Irisin与多囊卵巢综合征代谢紊乱的研究进展

多囊卵巢综合征(PCOS)是育龄期妇女常见的生殖障碍及代谢功能紊乱性疾病,常伴有肥胖、胰岛素抵抗、雄激素过多和血脂异常等代谢异常,PCOS代谢紊乱比单纯的生殖障碍更复杂。鸢尾素(Irisin)为新近发现的在PCOS患者体内异常表达的肌肉因子,其主要作用机制为诱导白色脂肪组织的"褐变",增加产热和能量消耗,已有研究表明Irisin在肥胖、2型糖尿病、脂质代谢和心血管疾病、非酒精性脂肪肝等代谢障碍性疾病中发挥保护作用,但Irisin在PCOS的发生、发展中的作用尚不明确。本文综述Irisin在PCOS患者代谢紊乱发病机制中的作用,为PCOS的诊治提供新思路。     

饮食改善肥胖多囊卵巢综合征患者体内慢性炎症作用的研究进展

多囊卵巢综合征(PCOS)是典型的生殖障碍性疾病,主要表现为月经稀发、雄激素过多症或高雄激素血症(HA)、卵巢多囊样改变,有关PCOS的发病机制尚无定论,但目前认为PCOS患者体内的慢性炎症状态是发病机制之一。肥胖诱发的炎症可能会引发一连串的事件导致胰岛素抵抗(IR)、血脂异常增加、卵巢雄激素生成增多,最终导致PCOS患者发生生殖障碍。近年流行病学数据表明,饮食中的某些成分可能会影响生殖健康,尤其是与炎症有关的女性生殖疾病,如PCOS。本文根据流行病学和基础研究所见,简要概述慢性炎症在肥胖PCOS患者生殖障碍中的作用,为未来饮食干预肥胖PCOS患者的生殖结局提供依据。     

多囊卵巢综合征患者的肥胖和代谢功能障碍

多囊卵巢综合征(PCOS)是育龄期妇女常见的内分泌紊乱性疾病,与代谢紊乱性疾病,如血脂异常、代谢综合征、睡眠呼吸暂停综合征和2型糖尿病等的发生密切相关。肥胖和胰岛素抵抗是PCOS常见的两种症状。PCOS患者肥胖的患病率明显增加,即使在非肥胖的患者中亦存在腹部脂肪堆积的现象。脂肪组织的功能紊乱是代谢紊乱的高风险因素。PCOS患者的脂肪组织存在明显的功能异常,包括脂解作用的受损、胰岛素作用的削弱,脂肪因子分泌的异常等,而PCOS脂肪功能的异常加速了胰岛素抵抗的发展。总结PCOS脂肪组织功能异常的特点及其对代谢紊乱的影响。     

多囊卵巢综合征患者的肥胖和代谢功能障碍

多囊卵巢综合征（PCOS）是育龄期妇女常见的内分泌紊乱性疾病,与代谢紊乱性疾病,如血脂异常、代谢综合征、睡眠呼吸暂停综合征和2型糖尿病等的发生密切相关。肥胖和胰岛素抵抗是PCOS常见的两种症状。PCOS患者肥胖的患病率明显增加,即使在非肥胖的患者中亦存在腹部脂肪堆积的现象。脂肪组织的功能紊乱是代谢紊乱的高风险因素。PCOS患者的脂肪组织存在明显的功能异常,包括脂解作用的受损、胰岛素作用的削弱,脂肪因子分泌的异常等,而PCOS脂肪功能的异常加速了胰岛素抵抗的发展。总结PCOS脂肪组织功能异常的特点及其对代谢紊乱的影响。     

自噬在多囊卵巢综合征中的研究进展

多囊卵巢综合征(PCOS)是育龄期妇女最常见的内分泌代谢紊乱性疾病之一,表现多样,目前其病理机制未完全阐明。近年来,越来越多的研究发现自噬在PCOS发生、发展及治疗中起着至关重要的作用,并与PCOS相关的代谢紊乱,如胰岛素抵抗、肥胖和低度慢性炎症密切相关。研究自噬在PCOS中的作用,有助于加深对PCOS发病机制的理解,同时为临床治疗提供新思路。     

