Galal Ahmed F, Mitwally Mohamed F
a Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, Minneapolis, MN 55454, USA.
b Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, 606 24th Avenue South, Suite 402, Minneapolis, MN 55454, USA.
Expert Rev Endocrinol Metab. 2009 Mar;4(2):183-192. doi: 10.1586/17446651.4.2.183.
Polycystic ovarian syndrome (PCOS) is the most frequent endocrine disorder and most common cause of anovulation in women of reproductive age. It is a heterogeneous disorder, characterized by excess androgen, ovulatory dysfunction and/or polycystic ovaries. The syndrome is known for its association with several reproductive problems, including infertility and obstetric adverse effects. In addition, significant long-term health problems have been strongly linked to PCOS, with women suffering from the disorder having a significantly higher risk of diabetes, cardiovascular risk and some types of cancer, such as endometrial cancer. Although its etiology is unknown, insulin resistance is believed to play a pivotal role in its pathophysiology, with insulin sensitizers found to provide an exciting option in managing health problems associated with PCOS. Almost a decade ago, we proposed a non-insulin-sensitizing mechanism of action for insulin sensitizers through their effect on steroidogenesis. Accumulating evidence supported such an assumption, with solid evidence for a modulating effect on steroidogenesis by metformin and glitazones in the ovaries, adrenal glands and fat cells. Furthermore, other exciting positive roles for insulin sensitizers, in particular glitazones, have been reported at the level of endothelial function. Studying the value of insulin sensitizers in preventing long-term health problems in women with PCOS is still in the stage of infancy.
多囊卵巢综合征（PCOS）是育龄女性中最常见的内分泌紊乱疾病，也是无排卵的最常见原因。它是一种异质性疾病，其特征为雄激素过多、排卵功能障碍和/或多囊卵巢。该综合征因与多种生殖问题相关而闻名，包括不孕症和产科不良影响。此外，严重的长期健康问题与PCOS密切相关，患有该疾病的女性患糖尿病、心血管疾病风险以及某些类型癌症（如子宫内膜癌）的风险显著更高。尽管其病因尚不清楚，但胰岛素抵抗被认为在其病理生理学中起关键作用，胰岛素增敏剂被发现为管理与PCOS相关的健康问题提供了一个令人兴奋的选择。大约十年前，我们提出了胰岛素增敏剂通过其对类固醇生成的作用的非胰岛素增敏作用机制。越来越多的证据支持这一假设，有确凿证据表明二甲双胍和格列酮类药物对卵巢、肾上腺和脂肪细胞中的类固醇生成有调节作用。此外，胰岛素增敏剂，特别是格列酮类药物，在内皮功能水平上还具有其他令人兴奋的积极作用。研究胰岛素增敏剂在预防PCOS女性长期健康问题方面的价值仍处于起步阶段。
