多囊卵巢综合征诊治新进展

Advance in Diagnosis and Treatment of Polycystic Ovary Syndrome

多囊卵巢综合征(PCOS)是常见的妇科内分泌疾病,是引起育龄女性无排卵性不孕的主要原因。PCOS的临床表现及生化指标具有高度的异质性,使PCOS的诊断标准难以统一,目前国际上常用的诊断标准包括美国国立卫生研究院(NIH)标准、欧洲人类生殖及胚胎学会(ESHRE)和美国生殖医学会(HSRM)制定的鹿特丹(Rotterdam)标准及美国雄激素学会(AES)标准。近年又出现了中国PCOS诊疗专家共识及美国内分泌协会(AACE)的诊治指南。因此制定并推广符合中国人特点的PCOS诊断标准迫在眉睫。PCOS确切的发病机制尚不清楚,多认为与遗传、环境、心理因素等密切相关,需进一步研究。对于有生育需求的PCOS患者,治疗方式主要包括生活方式调整、口服避孕药、胰岛素增敏剂、促排卵治疗、辅助生殖技术以及手术治疗等,应根据患者的特点选择个体化的方案。同时应加强远期管理,预防PCOS相关的远期并发症。综述PCOS现行的诊断标准、可能的发病机制及治疗方式的研究进展。

Polycystic ovary syndrome（PCOS）,a common endocrinal disorder in women of reproductive age,causes the non-ovulation infertility. It is difficult to reach the consensus on the diagnostic criteria due to the high heterogeneity of clinical presentation and biochemical criterion in PCOS patients. At present,the common international criteria include NIH criteria,Rotterdam criteria and AES criteria. The expert consensus of China and the clinical practice guideline of AACE were also published. It is urgent to develop a diagnostic criterion of PCOS based on Chinese features. The accurate pathogenesis of PCOS is still unclear,which is related to genetic,environment,psychology,and/or combined factors. Based on characteristics of patients, therapy for those women with fertility requirement should be individual,including mainly the adjustment of life style,oral contraceptives,insulin sensitizing agents,ovulation treatment,assisted reproductive technology and operation. Meanwhile,the long-term management should be emphasized to avoid the long-term complications. In this article,the advance in diagnosis,pathogenesis and treatment of PCOS was discussed.