Bozdag Gurkan, Mumusoglu Sezcan, Zengin Dila, Karabulut Erdem, Yildiz Bulent Okan
Department of Obstetrics and Gynecology, School of Medicine, Hacettepe University, 06100, Sihhiye, Ankara, Turkey.
Department of Biostatistics, School of Medicine, Hacettepe University, 06100, Sihhiye, Ankara, Turkey.
Hum Reprod. 2016 Dec;31(12):2841-2855. doi: 10.1093/humrep/dew218. Epub 2016 Sep 22.
What is the reported overall prevalence of polycystic ovary syndrome (PCOS) according to the criteria of the National Institutes of Health (NIH), Rotterdam or the Androgen Excess and PCOS Society (AE-PCOS Society)?
The reported overall prevalence of PCOS (95% CI) according to diagnostic criteria of the NIH, Rotterdam and the AE-PCOS Society is 6% (5-8%, n = 18 trials), 10% (8-13%, n = 15 trials) and 10% (7-13%, n = 10 trials), respectively.
PCOS is the most common endocrine disorder among women of reproductive age. Although many studies have investigated the prevalence of PCOS, there are discrepancies in their results, in part due to the use of various definitions of the syndrome and its subphenotypes, differences between study cohorts, ethnicities, and types of recruitment and sampling.
STUDY DESIGN, SIZE, DURATION: A systematic review and meta-analysis were performed on all published studies that have reported the prevalence of PCOS according to at least one subset of diagnostic criteria.
PARTICIPANTS/MATERIALS, SETTING, METHODS: To identify relevant studies based on the PRISMA statement, PubMed and Ovid databases were searched up to September 2015 by two blind investigators using the terms 'PCOS', 'polycystic ovarian disease', 'Stein Leventhal syndrome', 'Androgen Excess Society', 'National Institute of Health', 'Rotterdam', 'ESHRE/ASRM', 'criteria' and 'prevalence'. Articles that represented the prevalence of PCOS according to at least one subset of diagnostic criteria were included. Exclusion criteria were a focus on adolescent subjects, an absence of data on prevalence, inappropriate design or non-English reporting. An appraisal tool to evaluate the methodological quality of the available studies was generated by the authors.
A total of 55 reports remained following screening of the abstracts and text for the subject of the study. Of these, 24 articles were eligible and evaluated for qualitative and quantitative synthesis. Since heterogeneity was observed among studies, a random-effects model was used to estimate the prevalence and its 95% CI. The proportions of PCOS prevalence (95% CI) according to the diagnostic criteria of NIH, Rotterdam and AE-PCOS Society were 6% (5-8%, n = 18 trials), 10% (8-13%, n = 15 trials) and 10% (7-13%, n = 10 trials), respectively. When only unselected population studies were included, the given rates were 6% (5-8%, n = 3 trials), 9% (7-12%, n = 6 trials) and 10% (7-14%, n = 3 trials). The respective proportions for hirsutism, hyperandrogenaemia, polycystic ovaries (PCO) and oligo-anovulation were 13% (8-20%, n = 14 trials), 11% (8-15%, n = 9 trials), 28% (22-35%, n = 12 trials) and 15% (12-18%, n = 19 trials), respectively.
LIMITATIONS, REASONS FOR CAUTION: The effects of ethnic differences, particularly, on the presence or severity of hirsutism cannot be ruled out in any way. In addition, there was a lack of standardization in defining phenotypes of the syndrome and selection bias was evident in most of the studies regarding recruitment of the cohorts.
Geographical differences in frequencies of the components of the syndrome, such as oligo-anovulation and clinical/biochemical androgen excess, must be taken into account in the development and implementation of regional diagnostic and precision treatment strategies. Further efforts and resources are required to increase standardization of the methods and comparability of the study results on prevalence and phenotypic characterization of PCOS around the globe.
STUDY FUNDING/COMPETING INTERESTS: No funding to declare. The authors have no conflicts of interest to declare.
None.
根据美国国立卫生研究院（NIH）、鹿特丹或雄激素过多与多囊卵巢综合征协会（AE-PCOS协会）的标准，多囊卵巢综合征（PCOS）报告的总体患病率是多少？
根据NIH、鹿特丹和AE-PCOS协会的诊断标准，报告的PCOS总体患病率（95%CI）分别为6%（5-8%，n = 18项试验）、10%（8-13%，n = 15项试验）和10%（7-13%，n = 10项试验）。
PCOS是育龄女性中最常见的内分泌疾病。尽管许多研究调查了PCOS的患病率，但其结果存在差异，部分原因是该综合征及其亚表型的定义不同、研究队列、种族以及招募和抽样类型之间存在差异。
研究设计、规模、持续时间：对所有已发表的、根据至少一组诊断标准报告了PCOS患病率的研究进行了系统评价和荟萃分析。
参与者/材料、设置、方法：为了根据PRISMA声明识别相关研究，两名盲法研究者在2015年9月之前使用“PCOS”、“多囊卵巢疾病”、“斯坦-莱文塔尔综合征”、“雄激素过多协会”、“美国国立卫生研究院”、“鹿特丹”、“ESHRE/ASRM”、“标准”和“患病率”等术语在PubMed和Ovid数据库中进行了检索。纳入了根据至少一组诊断标准表示PCOS患病率的文章。排除标准为关注青少年受试者、缺乏患病率数据、设计不当或非英文报告。作者生成了一种评估工具来评估现有研究的方法学质量。
在对摘要和正文进行研究主题筛选后，共保留了55篇报告。其中，24篇文章符合条件并进行了定性和定量综合分析。由于研究之间存在异质性，因此使用随机效应模型来估计患病率及其95%CI。根据NIH、鹿特丹和AE-PCOS协会的诊断标准，PCOS患病率（95%CI）分别为6%（5-8%，n = 18项试验）、10%（8-13%，n = 15项试验）和10%（7-13%，n = 10项试验）。仅纳入未选择人群的研究时，给定的患病率分别为6%（5-8%，n = 3项试验）、9%（7-12%，n = 6项试验）和10%（7-14%，n = 3项试验）。多毛症、高雄激素血症、多囊卵巢（PCO）和少排卵的各自比例分别为13%（8-20%，n = 14项试验）、11%（8-15%，n = 9项试验）、28%（22-35%，n = 12项试验）和15%（12-18%，n = 19项试验）。
局限性、谨慎原因：种族差异的影响，特别是对多毛症的存在或严重程度的影响，无论如何都不能排除。此外，该综合征表型的定义缺乏标准化，并且在大多数关于队列招募的研究中存在明显的选择偏倚。
在制定和实施区域诊断和精准治疗策略时，必须考虑该综合征各组成部分（如少排卵和临床/生化雄激素过多）频率的地理差异。需要进一步努力和资源，以提高全球范围内PCOS患病率和表型特征研究结果的方法标准化和可比性。
研究资金/利益冲突：无需申报资金。作者声明无利益冲突。
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