Gynecological Endocrinology最新文献

This study assessed thyroid hormone sensitivity indices (THSI) and their impact on insulin resistance (IR) and dyslipidemia risk in euthyroid individuals with polycystic ovary syndrome (PCOS).A retrospective analysis of 226 PCOS patients and 189 healthy euthyroid controls was conducted. Demographic, metabolic, and thyroid function data were collected. Spearman correlation was utilized to assess relationships with THSI and metabolic parameters. The risk of IR and dyslipidemia in relation to THSI was assessed through logistic regression analysis. PCOS patients demonstrated significantly elevated levels of certain THSI, including the FT3/FT4 ratio and TFQI_FT3. The risk of IR was found to be increased in relation to higher quartiles of TSHI, TT3RI, TT4RI, TFQI_FT3, and TFQI_FT4. When controlled for age, BMI, and dyslipidemia, the TFQI_FT4-Q4 group exhibited a threefold higher risk of IR relative to the TFQI_FT4-Q1 group (OR = 3.00; 95% CI: 1.04, 8.64). The elevated risk of dyslipidemia was linked to higher quartiles of TFQI_FT3 (OR = 3.04; 95% CI: 1.13, 8.19). PCOS individuals with IR or dyslipidemia exhibit impaired central thyroid hormone sensitivity. Furthermore, a heightened susceptibility of IR and dyslipidemia is strongly correlated with impaired central thyroid hormone sensitivity among PCOS individuals.

Background: Thyroid autoimmune disorders (ADs) are common in midlife women and can impact various aspects of health, including sexual function. The effect of thyroid autoimmunity on the clinical manifestations of vulvovaginal atrophy (VVA) remains unclear.

Objective: To explore the relationship between thyroid ADs and VVA signs and symptoms in a sample of postmenopausal women.

Methods: Cross-sectional study including postmenopausal women not using systemic hormone therapy. VVA signs were assessed using the vaginal health index (VHI) and vulvar health index (VuHI); VVA symptoms were rated on a four-point severity scale.

Results: Among 112 women enrolled, 28 had thyroid ADs. A significantly higher percentage of women with thyroid ADs showed vaginal atrophy (75 vs. 45.2%, p < .05). A greater proportion of women with thyroid ADs exhibited vulvar atrophy or both vaginal and vulvar atrophy, though these differences were not statistically significant. Women with thyroid ADs reported significantly higher scores for dryness, burning/itching, irritation/inflammation, and dyspareunia compared to those without it. A higher percentage of women with thyroid ADs experienced severe dyspareunia (45 vs. 20.6%, p < .05), severe burning/itching (33.3 vs. 9.1%, p < .05), and severe stress urinary incontinence (17.9 vs. 3.6%, p < 0.05).

Conclusions: This study suggests that thyroid ADs may contribute to genital aging, with an apparent greater involvement in vaginal signs of atrophy. Women with thyroid ADs reported more severe VVA symptoms, but specific symptomatological clusters should be investigated in larger samples. Our data support the need to explore further the role of thyroid disorders in VVA.

Background: Gestational diabetes mellitus (GDM) is globally recognized as a significant pregnancy-related condition, contributing to complex complications for both mothers and infants. Traditional glucose tolerance tests lack the ability to identify the risk of GDM in early pregnancy, hindering effective prevention and timely intervention during the initial stages.

Objective: The primary objective of this study is to pinpoint potential risk factors for GDM and develop an early GDM risk prediction model using neural networks to facilitate GDM screening in early pregnancy.

Methods: Initially, we employed statistical tests and models, including univariate and multivariate logistic regression, to identify 14 potential risk factors. Subsequently, we applied various resampling techniques alongside a multi-layer perceptron (MLP). Finally, we evaluated and compared the classification performances of the constructed models using various metric indicators.

Results: As a result, we identified several factors in early pregnancy significantly associated with GDM (p < 0.05), including BMI, age of menarche, age, higher education, folic acid supplementation, family history of diabetes mellitus, HGB, WBC, PLT, Scr, HBsAg, ALT, ALB, and TBIL. Employing the multivariate logistic model as the baseline achieved an accuracy and AUC of 0.777. In comparison, the MLP-based model using NearMiss exhibited strong predictive performance, achieving scores of 0.943 in AUC and 0.884 in accuracy.

Conclusions: In this study, we proposed an innovative interpretable early GDM risk prediction model based on MLP. This model is designed to offer assistance in estimating the risk of GDM in early pregnancy, enabling proactive prevention and timely intervention.

Thyroid gland size increases during pregnancy due to physiological changes. 2-3% of pregnancies, a thyroid nodule (TN) may either newly develop or an existing one may increase in size. Factors such as age, parity, and iodine status can influence the development of TN. Surveillance of TN in pregnancy is essentially similar to that of the general population as it is contraindicated. Fine needle aspiration cytology (FNAC) can be delayed until after delivery unless malignancy is suspected. Surgery is reserved for severe cases, those with rapid growth, or those with suspicious features. Surgery is typically performed during the second trimester. Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer during pregnancy, which ranks second among cancers affecting pregnant women. Given the challenges involved, the prognosis is still favorable, have minimal impact on survival rates or recurrence. Treatment guidelines suggest regular monitoring of TSH and thyroid ultrasound (TUS), ensuring careful management of TC, especially in cases of aggressive.

