Objective： To investigate the clinical efficacy of metformin combined with orlistat in obese patients with polycystic ovary syndrome (PCOS) and insulin resistance. Methods： A total of 150 obese PCOS patients with insulin resistance were randomly divided into control group and research group, with 75 cases in each group. The control group was given basic treatment such as metformin and ethinylestradiol cycloproterone, and the research group was treated with basic treatment combined with orlistat. After 3 months of treatment, the differences in anthropometric indicators, glycolipid metabolism indicators and sex hormone levels between the two groups were compared. Results： After 3 months of treatment, compared with the control group, the body weight, body mass index (BMI), waist-to-hip ratio (WHR), body fat percentage, fasting plasma glucose (FPG), 2 h postprandial plasma glucose (2hPG), fasting insulin (FINS), glycosylated hemoglobin (HbA1c), and homeostasis model assessment-IR (HOMA-IR) of the research group were significantly decreased (P<0.05); and the triglyceride, total cholesterol, low density lipoprotein cholesterol in the research group were also significantly decreased (P<0.05), while high density lipoprotein cholesterol was significantly increased (P<0.05); the levels of luteinizing hormone (LH), estradiol, testosterone, prolactin and LH/follicle stimulating hormone （FSH） were greatly decreased (P<0.05), while there was no significant difference in FSH (P>0.05). Conclusion： Metformin combined with orlistat in the treatment of obese PCOS with insulin resistance could significantly improve the glucose and lipid metabolism, reduce weight and insulin resistance and improve sexual hormone disorder.

 

 

Objective： To observe the clinical efficacy of electroacupuncture on hyperandrogenism in patients with polycystic ovary syndrome (PCOS) of kidney deficiency and phlegm dampness. Methods： A total of 68 patients of PCOS with kidney deficiency and phlegm dampness were randomly divided into observation group (34 cases, 2 cases dropped off ) and control group (34 cases, 1 case dropped off). The observation group was treated with electroacupuncture, and the control group was treated with comfort electroacupuncture. The levels of serum testosterone and androstenedione were detected before and 3 months after the intervention, and combined with hairy score, acne score, menstrual status score, biphasic rate of basal body temperature and TCM syndrome score index, the therapeutic effects between the two groups were compared. Results： After 3 months of intervention, the total effective rate of the observation group was better than that of the control group (P<0.01). Compared with the control group, the levels of serum testosterone, androstendione, acne score and menstrual status score in the observation group were significantly decreased (P<0.01), but there was no difference in hirsutism score (P>0.05). Compared with the control group, the biphasic rate of basal body temperature in the observation group was insignificant (P>0.05), after 1 month of intervention. After 2 months of intervention, the observation group was better than the control group, and the difference was statistically significant (P<0.05). After 3 months of intervention, the biphasic rate of basal body temperature in the observation group was significantly higher than the control group (P<0.01). After 3 months of electroacupuncture intervention, the acne score, menstrual status score, serum testosterone and androstendione levels were decreased in the observation group (P<0.05), but there was no significant difference in hirsute score compared with that before intervention (P>0.05). There was no significant difference in hairy score, acne score, menstrual status score, serum testosterone and androstenadione levels in control group after 3 months of placebo electroacupuncture intervention (P>0.05). Conclusion： Electroacupuncture can reduce the levels of serum testosterone and androstenadione, reduce acne score and menstrual condition score, improve biphase ratio of basal body temperature, hyperandrogenemia and clinical symptoms in patients with polycystic ovary syndrome with kidney deficiency and phlegm dampness.
［Key words］acupuncture therapy; electroacupuncture; kidney deficiency and phlegm dampness; polycystic ovary syndrome; hyperandrogenism; clinical efficacy

多囊卵巢综合征（polycysticovarysyndrome，PCOS）是常见的生殖内分泌及代谢紊乱性疾病，且PCOS的发生常伴随胰岛素抵抗（insulinresistance，IR），严重危害育龄期女性的身心健康。西医治疗PCOS-IR多以促排卵和增强胰岛素敏感性为主，治疗效果明显，但易反复发作。中医认为肾虚血瘀是PCOSIR发病的基本病机，补肾活血是治疗本病的基本方法，中药、针灸及中药调周法等治疗效果良好。本文对PCOS-IR的中西医治疗进展进行归纳总结，以期为PCOSIR的临床诊疗提供借鉴。

多囊卵巢综合征(polycysti covary syndrome,PCOS)是女性最常见的内分泌代谢疾病之一，其临床表现主要包括月经紊乱、多毛、肥胖、不孕，并伴发高雄激素、高胰岛素血症和胰岛素抵抗等症状。体重指数(body mass index,BMI)可反映机体整体肥胖情况，BMI值过高影响PCOS表型特征的发展，加剧病情，不利于治疗预后。本文总结近年来BMI与PCOS的研究进展，以期为临床诊疗提供参考。

