Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline.
Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline.
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DOI：
10.1210/jc.2013-2350
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发表时间：
2013-12
期刊：
影响因子：
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通讯作者：
Endocrine Society
中科院分区：
文献类型：
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作者：
Legro RS;Arslanian SA;Ehrmann DA;Hoeger KM;Murad MH;Pasquali R;Welt CK;Endocrine Society
目的是为多囊卵巢综合征（PCOS）的诊断和治疗制定实践指南。由内分泌学会指定的专家工作组、一名方法学家和一名医学作家制定了该指南。本循证指南采用建议、评估、发展和评价分级（GRADE）系统来描述建议的强度和证据的质量。一次小组会议、几次电话会议和电子邮件通信促成了共识。内分泌学会和欧洲内分泌学会的委员会和成员对这些指南的初步草案进行了审查和评论。进行了两项系统评价，以总结支持证据。我们建议使用鹿特丹标准诊断多囊卵巢综合征（存在以下两个标准：雄激素过量，排卵功能障碍，或多囊卵巢）。对青少年和绝经期妇女进行多囊卵巢综合征的诊断是有问题的。高雄激素是中心的表现在青少年，而没有一致的表型在绝经后妇女。对多囊卵巢综合征妇女的评估应排除其他雄激素过量障碍和子宫内膜癌、情绪障碍、阻塞性睡眠呼吸暂停、糖尿病和心血管疾病的危险因素。激素避孕药是第一线管理月经异常和多囊卵巢综合征多毛/痤疮。克罗米芬目前是治疗不孕症的一线药物；二甲双胍对代谢/血糖异常和改善月经不规律有益，但在治疗多毛症、痤疮或不孕症方面作用有限或没有作用。激素避孕药和二甲双胍是青少年多囊卵巢综合征的治疗选择。体重减轻在改善PCOS状态中的作用本身尚不确定，但生活方式干预对超重/肥胖患者的其他健康益处是有益的。噻唑烷二酮类药物的风险收益比总体上不利，他汀类药物有待进一步研究。
The aim was to formulate practice guidelines for the diagnosis and treatment of polycystic ovary syndrome (PCOS). An Endocrine Society-appointed Task Force of experts, a methodologist, and a medical writer developed the guideline. This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe both the strength of recommendations and the quality of evidence. One group meeting, several conference calls, and e-mail communications enabled consensus. Committees and members of The Endocrine Society and the European Society of Endocrinology reviewed and commented on preliminary drafts of these guidelines. Two systematic reviews were conducted to summarize supporting evidence. We suggest using the Rotterdam criteria for diagnosing PCOS (presence of two of the following criteria: androgen excess, ovulatory dysfunction, or polycystic ovaries). Establishing a diagnosis of PCOS is problematic in adolescents and menopausal women. Hyperandrogenism is central to the presentation in adolescents, whereas there is no consistent phenotype in postmenopausal women. Evaluation of women with PCOS should exclude alternate androgen-excess disorders and risk factors for endometrial cancer, mood disorders, obstructive sleep apnea, diabetes, and cardiovascular disease. Hormonal contraceptives are the first-line management for menstrual abnormalities and hirsutism/acne in PCOS. Clomiphene is currently the first-line therapy for infertility; metformin is beneficial for metabolic/glycemic abnormalities and for improving menstrual irregularities, but it has limited or no benefit in treating hirsutism, acne, or infertility. Hormonal contraceptives and metformin are the treatment options in adolescents with PCOS. The role of weight loss in improving PCOS status per se is uncertain, but lifestyle intervention is beneficial in overweight/obese patients for other health benefits. Thiazolidinediones have an unfavorable risk-benefit ratio overall, and statins require further study.