多囊卵巢综合征患者生活方式的调整与减重治疗

多囊卵巢综合征(PCOS)是育龄期女性最常见的内分泌及代谢紊乱性疾病之一。生活方式调整包括饮食控制、运动和行为十预,改善超重或者肥胖PCOS患者的代谢和内分泌异常,被推荐为PCOS患者的一线治疗。当生活方式干预联合减重药物治疗时,可对超重/肥胖PCOS患者的内分泌异常改善发挥更有效的作用。奥利司他、二甲双胍和肌醇等药物用于PCOS患者人群,可有效减轻体质量和改善PCOS临床症状,但目前仅有奥利司他获批为减肥适应证药物。此外减重手术也是肥胖PCOS女性的有效治疗手段。本文对生活方式调整和减重药物对PCOS的代谢和内分泌影响的相关研究进行综述。     

肠道菌群与多囊卵巢综合征的免疫学机制研究进展

多囊卵巢综合征(PCOS)是育龄期女性常见的内分泌和代谢紊乱性疾病,是导致育龄女性月经失调和不孕的常见原因之一。PCOS的病因至今尚不完全清楚,近年来免疫因素及代谢异常成为PCOS的研究热点。肠道菌群作为人体不可或缺的"微生物器官",影响着宿主的营养代谢及免疫功能,在肥胖、胰岛素抵抗、桥本氏甲状腺炎等内分泌代谢疾病以及自身免疫疾病中有着十分重要的作用。本文拟从免疫学角度对肠道菌群参与PCOS的可能发病机制做一综述,以期为PCOS的治疗提供新的思路。     

多囊卵巢综合征子宫内膜胰岛素抵抗的分子机制及生物学效应

多囊卵巢综合征(PCOS)作为一种生殖障碍与代谢紊乱并存的内分泌疾病,是育龄期妇女不孕的最常见原因。PCOS患者以无排卵性不孕为主,但通过促排卵药物纠正后,PCOS患者仍存在低种植率、高流产率的现象,其重要原因之一是PCOS患者内分泌及代谢紊乱影响其子宫内膜功能。胰岛素抵抗(IR)作为PCOS的代谢特征之一,已有证据显示子宫内膜IR影响子宫内膜生理功能,可能降低子宫内膜容受性,并增加子宫内膜疾病的发病风险。进一步了解子宫内膜IR的分子机制及生物学效应,将有助于为PCOS患者提供更好的治疗策略。     

脂肪细胞因子与多囊卵巢综合征

多囊卵巢综合征(PCOS)是一种伴有肥胖,胰岛素抵抗的常见代谢性疾病,而脂肪细胞因子在参与肥胖、胰岛素抵抗及相关疾病的发生中起着重要作用.综述近年来研究较多的脂肪细胞因子瘦素、肿瘤坏死因子-α、抵抗素及脂联素在PCOS患者中的表达情况及其作用特点,为PCOS的病因学研究提供新的思路.     

脂肪细胞因子与多囊卵巢综合征

多囊卵巢综合征(PCOS)是一种伴有肥胖，胰岛素抵抗的常见代谢性疾病，而脂肪细胞因子在参与肥胖、胰岛素抵抗及相关疾病的发生中起着重要作用。综述近年来研究较多的脂肪细胞因子瘦素、肿瘤坏死因子-α、抵抗素及脂联素在PCOS患者中的表达情况及其作用特点，为PCOS的病因学研究提供新的思路。     

Das Syndrom der polyzystischen Ovarien

The polycystic ovary syndrome (PCOS) is the most frequent endocrine disorder of women in the reproductive phase. Important determinants for the extent and course of the disorder are the presence of a metabolic syndrome with obesity, insulin resistance and hypercortisolism. The metabolic syndrome is influenced by behavioral factors like eating behavior and physical activity. There are data hinting to a link between PCOS, eating disorders, depressive disorders and other psychiatric disorders. This opens a behavioral medicine perspective to the treatment of PCOS.     

