多囊卵巢综合征患者反复妊娠丢失的因素

Factors of Recurrent Pregnancy Loss in Patients with Polycystic Ovary Syndrome

多囊卵巢综合征(PCOS)的多种病理改变与反复妊娠丢失相关。PCOS患者的高胰岛素血症和胰岛素抵抗可通过干扰正常的胎盘附着导致妊娠丢失;临床常用二甲双胍纠正胰岛素代谢异常,也可减少妊娠丢失。PCOS患者雄激素过多可能导致不孕、妊娠丢失及妊娠期并发症,尚需要更多高质量的临床研究探讨。此外,肥胖和血脂异常会增加PCOS患者发生RPL的概率,通过饮食结构调整、生活方式干预及体质量管理,以减少肥胖的不良影响,改善妊娠结局。本文从胰岛素代谢、糖脂代谢、雄激素、同型半胱氨酸和维生素D等多方面分析PCOS患者反复妊娠丢失的因素,以期为PCOS患者的生育和辅助生殖治疗提供指导。

Multiple pathological factors of polycystic ovary syndrome(PCOS)are associated with recurrent pregnancy loss(RPL).Hyperinsulinemia and insulin resistance in PCOS patients can lead to pregnancy loss by interfering with the normal placental attachment.Metformin is clinically used to correct the abnormal metabolism related to hyperinsulinemia,and to reduce pregnancy loss.Excessive androgen in PCOS patients may lead to infertility,RPL and pregnancy complications.However,more high-quality clinical studies are needed to understand the relationship between excessive androgen and RPL.In addition,obesity and dyslipidemia increase the probability of RPL in PCOS patients.Dietary structure adjustment,lifestyle intervention and body weight management will reduce the adverse effects of obesity,and improve pregnancy outcomes.In this paper,we analyzed the factors of RPL in PCOS patients from insulin metabolism,glucolipid metabolism,androgen,homocysteine and vitamin D,in order to provide a clinical guidance for the fertility and assisted reproductive therapy of PCOS patients.