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[多囊卵巢综合征(PCOS)]

[Polycystic ovary syndrome (PCOS)].

作者信息

Torre A, Fernandez H

机构信息

Université Paris-Sud, UMR-S0782, Service de gynécologie-obstétrique et de médecine de la reproduction, hôpital Antoine-Béclère, APHP, 157, rue de la Porte-de-Trivaux, 92141 Clamart cedex, France.

出版信息

J Gynecol Obstet Biol Reprod (Paris). 2007 Sep;36(5):423-46. doi: 10.1016/j.jgyn.2007.04.002. Epub 2007 May 30.

Abstract

Polycystic ovaries syndrome (PCOS) is one of the most common female hormonal disorders. Its multiple components--reproductive, metabolic, neoplasic and cardiovascular--have a major impact on the public health. Androgen excess and resistance to insulin, probably from genetic origin, are responsible for most of the clinical symptomatology. Resistance to insulin seems to be accompanied by a greater risk of glucose intolerance, type 2 diabetes, lipidic anomalies and can involve the development of cardiovascular diseases. In addition, sleep apnea syndrome is more progressively described in PCOS. Infertility, menses disorders and hirsutism often push these patients to consult their physician. A better understanding of the physiopathological mechanisms led to the emergence of new therapeutic options increasing the sensitivity to insulin. Besides the pregnancy wishes, cares aim to attenuate the marks of the hyper-androgenism (hormonal treatment and cosmetic) and to correct cardiovascular, respiratory and gynaecological risk factors. In case of infertility by anovulation, cares must be performed by trained experts to minimize the risk of ovarian hyper-stimulation syndrome and multiple pregnancies. A gradation from loose weight to clomiphene citrate ovulation induction, ovarian drilling, low dose gonadotropin, in vitro fertilisation, or in vitro maturation of oocytes should bring back good reproduction potential.

摘要

多囊卵巢综合征(PCOS)是最常见的女性激素紊乱疾病之一。其多个方面——生殖、代谢、肿瘤和心血管方面——对公众健康有重大影响。雄激素过多和胰岛素抵抗可能源于遗传,是大多数临床症状的原因。胰岛素抵抗似乎伴随着更高的葡萄糖不耐受、2型糖尿病、脂质异常风险,并且可能涉及心血管疾病的发展。此外,多囊卵巢综合征患者中睡眠呼吸暂停综合征的描述越来越多。不孕、月经紊乱和多毛症常常促使这些患者就医。对生理病理机制的更好理解导致了新的治疗选择的出现,这些选择提高了对胰岛素的敏感性。除了怀孕意愿外,治疗旨在减轻高雄激素血症的症状(激素治疗和美容),并纠正心血管、呼吸和妇科风险因素。如果因无排卵导致不孕,必须由训练有素的专家进行治疗,以尽量降低卵巢过度刺激综合征和多胎妊娠的风险。从减肥到克罗米芬促排卵、卵巢打孔、低剂量促性腺激素、体外受精或卵母细胞体外成熟的分级治疗应能恢复良好的生殖潜力。

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