生活方式干预疗法在多囊卵巢综合征治疗中的作用

多囊卵巢综合征（PCOS）是一种多起因、异质性的女性内分泌系统疾病,影响患者生殖及代谢,并发心血管病及精神心理问题风险增高。生活方式干预疗法能够减轻月经紊乱、多毛痤疮等症状并有利于治疗不孕,延缓远期代谢综合征的发生,改善生活质量。因而成为PCOS患者尤其合并肥胖者重要的一线治疗方案。     

Polycystic ovary syndrome,adipose tissue and metabolic syndrome

Purpose

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder that affects women of reproductive age and is characterized by ovulatory dysfunction and/or androgen excess or polycystic ovaries. Women with PCOS present a number of systemic symptoms in addition to those related to the reproductive system. It has been associated with functional derangements in adipose tissue, metabolic syndrome, type 2 diabetes, and an increased risk of cardiovascular disease (CVD).

Methods

A detailed literature search on Pubmed was done for articles about PCOS, adipokines, insulinresistance, and metabolic syndrome. Original articles, reviews, and meta-analysis were included.

Results

PCOS women are prone to visceral fat hypertrophy in the presence of androgen excess and the presence of these conditions is related to insulin resistance and worsens the PCO phenotype. Disturbed secretion of many adipocyte-derived substances (adipokines) is associated with chronic low-grade inflammation and contributes to insulin resistance. Abdominal obesity and insulin resistance stimulate ovarian and adrenal androgen production, and may further increase abdominal obesity and inflammation, thus creating a vicious cycle.

Conclusion

The high prevalence of metabolic disorders mainly related to insulin resistance and CVD risk factors in women with PCOS highlight the need for early lifestyle changes for reducing metabolic risks in these patients.

     

Polycystic ovary syndrome in the Indian Subcontinent

Polycystic ovary syndrome (PCOS) is a complex, multifaceted, heterogeneous disorder that affects approximately 5 to 10% of women of reproductive age. It is characterized by hyperandrogenism, polycystic ovaries, and chronic anovulation along with insulin resistance, hyperinsulinemia, abdominal obesity, hypertension, and dyslipidemia as frequent metabolic traits (metabolic syndrome) that culminate in serious long-term consequences such as type 2 diabetes mellitus, endometrial hyperplasia, and coronary artery disease. It is one of the most common causes of anovulatory infertility. However, the heterogeneous clinical features of PCOS may change throughout the life span, starting from adolescence to postmenopausal age, largely influenced by obesity and metabolic alterations, and the phenotype of women with PCOS is variable, depending on the ethnic background. The etiology of PCOS is yet to be elucidated; however, it is believed that in utero fetal programming may have a significant role in the development of PCOS phenotype in adult life. Though a woman may be genetically predisposed to developing PCOS, it is only the interaction of environmental factors (obesity) with the genetic factors that results in the characteristic metabolic and menstrual disturbances and the final expression of the PCOS phenotype. Irrespective of geographic locations, a rapidly increasing prevalence of polycystic ovarian insulin resistance syndrome, excess body fat, adverse body fat patterning, hypertriglyceridemia, and obesity-related disease, such as diabetes and cardiovascular disease, have been reported in Asian Indians, suggesting that primary prevention strategies should be initiated early in this ethnic group. In lieu of the epidemic increase in the prevalence of obesity and diabetes mellitus in most industrialized countries including China and India owing to Westernization, urbanization, and mechanization, and evidence suggesting a pathogenetic role of obesity in the development of PCOS and related infertility, active intervention to combat the malice of these disorders is warranted. Pharmacologic therapy is a critical step in the management of patients with metabolic syndrome when lifestyle modifications fail to achieve the therapeutic goals, and studies in China and India have proved to be effective.     

棕色脂肪组织及其与多囊卵巢综合征相关性研究新进展

多囊卵巢综合征（polycystic ovarian syndrome，PCOS）是常见生殖代谢障碍性疾病，具有高度异质性，以肥胖、胰岛素抵抗（IR）、多毛、不孕为主要表现，后期引发心脑血管疾病、卵巢癌等远期并发症，对患者身心健康造成严重危害。棕色脂肪组织（brown adipose tissue，BAT）是人体产热的主要组织，在新陈代谢过程中发挥重要作用。研究发现，BAT与PCOS的形成关系密切，一方面BAT代谢障碍引发的肥胖进一步加速了IR、排卵异常及相关并发症的发生；另一方面，BAT特异性分泌的细胞因子是减轻IR，并降低PCOS炎症状态的关键。与此同时，针对BAT与PCOS的关系研究而衍生了包括外源性BAT移植、鸢尾素因子补充、药物诱导脂肪组织棕色化等治疗方法，使PCOS治疗手段多样化。现就BAT及其与PCOS关系的研究进展进行综述。     

Syndrome des ovaires polymicrokystiques : une pathologie à risque obstétrical ?

