Impact of Bariatric Surgery on Clinical, Biochemical, and Hormonal Parameters in Women with Polycystic Ovary Syndrome (PCOS)
减肥手术对多囊卵巢综合征 (PCOS) 妇女临床、生化和激素参数的影响
- 作者列表："Singh, Devender","Arumalla, Kirit","Aggarwal, Sandeep","Singla, Vitish","Ganie, Ashraf","Malhotra, Neena
Abstract There is limited data on the impact of bariatric surgery on polycystic ovarian syndrome (PCOS) especially in the Indian population. Background To study the impact of bariatric surgery in women with PCOS in terms of clinical, hormonal, and radiological aspects of polycystic ovarian syndrome. Methods A prospective observational study of 50 women who underwent bariatric surgery at our tertiary care center. Evaluation of anthropometric data and menstrual cyclicity as well as markers of hyperandrogenism was done preoperatively and at 3- and 6-month and 1-year follow-up. Results Eighteen (36%) women were diagnosed to have PCOS. % EWL at 3-months ( n = 14), 6-month ( n = 14), and 1-year ( n = 11) follow-up was 31%, 49%, and 63% respectively among women with PCOS. All females regained their normal menstrual cycle at 3 months of follow-up. Hirsutism resolved completely among 44% (5/11) with a decline in median hirsutism score from 11 to 9 at 1-year follow-up. Mean serum testosterone decreased from 0.83 ± 0.38 ng/ml preoperatively to 0.421 ± 0.25 ng/ml at 1-year follow-up ( p ˂ 0.01), whereas changes in levels of serum LH and FSH were not significant. Seventy-seven percent of females (14/18) had polycystic ovaries preoperatively on USG; out of which, 55% (i.e., 4/7) showed complete resolution at 1-year follow-up. Metabolic syndrome resolved completely at 1-year follow-up in both PCOS and non PCOS group. Conclusions Bariatric surgery results in an effective and sustained weight loss with improvement in clinical, hormonal, and radiological parameters associated with PCOS.
文摘关于减肥手术对多囊卵巢综合征 (PCOS) 的影响，尤其是在印度人群中，数据有限。背景研究减肥手术对多囊卵巢综合征妇女的临床、激素和放射学方面的影响。方法一项前瞻性观察性研究，研究对象为在我们三级医疗中心接受减肥手术的 50 名女性。术前、 3 个月和 6 个月及 1 年随访时进行人体测量数据和月经周期以及高雄激素血症标志物的评价。结果 18 例 (36%) 女性被诊断为 PCOS。%3 个月 (n = 14) 、 6 个月 (n = 14) 和 1 年 (n = 11) 的 EWL PCOS 患者的随访率分别为 31% 、 49% 和 63%。所有女性在随访 3 个月时恢复正常月经周期。1 年随访时，44% 例 (5/11) 的多毛症完全消退，中位多毛症评分从 11 分降至 9 分。平均血清睾酮从术前的 0.83 ± 0.38 ng/ml 降至 1 年随访时的 0.421 ± 0.25 ng/ml (p 0.01), 而血清 LH 和 FSH 水平变化不显著。14/18 的女性 (55%) 在 USG 术前有多囊卵巢; 其中，(即4/7) 在 1 年随访时显示完全消退。PCOS 组和非 PCOS 组 1 年随访时代谢综合征均完全缓解。结论减肥手术可有效和持续减轻体重，改善与 PCOS 相关的临床、激素和影像学参数。
METHODS:Polycystic Ovary Syndrome (PCOS) is the most common endocrine disorder amongst women of reproductive age, whose aetiology remains unclear. To improve our understanding of the molecular mechanisms underlying the disease, we conducted a genome-wide DNA methylation profiling in granulosa lutein cells collected from 16 women suffering from PCOS, in comparison to 16 healthy controls. Samples were collected by follicular aspiration during routine egg collection for IVF treatment. Study groups were matched for age and BMI, did not suffer from other disease and were not taking confounding medication. Comparing women with polycystic versus normal ovarian morphology, after correcting for multiple comparisons, we identified 106 differentially methylated CpG sites with p-values <5.8 × 10 that were associated with 88 genes, several of which are known to relate either to PCOS or to ovarian function. Replication and validation of the experiment was done using pyrosequencing to analyse six of the identified differentially methylated sites. Pathway analysis indicated potential disruption in canonical pathways and gene networks that are, amongst other, associated with cancer, cardiogenesis, Hedgehog signalling and immune response. In conclusion, these novel findings indicate that women with PCOS display epigenetic changes in ovarian granulosa cells that may be associated with the heterogeneity of the disorder.
METHODS::Introduction: Approximately 1% of adolescents have polycystic ovary syndrome (PCOS) and almost 40-70% of these patients are overweight or obese. Obese adolescents with PCOS have more severe insulin resistance and hyperandrogenemia, a more adverse lipid profile and a worse quality of life than normal-weight adolescents with PCOS. Accordingly, weight loss is an important component of the management of these patients.Areas covered: The authors discuss the different options for weight loss in obese adolescents with PCOS. Lifestyle changes appear to be effective but adherence to this intervention is suboptimal. There are also limited data regarding the optimal diet in this population. Few small studies have evaluated the effects of pharmacotherapy in these patients. Conflicting data have been reported regarding the effects of metformin on body weight. Notably, agents that have been approved for weight loss in adults have not been evaluated in adolescents with PCOS.Expert opinion: More studies are needed to identify the most appropriate diet for obese adolescents with PCOS. Well-designed randomized controlled studies are also needed to define the safety and efficacy of pharmacotherapy in this population.
METHODS::Polycystic ovary syndrome (PCOS) is a hormonal disorder common among women of reproductive age. Although much is understood concerning the pathology of PCOS, further investigation into the influence of microribonucleic acids (miRNAs) on the proliferation of ovarian granulosa cells (GCs) is needed. This study investigated the role of specific miRNAs in ovarian dysfunction of PCOS and its effect on the proliferation of GCs. Initially, miRNA profiling was performed on the ovarian cortexes of 15 rats in which PCOS had been induced and 15 rats without PCOS (non-PCOS). This mechanical study was performed on ovarian GCs extracted from human chorionic gonadotrophin (hCG)-induced rats. Insulin was used to treat GCs to establish the PCOS cell model. Increased Equus caballus mir-9119 expression was observed and confirmed in the insulin-induced model of PCOS in GCs (GC-PCOS) as well as in the hCG-induced rats when compared to non-PCOS rats and cells. Observation and confirmation were carried out through both miRNA array and quantitative PCR. In contrast, downregulation of the nuclear factor kappa B (NFκB) p65 was observed in the PCOS cell model. Additionally, annexin V, FITC, and propidium iodide flow cytometry showed overexpression of miR-9119-induced apoptosis. In this study, we revealed that miR-9119 inhibition regulates p65 expression levels in insulin-treated GCs by binding to the 3'-untranslated of p65. Additionally, regulation of p65 expression was positively correlated with the expression of the double-stranded RNA endoribonuclease DICER. Moreover, RNA silencing/overexpression of p65 affected the functional role of miR-9119. In conclusion, GCs of PCOS, the expression of miR-9119, and targeted NFκB/p65-DICER axis are upregulated in order to maintain cell viability and prevent apoptosis, thereby promoting Anti-Müllerian hormone production in GCs. This study may provide a new understanding of the mechanism of GC dysfunction.