Hypothesis/Aims of study. Dyslipidemia is a common metabolic disorder and is an atherogenic factor in the development of cardiovascular disease in women with polycystic ovary syndrome. Currently, four phenotypes of polycystic ovary syndrome are distinguished, associated in varying degrees of severity with dyslipidemia, insulin resistance, impaired glucose tolerance, and diabetes mellitus on one hand and chronic inflammation and oxidative stress on the other. Hyperandrogenic phenotypes (A, B, C) in polycystic ovary syndrome are associated with the development of adverse metabolic disorders and associated complications. The aim of this study was to evaluate the lipid profile in the serum of women of reproductive age with various polycystic ovary syndrome phenotypes. Study design, materials and methods. The study included 86 women of reproductive age from 22 to 37 years old (average age was 26.6 4.3 years), who, in accordance with polycystic ovary syndrome phenotypes (A, B, C, D), were divided into four groups. We studied the levels of anti-Mllerian hormone, follicle-stimulating and luteinizing hormones, prolactin, estradiol, and androgens from days 2 to 5 of the menstrual cycle. The levels of progesterone in the blood serum were determined by the enzyme immunoassay on days 20 to 23 of the menstrual cycle for three consecutive cycles. We also used echographic methods for diagnosing polycystic ovaries. All women underwent a biochemical blood test with an assessment of the lipid profile parameters (total cholesterol, triglycerides, high-density lipoproteins (HDL), and low-density lipoproteins, LDL). Besides, an oral glucose tolerance test was assessed with the study of plasma glucose and insulin levels on an empty stomach and two hours after ingestion of 75 g of glucose, the HOMA-IR index being used to assess insulin resistance. Results. Phenotype A was found in 40 (46.5%) women with polycystic ovary syndrome, phenotype B in 22 (25.6%), phenotype C in 10 (11.6%), and phenotype D (non-androgenic) in 14 (16.3%) patients with PCOS. Of those 42 (48.8%) individuals had changes in carbohydrate metabolism (impaired glucose tolerance), of whom 39 (92.8%) women had androgenic polycystic ovary syndrome phenotypes (A, B, C). Both non-androgenic phenotype D and impaired glucose tolerance were found in 7.2% of cases. In women with hyperandrogenic polycystic ovary syndrome phenotypes, both the fasting and stimulated insulin levels were increased significantly comparing to the non-androgenic anovulatory phenotype (p 0.05). The HOMA-IR index in women with phenotypes A, B and C was significantly (p 0.05) higher than in patients with non-androgenic phenotype D. When evaluating the lipid profile parameters, no significant differences in cholesterol level and atherogenic coefficient in women with various polycystic ovary syndrome phenotypes were found. The levels of triglycerides and LDL were significantly (p 0.05) higher in women with androgenic phenotype B compared to those in patients with non-androgenic phenotype D and they correlated significantly (p 0.05) with the serum levels of androgens and sex hormone-binding globulin (SHBG). Patients with androgenic polycystic ovary syndrome phenotypes (A and B) had significantly (p 0.05) decreased HDL levels that correlated negatively (r = 0.29; p 0.05) with the levels of free testosterone and SHBG, when compared to the same parameters in women with non-androgenic phenotype D. In women with androgenic polycystic ovary syndrome phenotypes (A, B, C), a significant correlation (r = 0.27; p 0.05) between the levels of stimulated insulin and SHBG were found, and a direct relation (r = 0.32; p 0.05) between those parameters and increased levels of triglycerides and LDL was also revealed. Conclusion. In women with hyperandrogenic and anovulatory polycystic ovary syndrome phenotypes A and B, atherogenic dyslipidemia and impaired carbohydrate metabolism were significantly more pronounced, when compared with patients with non-androgenic phenotype D. A differential and personalized approach to the examination of patients with various polycystic ovary syndrome phenotypes is an important step in the prevention of the risks of developing cardiovascular diseases in women of reproductive age.
