Barber Thomas M, Vojtechova Petra, Franks Stephen
Clinical Sciences Research Laboratories, Division of Metabolic and Vascular Health, University of Warwick, University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, UK.
Horm Mol Biol Clin Investig. 2013 Sep;15(3):91-103. doi: 10.1515/hmbci-2013-0014.
Polycystic ovary syndrome (PCOS) is a common condition characterized by reproductive and hyperandrogenic features and is often associated with obesity and metabolic dysfunction. Overall, women with PCOS have a substantially greater prevalence of metabolic syndrome than women from the general population. Furthermore, PCOS per se (independent of its frequent association with obesity) often confers cardiometabolic risk (including insulin resistance), and its concurrence with obesity often represents a metabolic "double-whammy" from the adverse effects of PCOS and obesity. The introduction of the Rotterdam diagnostic criteria for PCOS in 2003 has broadened the scope of this condition. The Rotterdam diagnostic criteria have also introduced two new phenotypic subgroups (including normoandrogenemic women with PCOS) that have provided novel insights into a potential role for hyperandrogenism in the development of adverse cardiometabolic risk in women with PCOS. Based on evidence from cross-sectional and interventional studies, hyperandrogenism, obesity, and cardiometabolic risk in women appear to be linked through complex and multidirectional pathways. Furthermore, data from obese women without a formal diagnosis of PCOS also suggest that these interrelationships often exist in female obesity per se (in milder forms than occurs in PCOS). Data from female-to-male transsexuals are particularly informative because these show direct effects of hyperandrogenism (induced through exogenous use of androgenic therapies) on fat distribution and cardiometabolic risk in women. A challenge for the future will be to disentangle and improve our understanding of this complex pathogenic web, thereby facilitating novel and targeted therapies for the hyperandrogenic and adverse cardiometabolic manifestations of PCOS.
多囊卵巢综合征（PCOS）是一种常见病症，其特征为生殖方面的问题和雄激素过多，常与肥胖及代谢功能障碍相关。总体而言，患有PCOS的女性患代谢综合征的患病率显著高于普通人群中的女性。此外，PCOS本身（独立于其与肥胖的常见关联）通常会带来心脏代谢风险（包括胰岛素抵抗），而它与肥胖同时存在往往代表着PCOS和肥胖的不良影响所形成的代谢“双重打击”。2003年引入的PCOS鹿特丹诊断标准拓宽了这一病症的范畴。鹿特丹诊断标准还引入了两个新的表型亚组（包括雄激素正常的PCOS女性），这为雄激素过多在PCOS女性不良心脏代谢风险发展中的潜在作用提供了新的见解。基于横断面研究和干预性研究的证据，女性体内的雄激素过多、肥胖和心脏代谢风险似乎通过复杂且多向的途径相互关联。此外，未被正式诊断为PCOS的肥胖女性的数据也表明，这些相互关系在女性肥胖本身中常常存在（形式比PCOS中出现的更为轻微）。女性向男性变性者的数据尤其具有参考价值，因为这些数据显示了雄激素过多（通过外源性使用雄激素疗法诱导产生）对女性脂肪分布和心脏代谢风险的直接影响。未来的一个挑战将是理清并加深我们对这个复杂致病网络的理解，从而为PCOS的雄激素过多和不良心脏代谢表现开发新的靶向治疗方法。
