Department of Emergency and Organ Transplantation (DETO), Section of Internal Medicine, Endocrinology and Metabolic Diseases, University of Bari Medical School, Bari, Italy.
Reprod Biomed Online. 2009 Oct;19(4):552-63. doi: 10.1016/j.rbmo.2009.05.010.
In the last few years, polycystic ovary syndrome (PCOS) has deserved major attention because it is linked to the same cluster of events that promote the metabolic syndrome. This review will point out the relationships between fat excess, insulin resistance and the metabolic syndrome. Adipocytes are actually considered as endocrine cells that synthesize and release molecules (adipokines) that play an endocrine/paracrine role, such as adiponectin, atrial natriuretic peptide, leptin, resistin, tumour necrosis factor alpha (TNFalpha). Metabolic syndrome is a chronic low-grade inflammatory condition in which adipokines play a major role. Isolated adipocytes from women with PCOS express higher mRNA concentrations of some adipokines involved in cardiovascular risk and insulin resistance. However, environmental factors and lifestyle play a major role in determining the appearance of the phenotypes of PCOS. In morbid obese women with PCOS, bariatric surgery decreases bodyweight and fat excess and reverses hyperandrogenism and sterility. In lean or overweight women with PCOS, changes in lifestyle in combination with drugs reducing visceral fat and insulin resistance reverse the symptoms and signs of PCOS. Promising treatments for PCOS seem to be insulin sensitizers such as metformin and glitazones.
在过去的几年中，多囊卵巢综合征（PCOS）受到了极大的关注，因为它与促进代谢综合征的同一组事件有关。本文将指出脂肪过多、胰岛素抵抗和代谢综合征之间的关系。脂肪细胞实际上被认为是合成和释放分子（脂肪因子）的内分泌细胞，这些分子发挥着内分泌/旁分泌作用，如脂联素、心钠肽、瘦素、抵抗素、肿瘤坏死因子-α（TNF-α）。代谢综合征是一种慢性低度炎症状态，其中脂肪因子起着重要作用。从患有 PCOS 的女性的分离的脂肪细胞中表达了更高的一些涉及心血管风险和胰岛素抵抗的脂肪因子的 mRNA 浓度。然而，环境因素和生活方式在决定 PCOS 的表型出现方面起着重要作用。在患有 PCOS 的病态肥胖女性中，减重手术可降低体重和脂肪过多，并逆转高雄激素血症和不育症。在患有 PCOS 的瘦或超重女性中，改变生活方式并结合减少内脏脂肪和胰岛素抵抗的药物可逆转 PCOS 的症状和体征。对于 PCOS 有希望的治疗方法似乎是胰岛素增敏剂，如二甲双胍和噻唑烷二酮。