 

 Objective： To investigate the correlation between serum prolactin levels and sex hormones and glucose/lipid metabolism in patients with polycystic ovary syndrome (PCOS). Methods： A total of 657 women diagnosed with PCOS from Gynecology Outpatient Clinic of the First Affiliated Hospital of Heilongjiang University of Chinese Medicine from January 2015 to November 2018, and 60 healthy women without PCOS who were randomly selected to undergo physical examination during the same period were enrolled in the study. The anthropometric indicators, sex hormone indicators, glucose metabolism indicators and lipid metabolism indicators of PCOS patients were measured. According to the level of prolactin from low to high, PCOS patients were divided into 4 subgroups, Q1~Q4, the above indicators of the four groups were analysed and compared by non-parametric tests; the oral glucose tolerance test (OGTT) and insulin release test (IRT) were performed on the PCOS and control groups, and the glucose metabolism levels of PCOS patients in the PCOS and control groups and at different prolactin levels were analysed. Results： There were statistically significant differences in age, waist-to-hip ratio, estradiol, testosterone, sex hormone binding globulin (SHBG), triglyceride (TG) levels and homeostasis model assessment of β-cell (HOMA-β) among the four subgroups (P<0.05), among which age, waist-to-hip ratio, estradiol level and HOMA-β in Q4 group were significantly lower than those in Q1 group (P<0.05), and TG level was significantly lower than those in Q1 and Q2 group (P<0.05), testosterone was greatly lower than that of the other three groups (P<0.05), and SHBG level was markedly higher than that of Q3 group (P<0.05), the OGTT and IRT results showed that the blood glucose level in the PCOS group was higher than that in the control group on the whole, with the blood glucose levels at 60 min and 180 min significantly higher than those in the control group (P<0.05); the blood glucose level of the two groups reached the peak 30 min after oral glucose administration, and the IRT result was not statistically significant. The blood glucose of 120 min in group Q4 was significantly lower than that in group Q1 and Q2 (P<0.05), but no significant difference was observed at other times. IRT results showed that insulin secretion in the four subgroups decreased with time after 60 min, and the insulin level in group Q4 was lower than that in group Q1 and Q2 for a long time, and the performance was obvious at 60 and 120 min (P<0.05 or P<0.01). At 180 min, insulin value in groups Q1 to Q4 did not return to baseline level. After adjusting for age and BMI, multiple linear regression analysis showed that serum prolactin level was negatively correlated with LH/FSH ratio, testosterone, HOMA-β and TG levels, while positively correlated with SHBG level (P<0.05). Conclusion： PCOS patients with low-level prolactin showed significantly abnormal increase of androgen and decrease of glucose and lipid metabolism, and prolactin levels were negatively correlated with HOMA-β.
［Key words］polycystic ovary syndrome; prolactin; insulin resistance; oral glucose tolerance test (OGTT); insulin release test (IRT)

多囊卵巢综合征（polycystic ovary syndrome，PCOS）是一种复杂的异质性疾病，病因及发病机制复杂多样。量子力学的本质是量子纠缠。人体内环境中的各种成分如细胞、间质、离子、细胞因子及水分子之间的关系，即类同于量子与量子的关系。外部压力或内环境自我打压，导致人体内量子纠缠态失衡，进而致病。全身系统的低度炎症状态、神经内分泌的炎症浸润、环境毒物的损伤、肠道菌群紊乱的炎症激惹、中医能量经络的阻滞以及情绪卡点等，本质根源都是自我打压。因此，关于PCOS发生的病因，不管是神经、代谢、内分泌、压力、毒物等，根据量子力学的观点，其病理生理学特征的共性为自我打压。

多囊卵巢综合征(polycystic ovary syndrome，PCOS)是临床常见的一种生殖内分泌激素异常和代谢紊乱的疾病，临床症状表现多样，病因病机复杂。近年来的研究表明，遗传学、生殖内分泌激素、炎症因子、肠道菌群、微小RNA、信号转导通路和胰岛素抵抗等与PCOS的发生发展密切相关。关于PCOS的治疗方式，西医多针对雄激素升高、排卵异常、月经不调、胰岛素抵抗等进行对症治疗；中医注重调理，通过整体观的思想对不同的辨证分型采用中药调理、针灸和针药结合等方式进行治疗；中西医结合治疗充分发挥了现代医学与传统医学之间的优势，在采用西医对症治疗的同时结合中医治疗方式进行辨证论治，从整体把控，疗效显著。因此，本文对近几年PCOS病因病机的研究，以及对西医、中医和中西医结合治疗PCOS的方法作一综述。

