Dunaif A
Department of Medicine, Penn State University College of Medicine, Hershey 17033.
Am J Med. 1995 Jan 16;98(1A):33S-39S. doi: 10.1016/s0002-9343(99)80057-6.
Polycystic ovary syndrome is the most common endocrine disorder in women of reproductive age. Recent prevalence estimates suggest that 5-10% of premenopausal women have the full-blown syndrome of hyperandrogenism, chronic anovulation, and polycystic ovaries. Evidence suggests that women with polycystic ovary syndrome have a unique disorder of insulin action and are at increased risk to develop non-insulin-dependent diabetes mellitus. Further, non-insulin-dependent diabetes mellitus in women with polycystic ovary syndrome has a substantially earlier age of onset (third to fourth decades) than it does in the general population (sixth to seventh decades). Studies assessing whether abnormalities in insulin action are intrinsic or secondary to the hormonal milieu have found that insulin-induced receptor autophosphorylation is markedly diminished in approximately 50% of polycystic ovary syndrome women. This defect is unique to women with polycystic ovary syndrome and is not seen in other common insulin-resistant states of obesity and non-insulin-dependent diabetes mellitus. In polycystic ovary syndrome women who have normal receptor autophosphorylation, it remains likely that signaling mechanisms downstream of the receptor are abnormal, since these women are also insulin resistant. This distinctive post-insulin-binding defect appears to be genetic, since it is present in cells removed from the in vivo environment for generations.
多囊卵巢综合征是育龄女性最常见的内分泌紊乱疾病。近期患病率估计表明，5%至10%的绝经前女性患有雄激素过多、慢性无排卵和多囊卵巢的典型综合征。有证据表明，多囊卵巢综合征女性存在独特的胰岛素作用紊乱，患非胰岛素依赖型糖尿病的风险增加。此外，多囊卵巢综合征女性患非胰岛素依赖型糖尿病的发病年龄（三十至四十岁）比一般人群（六十至七十岁）要早得多。评估胰岛素作用异常是内在的还是激素环境继发的研究发现，约50%的多囊卵巢综合征女性胰岛素诱导的受体自身磷酸化明显减少。这种缺陷是多囊卵巢综合征女性所特有的，在肥胖和非胰岛素依赖型糖尿病等其他常见胰岛素抵抗状态中未见。在受体自身磷酸化正常的多囊卵巢综合征女性中，受体下游的信号传导机制仍可能异常，因为这些女性也存在胰岛素抵抗。这种独特的胰岛素结合后缺陷似乎是遗传性的，因为它在从体内环境中取出几代的细胞中都存在。
