青春期多囊卵巢综合征诊治共识ppt课件.ppt

Diagnostic features of PCOS are hirsutism, anovulation, and polycystic ovaries, which show arrested follicular maturation; obesity and insulin resistance are frequently associated conditions. The major biochemical feature of PCOS is androgen excess, which causes hirsutism. Androgens also appear to inhibit the negative-feedback effects of estrogens and progesterone on pulsatile LH release. Women with PCOS have increased pulsatile GnRH release, which results in higher levels of LH and lower levels of FSH in most individuals. Higher LH (and insulin) levels seem to cause increased androgen production by follicular theca cells whereas lower FSH levels lead to anovulation. Obesity and insulin resistance decrease levels of sex-hormone-binding globulin and thereby increase testosterone bioactivity. If follicular granulosa cells are insulin resistant, it might affect their responses to FSH; otherwise, granulosa cells appear to be very capable of releasing estrogen in response to FSH, perhaps as a result of the actions of androgens and insulin. Abbreviations: FSH, follicle-stimulating hormone; GnRH, gonadotropin-releasing hormone; LH, luteinizing hormone. * 青春期多囊卵巢综合征诊治共识 前 言 多囊卵巢综合征(polycystic ovary syndrome, PCOS)是育龄女性最常见的内分泌紊乱性疾病, 是引起不排卵性不孕的主要原因 PCOS临床表现异质性，不但严重影响患者的生殖功能，而且远期并发症如子宫内膜癌发病率增加，相关的代谢失调包括高雄激素血症、胰岛素抵抗、糖代谢异常、脂代谢异常、心血管疾病危险也增加 目前认为，对PCOS的诊断应从青春期开始。根据2003年鹿特丹诊断标准，国外青春期PCOS发病率为8.3%～9.13%，国内约为5.74%。 PCOS的病理生理学 Franks, S.?et al, Int J Obes. 2008,?32:1035–1041 下丘脑-垂体-卵巢轴（HPO）功能紊乱； 胰岛素抵抗和高胰岛素血症； 肾上腺内分泌功能异常 PCOS的病理生理学 Chang RJ , Nat Clin Pract Endocrinol Metab 2007, 3: 688–695 高雄激素、高雌激素、黄体生成素增加、卵泡刺激素降低、高胰岛素 1. 月经改变： 青春期PCOS的月经模式主要表现为月经稀发、月经不规律和继发性闭经。约85％女孩在初潮第1年的月经都是无排卵的，但绝大部分在初潮后2年出现规律排卵，持续无排卵少女可能是发生青春期PCOS的高危人群。初潮2年后仍出现月经稀发或闭经者应高度警惕PCOS的发生。青春期月经稀发同时伴有高雄激素临床和生化表现可能是PCOS的特点之一。 青春期ＰＣＯＳ主要临床特征 2. 高雄激素血症 患有PCOS的青少年常有多毛症和（或）开始于初潮前或在初潮前后发生的痤疮。国内研究显示，初潮后２～３年的青春期PCOS患者Ferriman-Gallwey评分（ F-G 评分）、睾酮（T）、游离睾酮（FT）和游离雄激素指数（FAI）都明显有别于同龄青春期对照组患者。 青春期PC