Polycystic ovary syndrome: insight into pathogenesis and a common association with insulin resistance
Polycystic ovary syndrome: insight into pathogenesis and a common association with insulin resistance
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DOI：
10.7861/clinmedicine.16-3-262
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发表时间：
2016-06-01
影响因子：
4.4
通讯作者：
Franks, Stephen
中科院分区：
文献类型：
--
作者：
Barber, Thomas M.;Dimitriadis, George K.;Franks, Stephen
多囊卵巢综合征（PCOS）是一种常见的疾病，通常发生在育龄妇女身上。PCOS的主要临床和生化特征包括生殖功能障碍和高雄激素特征。根据流行病学和遗传学研究的数据，PCOS也与肥胖密切相关。因此，PCOS通常在那些携带遗传易感性的妇女中表现出来，并且体重也增加。体重增加和肥胖在PCOS发展中的作用至少部分是通过胰岛素抵抗的恶化介导的。在这种情况下发生的代偿性高胰岛素血症会破坏卵巢功能，增加雄激素的产生并阻止卵巢卵泡发育。胰岛素抵抗也有助于PCOS与不良代谢风险的密切联系，包括血脂异常，血脂异常和脂肪肝。相反，仅5%体重的适度体重减轻伴随胰岛素敏感性的改善，经常导致高雄激素、生殖和代谢特征的临床上有意义的改善。未来开发的新的治疗方法，肥胖妇女与PCOS应集中在促进减肥和改善胰岛素敏感性。在这种情况下，补充生活方式改变的疗法，如饮食调整和运动，特别是在减肥的维持阶段是重要的。PCOS治疗的假定新靶点包括人类棕色脂肪组织。
Polycystic ovary syndrome (PCOS) is a common condition that typically develops in reproductive-age women. The cardinal clinical and biochemical characteristics of PCOS include reproductive dysfunction and hyperandrogenic features. PCOS is also strongly associated with obesity based on data from epidemiological and genetic studies. Accordingly, PCOS often becomes manifest in those women who carry a genetic predisposition to its development, and who also gain weight. The role of weight gain and obesity in the development of PCOS is mediated at least in part, through worsening of insulin resistance. Compensatory hyperinsulinaemia that develops in this context disrupts ovarian function, with enhanced androgen production and arrest of ovarian follicular development. Insulin resistance also contributes to the strong association of PCOS with adverse metabolic risk, including dysglycaemia, dyslipidaemia and fatty liver. Conversely, modest weight loss of just 5% body weight with improvement in insulin sensitivity, frequently results in clinically meaningful improvements in hyperandrogenic, reproductive and metabolic features. Future developments of novel therapies for obese women with PCOS should focus on promotion of weight loss and improvement in insulin sensitivity. In this context, therapies that complement lifestyle changes such as dietary modification and exercise, particularly during the maintenance phase of weight loss are important. Putative novel targets for therapy in PCOS include human brown adipose tissue.