肥胖与青少年多囊卵巢综合征

多囊卵巢综合征（PCOS）是育龄妇女常见生殖内分泌疾病。近年发现,随着儿童肥胖患病率增加,青少年PCOS发病率也逐年提高。肥胖可通过增加外周循环胰岛素水平影响PCOS发病机制,PCOS患者高雄激素血症也会增加内脏脂肪沉积。肥胖会增加与PCOS相关的代谢和心血管方面的并发症的患病风险,如胰岛素抵抗（IR）、高脂血症、高血压以及临床症状不明显的动脉粥样硬化等。早期识别青春期PCOS,有利于及时纠正、阻断其内分泌紊乱,防止近期及远期并发症发生。     

肥胖与青少年多囊卵巢综合征

多囊卵巢综合征（PCOS）是育龄妇女常见生殖内分泌疾病。近年发现,随着儿童肥胖患病率增加,青少年PCOS发病率也逐年提高。肥胖可通过增加外周循环胰岛素水平影响PCOS发病机制,PCOS患者高雄激素血症也会增加内脏脂肪沉积。肥胖会增加与PCOS相关的代谢和心血管方面的并发症的患病风险,如胰岛素抵抗（IR）、高脂血症、高血压以及临床症状不明显的动脉粥样硬化等。早期识别青春期PCOS,有利于及时纠正、阻断其内分泌紊乱,防止近期及远期并发症发生。     

多囊卵巢综合征患者的辅助生殖治疗结局

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,发病率达6%~10%。由于稀发排卵或无排卵,常常伴发不孕的问题。近年来,辅助生殖技术(ART)越来越多地应用于此类患者。研究表明不同类型的PCOS患者,如肥胖、高促黄体生成激素(LH)、高雄激素及胰岛素抵抗(IR),其ART助孕结局均较非PCOS患者差,虽然发生机制各有特点,但不同的病理生理异常相互作用,最终多反映为卵子质量下降,表现为PCOS患者ART治疗的临床妊娠率低、早期自然流产率高。本文就不同类型的PCOS患者的辅助生殖治疗结局以及影响其结局的因素进行论述,并探讨能够改善PCOS患者辅助生殖治疗结局的措施。     

多囊卵巢综合征和肥胖及其治疗的研究进展

多囊卵巢综合征(PCOS)是一种异质性的内分泌紊乱疾病,在育龄妇女中高发.临床上发现PCOS和肥胖密切相关,PCOS患者中肥胖者居多,而肥胖的PCOS患者与非肥胖患者相比,有更加严重的内分泌代谢紊乱,肥胖在PCOS中可能起一定的病因作用.因此,需要更加重视肥胖PCOS患者的治疗,除常规PCOS的治疗外,肥胖患者还需纠正长期代谢紊乱导致的远期并发症.     

多囊卵巢综合征和肥胖及其治疗的研究进展

多囊卵巢综合征(PCOS)是一种异质性的内分泌紊乱疾病，在育龄妇女中高发。临床上发现PCOS和肥胖密切相关，PCOS患者中肥胖者居多，而肥胖的PCOS患者与非肥胖患者相比，有更加严重的内分泌代谢紊乱，肥胖在PCOS中可能起一定的病因作用。因此，需要更加重视肥胖PCOS患者的治疗，除常规PCOS的治疗外，肥胖患者还需纠正长期代谢紊乱导致的远期并发症。     

多囊卵巢综合征妊娠患者的产科结局

多囊卵巢综合征（PCOS）是生育期妇女最常见的生殖内分泌疾病,病因至今未明。高雄激素、胰岛素抵抗（IR）及高胰岛素血症是PCOS的病理生理基础。由于PCOS患者特殊的病理生理特点,妊娠后可能会并发流产、妊娠期糖尿病（GDM）、妊娠高血压疾病等合并症。充分认识PCOS患者的妊娠期并发症及新生儿结局,有针对性地预防和治疗母儿并发症,对保障母婴健康有重要意义。     

多囊卵巢综合征妊娠患者的产科结局

多囊卵巢综合征（PCOS）是生育期妇女最常见的生殖内分泌疾病,病因至今未明。高雄激素、胰岛素抵抗（IR）及高胰岛素血症是PCOS的病理生理基础。由于PCOS患者特殊的病理生理特点,妊娠后可能会并发流产、妊娠期糖尿病（GDM）、妊娠高血压疾病等合并症。充分认识PCOS患者的妊娠期并发症及新生儿结局．有针对性地预防和治疗母儿并发症,对保障母婴健康有重要意义。     