This study evaluated whether intramuscular human chorionic gonadotropin (HCG) administration before endometrial transformation improves outcomes in frozen-thawed embryo transfer (FET) cycles pretreated with gonadotrophin-releasing hormone agonist (GnRH-a). We retrospectively analyzed 579 GnRH-a down-regulated hormone replacement FET cycles. Patients were divided into an HCG group (n=299 cycles, received HCG) and a control group (n=280 cycles, no HCG).The HCG group demonstrated significantly higher clinical pregnancy rates (58.5% vs. 49.3%, p<0.05) and embryo implantation rates (53.0% vs. 42.2%, p<0.05) compared to controls. Subgroup analysis showed HCG significantly increased clinical pregnancy rates in blastocyst transfer cycles (63.7% vs. 52.8%, p<0.05) but not in cleavage-stage transfers (52.5% vs. 43.3%, p>0.05). Multivariate logistic regression, adjusting for confounders, identified HCG administration as an independent factor positively associated with clinical pregnancy (OR = 1.751, 95% CI = 1.227-2.500, p=0.002).Administering intramuscular HCG before endometrial transformation in FET cycles pretreated with GnRH-a may improve  clinical pregnancy rate and embryo implantation rate.

Introduction: The clinical study aimed to evaluate the levels of serum kisspeptin, NKB, and GABA in Chinese patients with polycystic ovary syndrome (PCOS) and explore their association with hormonal profiles, as well as the relationship between these levels in PCOS patients and controls.

Methods: From December 2022 to December 2023, medical records of 60 individuals diagnosed with PCOS and 32 healthy subjects were obtained. Serum kisspeptin, NKB and GABA levels were quantified using enzyme-linked immunosorbent assay (ELISA) kits. To assess the correlation, either Pearson's or Spearman's analytical method was employed between serum kisspeptin, NKB, and GABA levels and hormonal profiles.

Results: The results showed that serum kisspeptin and NKB levels were significantly lower in PCOS patients (p﹤.05), while GABA levels were elevated compared to those in the control group (p﹤.05). In PCOS patients, kisspeptin was notably positive-correlated with LH and LH/FSH (p﹤.05), but no significant correlation was found between NKB, GABA, and hormonal profiles. In PCOS, GABA levels had a strong positive correlation with NKB levels (r = 0.613, p = .000), but this was not observed in the control group. In control patients, kisspeptin levels were positively associated with NKB (r = 0.475, p = .011), strongly negatively correlated with GABA levels (r = -0.773, p = .000), but these were not observed in the PCOS group.

Conclusion: The study concluded that patients with PCOS have dysregulated levels of serum kisspeptin, NKB, and GABA and that they may have paradoxical effects under physiological and pathological situations.

Objective: To determine the variation of serum AMH levels in healthy Chinese women and establish AMH reference ranges accordingly.

Methods: This prospective cross-sectional multicenter study was designed to enroll healthy Chinese women of reproductive age (20-39 years) and perimenopausal age (40-49 years) from five reproductive centers in different regions of China. The study began in May 2022 and finished in February 2023. Age-specific 2.5th-97.5th percentiles AMH reference ranges were established. Multivariable linear regressions were undertaken to analyze the association of serum AMH with different demographic and clinical variables, including antral follicle count (AFC).

Results: 1113 healthy Chinese women were enrolled, including 614 of premenopausal age and others of reproductive age. The AMH (ng/ml) reference ranges for Chinese women of reproductive age were 0.87-9.89 (20-24 years), 0.42-8.24 (25-29 years), 0.34-7.46 (30-34 years), and 0.28-5.66 (35-39 years). For perimenopausal women, their reference ranges were 0.12-4.63 (40-41 years), 0.01-4.12 (42-43 years), 0.01-2.65 (44-45 years), 0.01-1.90 (46-47 years), and 0.01-1.08 (48-49 years). The regression of AMH on AFC adjusted by age is Log10(AMH)=0.2594-0.0235*Age + 0.0632*AFC.

Conclusions: This study established the age-specific serum AMH reference ranges for healthy Chinese women of reproductive and premenopausal age, and observed that the consistent decrease of AMH after 20 years accelerated around the beginning of perimenopause (40 years).

Objectives: This study aims to investigate the effects and potential mechanisms of berberine in conjunction with Jianpi Yishen Huazhuo formulation (JPYSHZF) on obese rats that serve as a model for polycystic ovary syndrome (PCOS).

Methods: Letrozole combined with high-fat diet (HFD) was used to establish an overweight PCOS rat model. After successful modeling, each intervention group was monitored for 28 d. An oral glucose tolerance test (OGTT) is performed to assess glucose metabolism. Enzyme-linked immunosorbent assay (ELISA) was used to determine the levels of sex hormones and serum levels of gastrointestinal hormones in rats. Biochemical analyzers were used to assess blood lipid levels. The protein expression levels of p38, PI3K, GLUT4, and AKT in ovarian tissue were demonstrated using Western Blotting (WB). Real-time fluorescence quantitative PCR (RT-qPCR) was used to measure the mRNA expression levels of p38, PI3K, GLUT4 and AKT in the same tissue. The morphological changes of ovarian tissue were observed using Hematoxylin-eosin (HE).

Results: Treatment with berberine in conjunction with JPYSHZF has been shown to reduce serum testosterone T and luteinizing hormone (LH) levels while increasing serum follicle-stimulating hormone (FSH) and E2 levels. This combination therapy also decreases the LH/FSH ratio and ameliorates polycystic ovary-like pathological changes in the ovaries of rats with PCOS. Additionally, this treatment decreases serum TC, TG, and LDL-c levels while increasing HDL-c levels. It also reduces levels of GLU and Ghrelin while enhancing levels of CCK, PYY, and GLP-1. Furthermore, the relative 6 of PI3K and AKT proteins, as well as the mRNA levels of PI3K, GLUT4, and AKT, were found to be increased.

Conclusions: Berberine combined with JPYSHZF can improve the sex hormone levels, ovarian function, glucose and lipid metabolism levels, and gastrointestinal hormone levels in obese PCOS rats by activating the PI3K/AKT signaling pathway, thereby playing a role in treating obese PCOS.