合研讨并提出了统一的建议诊断标准，为这一疾病的研究及其成果交流提供了首要的重要基础。
ESHRE／ASRM建议的诊断标准是否符合汉族人群PCOS的诊断?汉族PCOS的患病状况、临床特征、遗传特点是否有其特殊性?育龄期合并糖代谢异常的PCOS患者在临床特征、遗传上是否有什么特点?本研究从下述两个部分、四个独立又密切相关方面对其进行了探讨。希望为汉族PCOS的临床诊断、远期并发症发生的防治提供一些理论依据。
一、济南市育龄汉族妇女多囊卵巢综合征的流行病学调查研究
1．PCOS患病状况及其临床特点的初步调查
2．体毛分布调查及适宜的临床高雄-多毛诊断标准探讨
二、山东汉族PCOS及其糖代谢的相关基础研究
3．性激素结合球蛋白基因启动子(TAAAA)n多态、血清水平与汉族PCOS及其糖代谢的关联性研究
4．纤溶酶原激活物抑制因子-1基因启动子4G／5G多态性与汉族不孕PCOS及其糖代谢的相关性研究
Section Ⅰ
The primary epidemic investigation of prevalence and characteristics of Chinese women with polycystic ovary syndrome
OBJECTIVE To investigate the prevalence and characters of polycystic ovary syndrome (PCOS) in Chinese from general Han ethnic population in Jinan city by ESHRE/ASRM criteria; to study this criteria's feasibility to Han ethnic PCOS diagnosis. METHODS With cluster sampling epidemic method, 1027 women from Jinan city were investigated by ESHRE/ASRM criteria. The prevalence, clinical and metabolitic characters on PCOS were analysed. RESULTS (1) According to the ESHRE/ASRM criteria, 85 PCOS patients were diagnosed from whole investigated population, the prevalence of PCOS in general Han population in Jinan city is accounted for 6.46%. (2) Single variable statistic and multinomial logistic regression analysis results show oligomenorrhea, irregularly menstruation, ovarian volume, follicle number in 2-9 mm diameter,hirsutism, acne, T, free androgen index(FAI) are the main statistic variables for PCOS's diagnosis which just meet the need of ESHRE/ASRM criteria., (3) Among all PCOS patients, check rates of Oligo-ovulation, PCO, biochemical and clinical of androgen excess signs for PCOS are 89.4%, 72.94%, 57.65% and 38.8% (1.18% hirsutism by F-G≥6 and 38.8% acne)respectively; check rates by all two criteria are 100%,but different group have different check rate; 48.2% and 11.8% patients meet 3 criteria but respectively with one of and both of androgen excess signs(clinical / biochemical); By our investigated F-G score ≥2 score standard, hirsutism is account for 37.65% in PCOS patients from general population. (4) PCOS is distribute in the ≤35 years old population groups; ageing, labor can influence each PCOS diagnostic criterion. (5) Infertility and obesity are accounted for 7.06% and 8.23% in general PCOS population, insulin
ESHRE／ASRM建议的诊断标准是否符合汉族人群PCOS的诊断?汉族PCOS的患病状况、临床特征、遗传特点是否有其特殊性?育龄期合并糖代谢异常的PCOS患者在临床特征、遗传上是否有什么特点?本研究从下述两个部分、四个独立又密切相关方面对其进行了探讨。希望为汉族PCOS的临床诊断、远期并发症发生的防治提供一些理论依据。
一、济南市育龄汉族妇女多囊卵巢综合征的流行病学调查研究
1．PCOS患病状况及其临床特点的初步调查
2．体毛分布调查及适宜的临床高雄-多毛诊断标准探讨
二、山东汉族PCOS及其糖代谢的相关基础研究
3．性激素结合球蛋白基因启动子(TAAAA)n多态、血清水平与汉族PCOS及其糖代谢的关联性研究
4．纤溶酶原激活物抑制因子-1基因启动子4G／5G多态性与汉族不孕PCOS及其糖代谢的相关性研究
Section Ⅰ
The primary epidemic investigation of prevalence and characteristics of Chinese women with polycystic ovary syndrome
OBJECTIVE To investigate the prevalence and characters of polycystic ovary syndrome (PCOS) in Chinese from general Han ethnic population in Jinan city by ESHRE/ASRM criteria; to study this criteria's feasibility to Han ethnic PCOS diagnosis. METHODS With cluster sampling epidemic method, 1027 women from Jinan city were investigated by ESHRE/ASRM criteria. The prevalence, clinical and metabolitic characters on PCOS were analysed. RESULTS (1) According to the ESHRE/ASRM criteria, 85 PCOS patients were diagnosed from whole investigated population, the prevalence of PCOS in general Han population in Jinan city is accounted for 6.46%. (2) Single variable statistic and multinomial logistic regression analysis results show oligomenorrhea, irregularly menstruation, ovarian volume, follicle number in 2-9 mm diameter,hirsutism, acne, T, free androgen index(FAI) are the main statistic variables for PCOS's diagnosis which just meet the need of ESHRE/ASRM criteria., (3) Among all PCOS patients, check rates of Oligo-ovulation, PCO, biochemical and clinical of androgen excess signs for PCOS are 89.4%, 72.94%, 57.65% and 38.8% (1.18% hirsutism by F-G≥6 and 38.8% acne)respectively; check rates by all two criteria are 100%,but different group have different check rate; 48.2% and 11.8% patients meet 3 criteria but respectively with one of and both of androgen excess signs(clinical / biochemical); By our investigated F-G score ≥2 score standard, hirsutism is account for 37.65% in PCOS patients from general population. (4) PCOS is distribute in the ≤35 years old population groups; ageing, labor can influence each PCOS diagnostic criterion. (5) Infertility and obesity are accounted for 7.06% and 8.23% in general PCOS population, insulin
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