| Background:Polycystic ovarian syndrome (PCOS) is an extremely common disorder affecting 5%～10% of women of reproductive age. Despite being heterogeneous in nature, the hallmarks of the disease are hyperandrogenism and chronic anovulation. Nowdays much studies has been learned about the pathophysiology of PCOS from its neuroendocrine underpinnings to an evergrowing understanding of the link between obesity, insulin resistance (IR) and PCOS. Women affected by PCOS also show a higher risk of type 2 diabetes, dyslipidaemia, hypertension and cardiovascular diseases. Besides, Because of chronic anovulation there also show a higher risk of endometrial cancer.When clinically evaluating a patient for the possibility of PCOS, it is also important to search for signs of IR. Upper-body obesity is a key component of the IR syndrome. Acanthosis nigricans on physical examination is a sign of IR. A personal or family history of type 2 diabetes mellitus or gestational diabetes mellitus, or the presence of hyertension should also be sought in the evaluation. Overall, the criteria for diagnosis of the IR syndrome in women should be evaluated in all patients.Based on this current understanding of PCOS, it is important that the patient and medical provider approach management not only toward improving the often troublesome hirsutism and infertility but also toward the long-term risks associated with IR. Indeed, the management of the PCOS patient often will vary over time as the patient enters different stages of life with different goals. In contrast, because of the long-term health implications of IR, the importance of lifestyle modification toward weight management and maintaining adequate physical activity should be the one constant in the management of these patients. The medical management of PCOS can be broken down into four components, three of which are "acute" issues (control of irregular menses, treatment of hirsutism and management of infertility) and one that is more "chronic". This latter issue may be the most important but least remembered by patients and providers alike management of the IR syndrome. "Acute" issues that need management may changed, however, a continuous life-long management approach is important for the IR of PCOS.The pathogenesis of PCOS is still not clear, many studies suggest that PCOS may be a polygenic disease, its occurrence may be the interaction of genetic and environmental factor. Xinjiang is a multiethnic gathering region lacking of related study on this diseases, There are a lot of difference between Uighurs and Han,such as living habits, eating habits, living area and so on. Therefore, The investigation and analysis the difference clinical phenotype of PCOS in the Uighurs and Han nationalities is very useful. It can provide some clues on further study on the pathogenesis of PCOS; Use some interventions to observe the difference in Uighur and Han on clinical performance, serum hormone levels, biochemical indicators may provide some theoretical basis on the clinical mangement of PCOS.Objective: 1) To obtain the distribution incidence of PCOS patients and high risk age groups in child-bearing women by questionnaire between Uighur and Han in some areas of Xinjiang, for the further study on the reasons for differences between PCOS patients in different nationalities; 2) According to the diagnostic criteria of the Rotterdam meeting,To analysis the difference characteristics of clinical, endocrine and metabolic Uighur and Han nationnalities; evaluated the characteristics change with ageing; 3) To investigate the environmental factors and genetic factors on the pathogenesis of PCOS; 4) Compared the differences about glucose and lipid metabolic in Uighur, and Han obese PCOS patients, for the further study of the pathogenesis of PCOS; 5) Analysis of PCOS patients with endocrine, metabolic characteristics and the correlation with insulin resistance; 6) To investigate the clinical feature and treatments of the puberty polycystic ovary syndrome (PCOS) in obesity, To study the efficacy and safety of compound Cyproterone Acetate and Metformin in the treatment of the puberty PCOS between the Uighurs and Hans.Method:Part I:1) 3010 childbearing age women in the survey, Check out the PCOS patients from them, 1:1 matched with normal women as control group at the same time. To find the distribution characters of PCOS; 2) To compare the different clinical manifestations of PCOS patients in Uighur and Han; 3) Analysis the diffence about the menstrual cycle,clinical hyperandrogenism in