Objective： To analyze the research status and hot spots of endometrial receptivity in polycystic ovary syndrome (PCOS) at home and abroad. Methods： The CNKI and Web of Science databases were searched on the subject of PCOS and endometrial receptivity, and the related papers on endometrial receptivity of PCOS were obtained. CiteSpace6.1.R6 software was used to realize the visual analysis of authors, institutions, countries and keywords. Results： This study included 242 Chinese papers and 155 English papers. Yang Xuefeng, Lessey Bruce A and others were the authors who have published the most papers. Hunan University of Traditional Chinese Medicine and Shanghai Jiao Tong Univ were the organizations that have published the most papers. The country that has published the most English papers was China, and the country that has published the most influential papers was Spain. The high-frequency keywords of Chinese papers were infertility, pregnancy outcome, etc. A total of 8 clusters were generated. The high-frequency keywords of English papers were embryo transfer, assisted reproduction, etc. A total of 10 clusters were generated. Conclusion： At present, the research field of endometrial receptivity in PCOS is in a rapid development stage. The research focused on the pathological mechanism and improvement methods of impaired endometrial receptivity in PCOS. Cross institutional, cross national and cross disciplinary exchanges and cooperation should be strengthened to promote the further development of research of endometrial receptivity in PCOS.
［Key words］polycystic ovary syndrome； endometrial receptivity； infertility； ovulation induction； assisted reproductive technology； visual analysis

多囊卵巢综合征（polycystic ovary syndrome，PCOS）是一种妇科内分泌疾病，以月经不调、高雄激素血症、代谢异常、生殖障碍等为主要临床表现，严重影响女性的生殖健康。外泌体是细胞分泌的一种细胞外囊泡，是一种天然的通讯分子，在生殖生物医学领域的诊断和治疗作用备受关注。目前，关于PCOS外泌体的研究有待进一步深入。本文主要从外泌体在PCOS中的作用及治疗价值等方面阐述其在PCOS中的发生发展机制，为PCOS治疗提供新思路。

Objective： To study the correlation of waisthip ratio with glucose and lipid metabolism, insulinlike growth factor1(IGF1) and insulin resistance(IR) in polycystic ovary syndrome（PCOS) patients. Methods： A total of 110 PCOS patients who were admitted to Jiangsu Shengze Hospital Affiliated to Nanjing Medical University from January 2018 to September 2021 were selected as the PCOS group, and 60 healthy subjects during the same period as the control group. Waisthip ratio, glucose and lipid metabolism indexes, IGF1 and homeostasis model for IR （HOMAIR) were measured in the two groups. The glucose and lipid metabolism indexes included fasting blood glucose(FPG), 2 h postprandial blood glucose （2 h PBG), total cholesterol(TC), highdensity lipoprotein cholesterol(HDLC), lowdensity lipoprotein cholesterol(LDLC), triglyceride(TG) and fasting insulin （FINS). The patients with waisthip ratio≥0.80 in the PCOS group were subgrouped into the abdominal obesity group, and the patients with waisthip ratio <0.80 into the nonabdominal obesity group, and the glucose and lipid metabolism indexes, IGF1, and HOMAIR were compared between the two groups.Pearson correlation analysis was used to evaluate the correlation between waisthip ratio and glucose and lipid metabolism, IGF1 and IR in PCOS patients. The ROC curve was used to analyze the predictive value of waisthip ratio for abnormal glucose and lipid metabolism, IGF-1 and IR in PCOS patients. Results： Compared with the control group, the PCOS group showed higher levels of the waisthip ratio, 2 h PBG, LDL-C, TG, FINS, IGF-1, HOMA-IR, and lower level of HDL-C (all P<0.05), while there was no significant difference between the levels of FPG and TC (both P>0.05). Compared with the nonabdominal obesity group, the levels of 2 h PBG, LDLC, TG, FINS, IGF-1 and HOMA-IR in the abdominal obesity group were significantly increased, and the levels of HDL-C were significantly decreased (all P<0.05), while there was no statistically significant difference between the levels of FPG and TC (both P>0.05). In PCOS patients, waisthip ratio was positively correlated with 2 h PBG, TG, IGF-1, HOMA-IR (all P<0.05), while negatively correlated with HDL-C(P<0.05). Waisthip ratio had good predictive value for abnormal blood glucose metabolism, abnormal blood lipid metabolism and IR in PCOS patients（AUC were 0.821, 0.793, 0.782, respectively). Conclusion： PCOS patients, especially those with higher waisthip ratio, showed obvious glycolipid metabolism disorders, abnormal increase of IGF1 and IR, and waisthip ratio has a good predictive value for glycolipid metabolism disorders and IR in PCOS patients.