Knochenhauer E S, Key T J, Kahsar-Miller M, Waggoner W, Boots L R, Azziz R
Department of Obstetrics and Gynecology, University of Alabama, Birmingham 35233, USA.
J Clin Endocrinol Metab. 1998 Sep;83(9):3078-82. doi: 10.1210/jcem.83.9.5090.
Estimates of the prevalence of the polycystic ovary syndrome (PCOS) in the general population have ranged from 2-20%. The vast majority of these reports have studied White populations in Europe, used limited definitions of the disorder, and/or used bias populations, such as those seeking medical care. To estimate the prevalence of this disorder in the United States and address these limitations, we prospectively determined the prevalence of PCOS in a reproductive-aged population of 369 consecutive women (174 White and 195 Black; aged 18-45 yr), examined at the time of their preemployment physical. Body measures were obtained, and body hair was quantified by a modified Ferriman-Gallwey (F-G) method. All exams were initially performed by 2 trained nurses, and any subject with an F-G score above 3 was reexamined by a physician, the same for all patients. Of the 369 women, 277 (75.1%) also agreed to complete a questionnaire and have additional blood drawn. Subjects were studied regardless of current estrogen/progestin hormonal use (28.5%). PCOS was defined as 1) oligoovulation, 2) clinical hyperandrogenism (i.e. hirsutism) and/or hyperandrogenemia, and 3) exclusion of other related disorders, such as hyperprolactinemia, thyroid abnormalities, and non-classic adrenal hyperplasia. Hirsutism was defined by a F-G score of 6 or more, and hyperandrogenemia was defined as a total or free testosterone, androstenedione, and/or dehydroepiandrosterone sulfate level above the 95th percentile of control values [i.e. all eumenorrheic women in the study, who had no hirsutism (F-G < or = 5) or acne and were receiving no hormonal therapy; n = 98]. Considering all 369 women studied, White and Black women had similar mean ages (29.4 +/- 7.1 and 31.1 +/- 7.8 yr, respectively), although White women had a lesser body mass than Black women (24.9 +/- 6.1 vs. 29.2 +/- 8.1 kg/m2, respectively; P < 0.001). Of these 7.6%, 4.6%, and 1.9% demonstrated a F-G score of 6 or more, 8 or 10, respectively, and there was no significant racial difference, with hirsutism prevalences of 8.0%, 2.8%, and 1.6% in Whites, and 7.1%, 6.1%, and 2.1% in Blacks, respectively. Of the 277 women consenting to a history and hormonal evaluation, 4.0% had PCOS as defined, 4.7% (6 of 129) of Whites and 3.4% (5 of 148) of Blacks. In conclusion, in our consecutive population of unselected women the prevalence of hirsutism varied from 2-8% depending on the chosen cut-off F-G score, with no significant difference between White and Black women. Using an F-G score of 6 or more as indicative of hirsutism, 3.4% of Blacks and 4.7% of Whites had PCOS as defined. These data suggest that PCOS may be one of most common reproductive endocrinological disorders of women.
普通人群中多囊卵巢综合征（PCOS）的患病率估计在2%至20%之间。这些报告中的绝大多数研究的是欧洲的白人人群，对该疾病的定义有限，和/或使用了有偏差的人群，比如那些寻求医疗护理的人群。为了估计美国该疾病的患病率并解决这些局限性，我们前瞻性地确定了369名连续的育龄妇女（174名白人、195名黑人；年龄18 - 45岁）在入职前体检时PCOS的患病率。测量了身体指标，并通过改良的费里曼 - 盖尔维（F - G）方法对体毛进行量化。所有检查最初由2名经过培训的护士进行，任何F - G评分高于3分的受试者都由医生重新检查，所有患者均如此。在这369名女性中，277名（75.1%）还同意填写问卷并抽取额外的血液样本。无论当前是否使用雌激素/孕激素（占28.5%），均对受试者进行研究。PCOS的定义为：1）排卵稀少；2）临床高雄激素血症（即多毛症）和/或高雄激素血症；3）排除其他相关疾病，如高泌乳素血症、甲状腺异常和非经典肾上腺皮质增生。多毛症定义为F - G评分为6分或更高，高雄激素血症定义为总睾酮、游离睾酮、雄烯二酮和/或硫酸脱氢表雄酮水平高于对照值的第95百分位数[即研究中所有月经周期正常、无多毛症（F - G≤5）或痤疮且未接受激素治疗的女性；n = 98]。考虑到所研究的全部369名女性，白人女性和黑人女性的平均年龄相似（分别为29.4±7.1岁和31.1±7.8岁），尽管白人女性的体重指数低于黑人女性（分别为24.9±6.1 vs. 29.2±8.1 kg/m²；P < 0.001）。其中，7.6%、4.6%和1.9%的女性F - G评分分别为6分或更高、8分或10分，且种族差异不显著，白人女性的多毛症患病率分别为8.0%、2.8%和1.6%，黑人女性分别为7.1%、6.1%和2.1%。在277名同意进行病史和激素评估的女性中，4.0%患有定义中的PCOS，白人女性中为4.7%（129名中有6名），黑人女性中为3.4%（148名中有5名）。总之，在我们连续选取的未经过筛选的女性人群中，根据所选的F - G评分临界值，多毛症的患病率在2%至8%之间，白人女性和黑人女性之间无显著差异。以F - G评分为6分或更高作为多毛症的指标，3.4%的黑人女性和4.7%的白人女性患有定义中的PCOS。这些数据表明，PCOS可能是女性最常见的生殖内分泌疾病之一。
