多囊卵巢综合征.ppt

Diagnostic features of PCOS are hirsutism, anovulation, and polycystic ovaries, which show arrested follicular maturation; obesity and insulin resistance are frequently associated conditions. The major biochemical feature of PCOS is androgen excess, which causes hirsutism. Androgens also appear to inhibit the negative-feedback effects of estrogens and progesterone on pulsatile LH release. Women with PCOS have increased pulsatile GnRH release, which results in higher levels of LH and lower levels of FSH in most individuals. Higher LH (and insulin) levels seem to cause increased androgen production by follicular theca cells whereas lower FSH levels lead to anovulation. Obesity and insulin resistance decrease levels of sex-hormone-binding globulin and thereby increase testosterone bioactivity. If follicular granulosa cells are insulin resistant, it might affect their responses to FSH; otherwise, granulosa cells appear to be very capable of releasing estrogen in response to FSH, perhaps as a result of the actions of androgens and insulin. Abbreviations: FSH, follicle-stimulating hormone; GnRH, gonadotropin-releasing hormone; LH, luteinizing hormone. * 成都市第二人民医院 内分泌科 ** ——临床诊断和治疗 前 言 多囊卵巢综合征(polycystic ovary syndrome, PCOS)是育龄女性最常见的内分泌紊乱性疾病, 是引起不排卵性不孕的主要原因 在我国有着庞大的患者群 PCOS临床表现异质性，不但严重影响患者的生殖功能，而且远期并发症如子宫内膜癌发病率增加，相关的代谢失调包括高雄激素血症、胰岛素抵抗、糖代谢异常、脂代谢异常、心血管疾病危险也增加 PCOS至今病因尚不明确 本病首先于1935年由Stein-Leventhal提出一组表现为闭经、肥胖、多毛、不孕和双侧卵巢呈多囊性增大的综合征，称之为Stein-Leventhal综合征 从60年代改称之为PCOS 前 言 PCOS占生育年龄妇女的5％～10 ％ ，占无排卵性不孕症患者的30％～60％，高发年龄是16～31岁（约占90％以上） 我国尚缺少全国性、大样本、多中心的研究结果 PCOS的流行病学 遗传因素：PCOS有家族聚集现象，被推测为一种多基因病，目前的候选基因研究涉及胰岛素作用相关基因、高雄激素相关基因和慢性炎症因子等 环境因素：宫内高雄激素、抗癫痫药物、地域、营养和生活方式等，可能是PCOS的危险因素、易患因素或高危因素，尚需进行流行病学调查后，完善环境与PCOS关系的认识 PCOS的确切病因尚不清楚 PCOS的病因 主要特点：异质性、终身性、进行性 PCOS的病理生理学 Franks, S.?et al, Int J Obes. 2008,?32:1035–1041 PCOS的病理生理学 Chang RJ , Nat Clin Pract Endocrinol Metab 2007, 3: 688–695 高雄激素、高雌激素、黄体生成素增加、卵泡刺激素降低、高胰岛素 PCOS的诊断标准 疑似PCOS 月经稀发或闭经或不规则子宫出血是诊断必须条件 另外,再符合下列2