Current Understanding of the Etiology, Symptomatology, and Treatment Options in Premature Ovarian Insufficiency (POI).
Current Understanding of the Etiology, Symptomatology, and Treatment Options in Premature Ovarian Insufficiency (POI).
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目前对卵巢功能不全（POI）的病因、症状和治疗选择的理解。
DOI：
10.3389/fendo.2021.626924
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发表时间：
2021
影响因子：
5.2
通讯作者：
Ishizuka B
中科院分区：
文献类型：
--
作者：
Ishizuka B
至少 1% 的女性患有卵巢早衰 (POI)，会导致终生健康问题和心理压力。 POI引起的不孕症过去被认为是绝对的，不孕症治疗几乎没有价值或没有价值。一般来说，人们认为医学对这些患者几乎没有什么帮助。 POI 的病因已被发现与遗传、染色体和自身免疫有关。此外，越来越多的癌症幸存者以及接受过卵巢手术（尤其是腹腔镜手术）的患者成为医源性 POI 的候选者。已知超过50个基因与POI存在因果关系，部分病例的病程已被阐明，但大多数病例的遗传背景仍无法解释，这表明需要发现更多与POI病因相关的基因。因此，在大多数情况下，POI的遗传背景尚未明确。众所周知，X单体表现为特纳氏综合症，与原发性闭经有关，但最近的研究表明，一些X染色体数量异常的女性可以在二三十岁时自发月经，有些甚至可以怀孕。从多个角度来看，建议 POI 女性接受激素替代疗法 (HRT)。它可以减轻血管舒缩和泌尿生殖系统症状，并预防骨质流失和心血管疾病。据报道，POI 会降低生活质量和预期寿命，而 HRT 可能有助于改善两者。绝经后女性 HRT 可能出现的大多数问题并不适用于患有 POI 的女性；因此，在 POI 中，HRT 应被视为雌激素（+黄体酮）的生理替代。这篇综述描述了 POI 患者不孕症治疗的一些新方法，这些方法可能会导致 POI 的新治疗方法，以及更敏感的次级/腔前卵泡标记物和基因诊断的开发。
Premature ovarian insufficiency (POI) occurs in at least 1% of all women and causes life-long health problems and psychological stress. Infertility caused by POI used to be considered absolute, with infertility treatment having little or no value. Generally, it has been thought that medicine can provide little service to these patients. The etiology of POI has been found to be genetic, chromosomal, and autoimmune. In addition, the increasing numbers of cancer survivors are candidates for iatrogenic POI, along with patients who have undergone ovarian surgery, especially laparoscopic surgery. Over 50 genes are known to be causally related to POI, and the disease course of some cases has been clarified, but in most cases, the genetic background remains unexplained, suggesting that more genes associated with the etiology of POI need to be discovered. Thus, in most cases, the genetic background of POI has not been clarified. Monosomy X is well known to manifest as Turner’s syndrome and is associated with primary amenorrhea, but recent studies have shown that some women with numerical abnormalities of the X chromosome can have spontaneous menstruation up to their twenties and thirties, and some even conceive. Hormone replacement therapy (HRT) is recommended for women with POI from many perspectives. It alleviates vasomotor and genitourinary symptoms and prevents bone loss and cardiovascular disease. POI has been reported to reduce quality of life and life expectancy, and HRT may help improve both. Most of the problems that may occur with HRT in postmenopausal women do not apply to women with POI; thus, in POI, HRT should be considered physiological replacement of estrogen (+progesterone). This review describes some new approaches to infertility treatment in POI patients that may lead to new treatments for POI, along with the development of more sensitive markers of secondary/preantral follicles and genetic diagnosis.
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