多囊卵巢综合征研究概述

Overview of Research on Polycystic Ovarian Syndrome

多囊卵巢综合征(polycystic ovarian syndrome,PCOS)是女性最常见内分泌失调疾病,常伴有胰岛素抵抗(insulin resistance,IR)、月经功能障碍、不孕症、代谢紊乱、多毛症及肥胖等多种异质性症状;根据鹿特丹诊断标准,即高雄激素血症,排卵功能障碍和多囊卵巢形态(polycystic ovary morphology,PCOM)3项症状中有任意两项就可诊断为PCOS。PCOS可能是一种复杂的多基因疾病,受表观遗传和环境的多重影响,IR和葡萄糖代谢失调也是PCOS的诱因。PCOS可能导致严重健康危害,PCOS的女性患葡萄糖不耐受和2型糖尿病的风险增加,也会增加子宫内膜瘤、代谢综合征(metabolic syndrome,MS)和轻度慢性炎症等发病风险,IR还会诱发血脂异常;PCOS治疗方案取决于患者的表型、病因和主要诉求,主要侧重于抑制和抵消雄激素分泌,改善代谢状态以及提高生育能力几个方面。PCOS导致的排卵障碍不孕症可采用盐酸二甲双胍缓释片、曲格列酮、来曲唑、促卵泡激素(follicle-stimulating hormone,FSH)、尿促性腺激素(human menopausal gonadotropin,HMG)和人绒毛膜促性腺激素(human chorionic gonadotropin,HCG)多种药物联合治疗。

Polycystic ovarian syndrome(PCOS)is the most common endocrine disorder in women,which is often associated with various heterogeneous symptoms such as insulin resistance(IR),menstrual dysfunction,infertility,metabolic disorders,hirsutism and obesity.PCOS is diagnosed according to the Rotterdam diagnostic criteria,which are hyperandrogenemia,ovulatory dysfunction and polycystic ovary morphology(PCOM)with any two of the three symptoms.PCOS may be a compound polygenic disease with multiple epigenetic and environmental influences,IR and dysregulated glucose metabolism are also contributing factors to PCOS.PCOS may lead to serious health risks,with women with PCOS at increased risk of glucose intolerance and type 2 diabetes,as well as increased risk of developing endometrioma,metabolic syndrome(MS)and mild chronic inflammatory disease,and IR may also predispose to dyslipidemia.Treatment options for PCOS depend on the patient's phenotype,etiology,and primary complaints,focusing on suppressing and counteracting androgen production,improving metabolic status,and enhancing fertility.Ovulationdisordered infertility due to PCOS can be treated with a combination of metformin hydrochloride extended-release tablets,troglitazone,letrozole,follicle-stimulating hormone(FSH),human menopausal gonadotropin(HMG),and human chorionic gonadotropin(HCG).