Uighur and Han and find out the changes with ageing; 4) To compare the differences characteristics in Uighur and Han with or without obese in PCOS patients with obesity, insulin resistance (IR), glucose and lipid metabolism's disorders; 5) To investigate the family history of diabetes (DM) and menstrual disorders, alopecia (NA) in patients with PCOS, PCOS patients with birth weight (BW), eating habits, exercise habits and to find out the relationship with PCOS; 6) Part II:166 cases came from outpatient department. The age was 18～45 years old, the mean age was (24.44±6.89) years old, A fasting blood sample was drawn on day five of menstrual cycle from each subjects. To detect sex hormone, hormone binding globulin (SHBG), oral glucose tolerance test (OGTT), Insulin releasing test (IRT). Use these combinations to evaluate the relation between PCOS and insulin resistance; 7) Part III: 105 patients (including the Uighur 45 patients and Han 60 patients) were proved the puberty PCOS in obesity were examed and received compound Cyproterone Acetate and Metformin for 6 cycles. Serum sex hormone, transvaginal pelvic ultrasonography, the clinical feature were determined before and after 6 cycles treatment. To observe the effective and safety on the clinical management.Result: Part I:1) 3010 survey questionnaires were issued,2867 questionnaires were recovered. The response rate were 95.25%.217 cases PCOS patients were diagnosed (126 cases of Han,91 cases of Uighur). The total PCOS diagnosed rate were 7.57%,6.93%and 8.68%in Uighur and Han respectively. The average age of 217 patients were (25.44±5.35) years old; All the patients were divided into 6 groups, The mainly distributes PCOS population is≤35 childbearing age Women, that was 94.01% in all, and 92.86%,95.60% in Han and Uighur respectively; 2) To investigate the difference of clinical symptoms of PCOS patients with Uighur and Han:The main manifestations in Uighure PCOS patients were oligo-ovulation, hyperandrogenism,hirsutism and obesity, The main performance of Han were LH/FSH>2 and acne. And the different races have different characteristics in distribution of hirsutism:hirsutism in Uighur PCOS patients showed that the hair were more in abdominal midline, pubic and armpit hair, in particularly, Showed a male pattern of pubic hair distribution, even extended to perianal and inguinal or ventral midline, while the Han Chinese patients with PCOS showed in face, surrounding of brest,lower jaw and ventral midline at a small amount of long and thickening hair (ranging from 3 to 10). The rate of oligo-ovulation were:in all 79.72%, in Han 76.98%, in Uighur 83.52%(P<0.05); ultrasound examination showed no difference in polycystic ovarian follicle performance in Uighur and Han; The rate of hyperandrogenism were:in all 58.99%,in Han 45.24%, in Uighur 78.02%(P<0.05); In this survey PCOS patients' F-G score more than 6 points the rate were:26.27% in all,50.55% in Uighur,8.73% in Han; F-G score more than 2 points the rate were:32.72% in all,53.85% in Uighur,17.46% in Han; Other specific PCOS clinical signs of hyperandrogenism is acne, PCOS patients had acne were: 30.88% in all, 36.51% in Han,23.08% in Uighurs (P<0.05). This group of patients the acne appears since puberty to be persistent till our survery. In this investigation the rate was 30.88%,52 cases of acne had been treated. 15 cases have disappeared. The average BMI were (23.12±3.26) (kg/m2) in PCOS patients, obese [BMI≥25 (kg/m2)] were 33.18% in all, 24.60% in Han Chinese, 45.05% in Uighur (P<0.05); LH/FSH>2 were 49.77% in all, 53.97% of them were Han,43.95% in Uighur (P<0.05).3) Compared with Uighur and Han patients aged 21 to 25, their menstrual cycles were longer than the other groups,the differences were statistically significant (P<0.05), The menstrual cycle shortening with ageing. In the Han and Uighur control group age between 26 to 30 years old, T high, SHBG lower, FAI higher than other age, the difference has statistically significant (P< 0.05), Uighur group F-G score higher than the Han group (P<0.05). Compared with other age patients between 18 to 25 years old, T, FAI were higher (P<0.05); Uighur PCOS patients' F-G score, T, FAI were higher than Han (P<0.05); and SHGB in the Uighur, Han was no significant difference between them (P>0.05). PCOS patients'high F-G score decreased with ageing; In Uighur PCOS groups'E2, LH, T, FAI higher than the Han, LH/FSH were lower, the difference were statistically significant (P<0.05). Compared with PCOS and control group, E2, LH, LH/FSH, T, FAI were higher, SHBG were lower than control group (P<0.05); 4) Compared with obese and non-obese PCOS patients of metabolism in Han and Uiger, metabolism indicators were significant differences (P<0.05); Compared with the control obese group, WHR, FNS, HOMA-IR were higher and ISI lower than control group (P<0.05), but in Uigers their have the same characteristic with Hans,Besides the TG, TC, LDL were higher than control groups. In non-obese group the PCOS patients WHR, FNS, FBG, HOMA-IR were higher, ISI lower than control group (P<0.05). Compared difference of PCOS on ovarian volume, number of small ovarian follicles were larger and more than control group (P<0.05). 