Dept. Obstetrics and Gynecology, Sheba Medical Center, Tel Aviv University, Tel Hashomer, 52651, Israel.
Dept. Obstetrics and Gynecology, Sheba Medical Center, Tel Aviv University, Tel Hashomer, 52651, Israel.
Best Pract Res Clin Obstet Gynaecol. 2019 Oct;60:42-55. doi: 10.1016/j.bpobgyn.2019.07.008. Epub 2019 Jul 29.
Premature ovarian insufficiency (POI) is a clinical syndrome defined by loss of ovarian activity before the age of 40 years and has a potentially devastating effect upon women's health, both physically and psychologically. An underlying autoimmune disease has been identified in approximately 20% of patients with POI, the most common of which are disorders of the thyroid and adrenal glands. Nevertheless, in the majority of cases, the etiology is unknown. The damage mechanism to the ovary is usually caused by antibodies, and autoimmune POI is usually characterized by cellular infiltration of the theca cells of growing follicles by various inflammatory cells. Yet, other various factors and proteins of unknown clinical significance are present. The major diagnostic tool for otherwise idiopathic POI is the presence of autoantibodies against various ovarian components that strongly support the option of autoimmune etiology of POI. Treatment of the underlying cause of POI is the main strategy, although immunosuppressive therapy should be considered in a selected population of well-defined autoimmune POI and, as in idiopathic POI, in whom the resumption of ovarian activity is possible.
卵巢早衰（POI）是一种临床综合征，其定义为 40 岁以前卵巢活动丧失，对女性的身心健康都有潜在的破坏性影响。约 20%的 POI 患者存在潜在自身免疫性疾病，最常见的是甲状腺和肾上腺疾病。然而，在大多数情况下，病因不明。卵巢损伤的机制通常是由抗体引起的，自身免疫性 POI 通常表现为各种炎症细胞浸润正在生长的卵泡的膜细胞。然而，目前还存在其他各种具有未知临床意义的因素和蛋白质。对于其他特发性 POI，主要的诊断工具是存在针对各种卵巢成分的自身抗体，这强烈支持 POI 的自身免疫病因。治疗 POI 的根本原因是主要策略，尽管免疫抑制疗法应考虑在明确自身免疫性 POI 的特定人群中使用，并且在特发性 POI 中也应考虑使用，因为在这些患者中可能恢复卵巢活动。