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age and the leading cause of female infertility. This condition is frequently associated with significant metabolic disorders, including obesity and hyperinsulinemia. Therefore, it seems essential to focus on the pregnancy of these patients and possible obstetric complications. Many studies suggest an increase in the risk of obstetric pathology: early miscarriage, gestational hypertension, preeclampsia, gestational diabetes mellitus diagnosed during early pregnancy, prematurity, low birthweight or macrosomia, neonatal complications and cesarean sections. However, it is difficult to conclude clearly about it, because of the heterogeneity of definition of PCOS in different studies. In addition, many confounding factors inherent in PCOS including obesity are not always taken into account and generate a problem of interpretation. However it seems possible to conclude that PCOS does not increase the risk of placental abruption, HELLP syndrome, liver disease, postpartum hemorrhage, late miscarriage and stillbirth.     

Polycystic ovary syndrome and type 2 diabetes mellitus

Polycystic ovary syndrome (PCOS) is a medical condition that has brought multiple specialists together. Gynecologists, endocrinologists, cardiologists, pediatricians, and dermatologists are all concerned with PCOS patients and share research data and design clinical trials to learn more about the syndrome. Insulin resistance is a common feature of PCOS and is more marked in obese women, suggesting that PCOS and obesity have a synergistic effect on the magnitude of the insulin disorder. It leads to increased insulin secretion by beta-cells and compensatory hyperinsulinemia. Hyperinsulinemia associated with insulin resistance has been causally linked to all features of the syndrome, such as hyperandrogenism, reproductive disorders, acne, hirsutism and metabolic disturbances. If beta-cell compensatory response declines, relative or absolute insulin insufficiency develops which may lead to glucose intolerance and type 2 diabetes. Moreover, insulin resistance in PCOS may be considered a risk factor for gestational diabetes (GD).     

Diagnose PCOS – was bedeutet das für die Betroffene?

Polycystic ovary syndrome (PCOS) is a heterogeneous and multifactorial disorder which is accompanied by gynecological, reproductive and metabolic comorbidities, such as infertility, a higher prevalence of cardiovascular risk factors, such as hypertension, dyslipidemia and type 2 diabetes as well as an increased risk of the development of cancer, e.?g. endometrial cancer. There is evidence that patients with PCOS are at a high risk for reduced quality of life and psychological disturbances in comparison to women of the same age. In addition, PCOS is also associated with an increased risk for affective disorders, such as depressive episodes, dysthymic disorders and bipolar disorders as well as anxiety symptoms. Although the clinical features of PCOS (e.g. irregular cycles, infertility, hyperandrogenism and obesity) affect the health-related quality of life, there is still some debate on whether the increased prevalence of psychological disorders is due to the PCOS itself or is induced by the symptoms. To date, a general screening with respect to psychological comorbidities of all women with PCOS is not recommended; nevertheless, a psychological assessment should be considered during the gynecological consultation and if necessary interdisciplinary therapeutic measures should be initiated.     

Quality of life and sexual function in women with polycystic ovary syndrome: a comprehensive review

Abstract

Polycystic Ovary Syndrome (PCOS) is the most common endocrinopathy among women of reproductive age. PCOS is a polysimptomatic disease, the leading manifestations of which are hyperandrogenic dermopathy, menstrual dysfunction, infertility and obesity. Dissatisfaction with one's own appearance, low self-esteem, a feeling of sexual unattractiveness cause chronic psychological discomfort, mood disturbances and problems in the relationship with a partner. The article presents an overview of scientific sources on the effect of polycystic ovary syndrome on the quality of life and the sexual function of women. Data recorded confirm the hypothesis that PCOS is not only an endocrine disorder, but a heterogeneous condition with reproductive, metabolic, and mental manifestations. The association of PCOS manifestations with a decrease in the quality of life and disorders in the sexual sphere of women was well assessed. Data presented in the review ensure the absolute medical and social importance of the study of PCOS.