ФГБНУ «НИИ акушерства, гинекологии и репродуктологии им. Д.О. Отта», Санкт-Петербург, Россия ■ С целью изучения овариальной ароматазной активности при синдроме поликистозных яичников (СПЯ) обследовано 49 больных СПЯ и 33 здоровые женщины репродуктивного возраста. Ароматазную активность определяли с помощью коэффициента эстрадиол/число антральных фолликулов в обоих яичниках (Э 2 /n). Значения овариальной ароматазы положительно коррелировали (р < 0,05) с результатами ее определения с помощью теста с ингибитором ароматазы летрозолом при СПЯ. Сниженная ароматазная активность антральных фолликулов имелась у 59 % больных СПЯ. Полученные данные указывают на то, что коэффициент Э 2 /n позволяет оценивать овариальную ароматазу и что абсолютный или относительный дефицит овариальной ароматазы лежит в основе патогенеза СПЯ. ■ Ключевые слова: синдром поликистозных яичников; овариальная ароматаза. ■ In order to study ovarian flavor ase activity in polycystic ovary syndrome (PCOS) examined 49 patients with PCOS and 33 healthy women of reproductive age. Aromatase activity determined using estradiol/number of antral follicles in both ovaries ratio (Е 2 /n). Values ovarian aromatase positively correlated (p < 0.05) with the results of its determination by a test with the aromatase inhibitor letrozole in PCOS. Reduced aromatase activity of antral follicles was present in 59 % of patients with PCOS. These data indicate that Е 2 /n ratio allows to evaluate ovarian aromatase and that an absolute or relative deficiency of ovarian aromatase underlies the pathogenesis of PCOS.■
BACKGROUND: Patients with any form of diabetes during pregnancy should achieve the target (close to physiological) values of glycaemia, the main condition for a safe course and outcomes of pregnancy. To accomplish this task, effective and safe methods of insulin therapy should be selected. AIM: To determine the glycaemic profile and pregnancy outcomes in women with type 1 diabetes treated with continuous subcutaneous insulin infusion (CSII) and multiple insulin injections (MII). METHODS: A continuous glucose monitoring (CGM) of 100 pregnant women with type 1 diabetes treated with CSII and 100 women treated with MII was conducted to assess the effectiveness of these insulin therapy regimens in achieving target blood glucose values. RESULTS: HbA1c levels were significantly lower during the first, second, and third trimesters in patients treated with CSII than those treated with MII. Glucose variability has already improved since the second trimester of pregnancy in women treated with CSII, which was not observed in those treated with MII. The period of hyperglycaemia according to the results in pregnant women treated with CSII was 25 [13; 38] %, which was lower than those treated with MII, 41 [18; 54] %. No risk of obstetric and perinatal complications was observed with the duration of the hyperglycaemic state of 25% of the CGM time, whereas the risk of neonatal hypoglycaemia appeared with the duration of the hypoglycaemic state of a mother with type 1 diabetes of 0.2%. The relationship between glucose variability in terms of MAGE and MODD and the risk of developing macrosomia has been observed, and the dependence of glucose variability (MODD and CONGA) and the risk of neonatal hypoglycaemia and preeclampsia have also been confirmed. CONCLUSION: Comprehensive assessment of the glycaemic profile when using CSII, confirmed the advantages of using CSII in pregnant women with type 1 diabetes to achieve the target glycaemia values, to reduce glucose variability and duration of hypoglycaemic episodes, which led to decreased frequency of obstetric and perinatal complications.
The article presents resent date of the pathogenesis and treatment of ovarian insufficiency in obese women and overweight and features and complications of pregnancy and delivery in obese women.
Hypothesis/aims of study. The adverse effects of type 1 diabetes mellitus on the female reproductive system have been proved by many studies. There is still conflicting literature on the impact of diabetes and other factor compensation on ovarian function in women with type 1 diabetes mellitus. Study design, materials and methods. The current analysis was undertaken to study the effects of diabetes compensation on ovarian function in women with type 1 diabetes mellitus. In order to this, 180 individuals aged 20 to 40 years were examined. The main group consisted of 112 diabetic patients with primary ovarian insufficiency, the comparison group included 68 women with type 1 diabetes mellitus and a normal ovulatory cycle. After 18–24 months following the therapy aimed to compensate diabetes, 63 patients with ovarian insufficiency were re-examined. The examination included determination of blood glucose, glycated hemoglobin (HbA1c), FSH, LH, prolactin, estradiol, total and free testosterone, 17-hydroxyprogesterone, dehydroepiandrosterone sulfate, dihydrotestosterone, progesterone, and sex hormone-binding globulin (SHBG) levels, as well as ultrasound examination in the first and second phases of the menstrual cycle. Results. Association of ovarian insufficiency with HbA1c level and the dose of insulin was found. Patients in the main group experienced a decrease in FSH and SHBG levels, an increase in the ovarian volume and the number of antral follicles compared to those in diabetic patients with a normal ovulatory cycle. In patients with decompensated diabetes and ovarian insufficiency, after the compensation of diabetes, the recovery of the ovulatory cycle was observed in 61.8 % of cases. Conclusion. Ovarian function in women with type 1 diabetes mellitus depends on HbA1c level and the dose of insulin. Diabetes compensation in women with type 1 diabetes mellitus contributes to the recovery of ovulation in 61.8 % of cases.
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