多囊卵巢综合征中卵巢颗粒细胞的研究进展

正多囊卵巢综合征(polycystic ovary syndrome,PCOS)是育龄期女性常见的生殖内分泌与代谢性疾病,也是导致原发性不孕症的主要原因~([1])。本病的临床表现具有异质性,包括月经不规律、排卵障碍、多毛、痤疮、肥胖等,常伴有生殖内分泌激素紊乱、胰岛素抵抗、脂代谢异常等特点~([2-3])。远期并发症包括代谢综合征、子宫内膜癌、糖尿病、心血管疾病及不良妊娠结局~([4-7])。卵泡的生长发育是一个精细而复杂的过程,其中卵巢颗粒细胞发挥着关     

多囊卵巢综合征患者孕前、孕期及产后管理中国专家共识（2023年版）

<正>多囊卵巢综合征(polycystic ovary syndrome,PCOS)是育龄期妇女常见的具有生殖、代谢、心理特征的生殖内分泌代谢性疾病。除了慢性排卵障碍、不孕、高雄激素血症、超重或肥胖、高胰岛素血症、代谢综合征等病理生理异常以外，焦虑、抑郁等心理问题也均影响其生殖健康。这些妇女不易妊娠，且妊娠后不仅流产、早产风险增加，而且妊娠期并发症和合并症如妊娠期糖尿病(GDM)、妊娠期高血压疾病等也明显增加^[1-2]，并可能影响子代远期发育及代谢^[1,3]。     

多囊卵巢综合征的临床症状及远期影响

正多囊卵巢综合征(polycystic ovary syndrome,PCOS)是一种常见的女性内分泌及代谢异常所致的病理状态,包含了多种病因导致的内分泌和代谢系统功能异常,其发病机制复杂,临床表现高度异质性。PCOS患者不仅有月经稀发、闭经、不孕、肥胖、多毛、痤疮等临床表现,影响女性生殖健康,还容易远期并发血脂异常、高血压、代谢综合征、早发糖尿病及心血管疾病(CVD),子宫内膜癌和乳腺癌的发生风险也明显增加。     

多囊卵巢综合征患者孕期风险和预防措施

多囊卵巢综合征患者存在肥胖、胰岛素抵抗、高雄激素血症和卵巢功能障碍等内分泌代谢紊乱,导致流产、妊娠期糖尿病和早产等疾病的风险增加,各种辅助生殖技术也给妊娠过程带来隐患,早期、针对性地采取预防措施可以改善母胎不良结局。     

Pregnancy complications in women with polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. There is an increasing body of evidence indicating that PCOS may have significant implications for pregnancy outcomes and long-term health of a woman and her offspring. Whether or not PCOS itself or the symptoms that coincide with PCOS, like obesity and fertility treatment, are responsible for these increased risks is a continuing matter of debate. Miscarriage rates among women with PCOS are believed to be increased compared with normal fertile women, although supporting evidence is limited. Pregnant women with PCOS experience a higher incidence of perinatal morbidity from gestational diabetes, pregnancy-induced hypertension, and preeclampsia. Their babies are at an increased risk of neonatal complications, such as preterm birth and admission at a neonatal intensive care unit. Pre-pregnancy, antenatal, and intrapartum care should be aimed at reducing these risks. The use of insulin sensitizing drugs to decrease hyperinsulinemic insulin resistance has been proposed during pregnancy to reduce the risk of developing preeclampsia or gestational diabetes. Although metformin appears to be safe, there are too few data from prospective, randomized controlled trials to support treatment during pregnancy.     

Pregnancy considerations in women with polycystic ovary syndrome

Women with polycystic ovary syndrome (PCOS) are subfecund, and while anovulatory infertility is most likely the primary cause, other factors may contribute. Recent data suggest that women with PCOS are at increased risk for preterm labor, preeclampsia, and gestational diabetes, though the evidence for increased miscarriage rates is less certain. There is no evidence-based schema for achieving pregnancy in women with PCOS, though lifestyle modification, clomiphene citrate, and metformin are the current front line therapies. There are few data to support treatment during pregnancy with metformin in women with PCOS to prevent pregnancy loss or pregnancy complications.     

Should insulin-sensitizing drugs be used in the treatment of polycystic ovary syndrome?

Insulin resistance is a central feature of polycystic ovary syndrome (PCOS). Hyperinsulinaemia contributes to anovulation, hyperandrogenism, infertility and early pregnancy loss in women with PCOS. Chronic hyperinsulinaemia also predisposes women with PCOS to increased risks of diabetes and cardiovascular events. Current data indicate that metformin, either as monotherapy or in combination with clomiphene in clomiphene-resistant patients, is an effective treatment for anovulation in PCOS. Initial evidence also suggests that insulin sensitizers may have a role in preventing early pregnancy loss. Of the available insulin-sensitizing agents, metformin has been the agent most frequently studied in PCOS, and has the least undesirable pregnancy safety profile. Ameliorating the metabolic syndrome associated with insulin resistance in PCOS with metformin may also prevent long-term cardiovascular and diabetes complications, pending further evidence. Based on these data, metformin should be a first-line therapy for women with PCOS.     

