Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland.
JAMA Pediatr. 2016 May 1;170(5):502-7. doi: 10.1001/jamapediatrics.2015.4866.
Polycystic ovary syndrome is characterized by an excess in androgen levels, ovarian dysfunction, and polycystic ovarian morphology but is also associated with metabolic dysfunction and risk factors for cardiovascular disease. To our knowledge, there are few therapeutic recommendations for these cardiometabolic risk factors and little evidence of their long-term clinical relevance to cardiovascular health.
To determine metabolic and/or cardiovascular outcomes in polycystic ovary syndrome treatment literature since the publication of the most recent Endocrine Society clinical practice guidelines in 2013.
We searched PubMed using a string of variations of polycystic ovary syndrome, therapy/treatment, and adolescence, and we included English-language original research articles published while the 2013 clinical practice guidelines were disseminated (ie, articles published from January 1, 2011, to June 1, 2015). Articles that appeared relevant based on a review of titles and abstracts were read in full to determine relevancy. References from relevant articles were reviewed for additional studies.
Four topic areas emerged: (1) lifestyle modification, (2) metformin vs placebo or estrogen-progestin oral contraceptives, (3) insulin-sensitizing agents, and (4) estrogen-progestin formulations. Most studies assessed the role of metformin as a monotherapy or dual therapy supplement and found significant benefit when including metformin in polycystic ovary syndrome treatment regimens. Studies showed improvements in cardiometabolic risk factors and, in several, androgen excess and cutaneous and menstrual symptoms. Studies were limited by sample size (range, 22-171), few adolescent participants, and short-term outcomes.
Findings show potential for metformin and estrogen-progestin dual therapy but warrant longitudinal studies examining outcomes from adolescence through middle age to determine the effect on long-term cardiovascular health.
多囊卵巢综合征的特点是雄激素水平过高、卵巢功能障碍和多囊卵巢形态，但也与代谢功能障碍和心血管疾病的危险因素有关。据我们所知，针对这些心脏代谢危险因素的治疗建议很少，并且几乎没有证据表明它们对心血管健康的长期临床相关性。
自 2013 年发布最新的内分泌学会临床实践指南以来，确定多囊卵巢综合征治疗文献中的代谢和/或心血管结局。
我们使用多囊卵巢综合征、治疗/治疗和青春期的各种变体在 PubMed 上进行了搜索，并且纳入了在 2013 年临床实践指南传播期间（即 2011 年 1 月 1 日至 2015 年 6 月 1 日）发表的英语原创研究文章。根据标题和摘要的审查，认为与标题和摘要相关的文章将进行全文阅读以确定相关性。从相关文章的参考文献中审查了其他研究。
出现了四个主题领域：（1）生活方式改变，（2）二甲双胍与安慰剂或雌激素-孕激素口服避孕药，（3）胰岛素增敏剂，和（4）雌激素-孕激素配方。大多数研究评估了二甲双胍作为单一疗法或双重疗法补充的作用，并发现将二甲双胍纳入多囊卵巢综合征治疗方案中具有显著益处。研究表明改善了心脏代谢危险因素，并且在几种情况下，雄激素过多和皮肤和月经症状得到改善。研究受到样本量小（范围为 22-171）、青少年参与者少和短期结果的限制。
研究结果表明二甲双胍和雌激素-孕激素双重疗法具有潜力，但需要进行纵向研究，以检查青春期至中年的结果，以确定其对长期心血管健康的影响。