5) BW, dietary habits, BMI, diabetes (Diabetes mellitus, DM) and menstrual disorders as family history have relation with PCOS (P<0.05); There were no relation among PCOS and exercise habits, alopecia in family history. BMI was negatively correlated with BW (r=-1.371, P<0.05). Part II:The manifestation of metabolic syndrome in PCOS:In IR group BMI, WHR were higher (P<0.05); but in non-IR group LH was higher (P<0.05); Compare with non-IR group, each OGTT and insulin level were different in IR group (P <0.05). TG was higher in non-IR group (P<0.05), Compare with non-obesity group the age, TC HOMA-IR and LH were higher (P<0.05), each OGTT and insulin level were higher in obesity group (P<0.05), Compare with non-hyperandrogenic group WHR, LH were higher in hyperandrogenic group (P<0.05), each OGTT and insulin level have no change in non-hyperandrogenic group and hyperandrogenic group (P>0.05), but in hyperandro-genic group TC, LDL were higher (P<0.05). In PCOS HOMA-IR and BMI, waistine, TG, have positive correlation; And have negative correlation with LH, There were no correlation with TC and T. BMI have negative correlation with LH.Part III:Compared with the normal women the menarche is as same as the puberty PCOS patients; but the major criterion is different. Hirsute in the Uighurs is much more than Hans (P<0.05). and acne is less than Hans (P<0.05). Menstrual cycle is longer than Hans (P<0.05).72 patients had regular uterine bleeding during compound Cyproterone Acetate and Metformin therapy their Hirsute and acne score decreased significantly (P<0.05). Serum estradiol (E2), luteinizing hormone (LH), follicle stimulating hormone (FSH), LH/FSH, Testosterone (T) and free androgen index (FAI) decreased significantly (P<0.05), while sex hormone binding globin (SHBG) increased significantly (P<0.05). Bilateral ovarian volumes shrunk and follicle numbers decreased significantly (P<0.05). Serum high density lipoprotein (HDL) increased significantly (P <0.05), Serum total cholesterol (TC) decreased significantly (P<0.05). Serum ISI decreased significantly (P<0.05).Conclusion:1) The mainly distributes PCOS population is≤35 childbearing age Women; PCOS occurs constituent ratio for the overall, Uighur and Han were 7.57%, 6.93%,8.68%; 2) The main manifestations in Uighure PCOS patients were oligo-ovulatio,hyperandrogenism,hirsutism and obesity,Han's were LH/FSH> 2 and acne. Different races have different distribution hirsutism. 3) The main manifestations in 21 to 25 were oligo-ovulation and become shorter with ageing, In 18 to 25 hyperandrogenism and clinical signs of androgen were the main performance and sex hormone binding globulin (SHBG) decreased; polycystic ovary syndrome patients and PCOS patients of different ages F-G score decreased with aging, and Uighur patients' F-G score still higher than Han. This may be related to difference of the ethnic; 4) PCOS obese patients have metabolic changes, but there are some difference between Uighur and Han, The characteristic of Han patients performance in abdominal obesity and insulin resistance,Besides these Uighur's characterized by hyperlipidemia. 5) PCOS were relevant with patients with birth weight (BW), body mass index (BMI), family history of diabetes, family history of menstrual disorders and so on. 6) Obesity, especially abdominal obesity, lipid metabolism have relation with insulin resistance in PCOS patients. Hyperandrogenism and high LH have not relevant with insulin resistance; 7) adolescent obesity PCOS patients in the Uighur, Han have some differences between the clinical manifestations. Compound Cyproterone Acetate and Metformin may well improve the adolescents with polycystic ovary syndrome in patients with symptoms of androgen and the endocrine status, have a certain effect on the resumption of ovulation. The side effects were small. |
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