Consensus on women's health aspects of polycystic ovary syndrome (PCOS): the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in females, with a high prevalence. The etiology of this heterogeneous condition remains obscure, and its phenotype expression varies. Two widely cited previous ESHRE/ASRM sponsored PCOS consensus workshops focused on diagnosis (published in 2004) and infertility management (published in 2008), respectively. The present third PCOS consensus report summarizes current knowledge and identifies knowledge gaps regarding various women's health aspects of PCOS. Relevant topics addressed-all dealt with in a systematic fashion-include adolescence, hirsutism and acne, contraception, menstrual cycle abnormalities, quality of life, ethnicity, pregnancy complications, long-term metabolic and cardiovascular health, and finally cancer risk. Additional, comprehensive background information is provided separately in an extended online publication.     

辅助生育技术妊娠早产的防治

随着辅助生育技术的不断发展和应用，其不良妊娠结局发生率高于自然妊娠的问题日渐突出，获得广泛关注。其中，早产是最常见、最严重的并发症之一，对早产儿有潜在、长期的影响。因此，要重视辅助生育技术妊娠早产的防治，并明确危险因素，探讨有效的干预措施。     

Pregnancy outcomes and the effect of metformin treatment in women with polycystic ovary syndrome: an overview

This article is a review of the literature assessing pregnancy outcomes and the effect of metformin treatment among women with polycystic ovary syndrome (PCOS). A review of research published in English was undertaken using PubMed and MEDLINE databases. The weight of the available evidence suggests that pregnant women with PCOS are at an increased risk of developing gestational diabetes, hypertensive disorders of pregnancy, preterm birth and early pregnancy loss. Obesity is a contributory factor for the increased risk of gestational diabetes in this group of women and is estimated to affect 5-40% of pregnant women with PCOS. The prevalence of other obstetric complications is estimated at 10-30% for gestational hypertension, 8-15% for pre-eclampsia and 6-15% for preterm birth. The association between PCOS and early pregnancy loss may not be direct, wherein the presence of PCOS-associated hyperinsulinemia, leading to hyperandrogenemia, has been implicated in the pathophysiology of early pregnancy loss. Apart from the role of metformin in improving the metabolic consequences accompanying PCOS, it has been shown to improve pregnancy rates in women with PCOS who are resistant to clomiphene citrate. In conclusion, pregnancy in women with PCOS is associated with adverse obstetric outcomes (multiple adverse obstetric risk). Whether metformin should be administered throughout pregnancy still remains controversial. Further prospective studies that foster a larger number of participants and adjust for all potentially confounding factors are needed.     

Metformin reduces abortion in pregnant women with polycystic ovary syndrome.

BACKGROUND: Women with polycystic ovary syndrome (PCOS) are considered to be at increased risk of miscarriage. Since metformin has beneficial effects on the risk factors contributing to first-trimester abortion in PCOS patients, we hypothesized that metformin - owing to its metabolic, endocrine, vascular and anti-inflammatory effects - may reduce the incidence of first-trimester abortion in PCOS women. MATERIALS AND METHODS: A prospective cohort study was set up to determine the beneficial effects of metformin on PCOS patients during pregnancy. Two hundred non-diabetic PCOS patients were evaluated while undergoing assisted reproduction. One hundred and twenty patients became pregnant while taking metformin, and continued taking metformin at a dose of 1000-2000 mg daily throughout pregnancy. Eighty women who discontinued metformin use at the time of conception or during pregnancy comprised the control group. RESULTS: Both groups were similar with respect to all background characteristics (age, body mass index, waist/hip ratio, follicle-stimulating hormone, luteinizing hormone, estradiol and dehydroepiandrosterone sulfate levels). Rates of early pregnancy loss in the metformin group were 11.6% compared with 36.3% in the control group (p < 0.0001; odds ratio = 0.23, 95% confidence interval 0.11-0.42). CONCLUSIONS: Administration of metformin throughout pregnancy to women with PCOS was associated with a marked and significant reduction in the rate of early pregnancy loss.     

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.     

多囊卵巢综合征诊断分型及临床意义

多囊卵巢综合征（PCOS）的临床表现多样,个体差异较大,通过对其进行诊断分型,关注PCOS患者不同的临床特征、生化特点以及远期代谢并发症的风险,有利于对患者进行个体化治疗和长期管理。