多囊卵巢综合征胰岛素抵抗的研究进展
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摘要
多囊卵巢综合征(PCOS)是青春期及育龄妇女最常见的内分泌和代谢紊乱性疾病,其发病率占育龄期妇女的5%-10%。PCOS的基本特征为长期不排卵或稀发排卵及其导致的月经不调及闭经、卵巢多囊性增大和高雄激素血症等,此外还表现有胰岛素抵抗(IR)及胰岛β细胞功能失调。本病从发现至今已有七十余年历史,而现代医学对其诊断及发病机制的认知在发展过程中发生了巨大的变化,随着现代医学对于PCOS的认识的日渐深入,发现IR与本病的发病密切相关,故近些年对于PCOS-IR的研究日渐增多,PCOS-IR逐渐成为近年研究PCOS的热点之一。IR在PCOS的并发症的发病方面以起着重要的作用,在生殖方面,IR是导致PCOS患者妊娠率降低的重要原因,PCOS患者妊娠期自然流产、妊娠期糖尿病(GDM)的患病率较普通人群高亦与IR有着密切的关系,此外IR亦为PCOS患者子宫内膜癌的发病风险增高的重要影响因子。同时PCOS患者代谢综合征的发病率升高,而代谢综合征与心血管风险紧密相连,这均与IR有密切的关系。由此可见,PCOS并非只对生殖系统造成影响,其健康效应涉及多个系统,并对患者远期健康状况有不良影响,而在这其中IR起着至关重要的作用。目前许多现代医学界学者对PCOS-IR做了大量的研究,提示PCOS-IR的改善可以改善其内分泌及生殖机能。而改善生活方式是改善PCOS患者IR的有效手段,口服降糖药已成为治疗PCOS患者IR的有效方法之一,已有研究提示孕期口服降糖药能够降低妊娠并发症的发生,但是此类药物在孕期的使用仍然需要商榷。在中医古籍中并无PCOS病名的记载,而其症状散见于“月经后错”“月经量少”“闭经”“不孕”等篇章中。现代中医学者对PCOS-IR具有其独到的见解,认为PCOS-IR的病因病机以肾虚、脾虚湿阻为主。经水出诸肾,肾主生殖,PCOS患者多见月经失调,闭经及不孕,故与肾虚关系密切。PCOS-IR患者糖代谢异常且多伴有肥胖,中医认为人体物质能量的代谢与各脏腑的功能协调有关,而其与脾胃的关系最为密切,脾胃后天之本,主运化输布,脾胃功能失常,水谷精微不能化生输布,蓄积体内而为痰湿脂浊,躯脂满溢而成肥胖,故PCOS-IR与脾虚湿阻亦存在着密切的关系。对于PCOS-IR的中医证型分布的研究也有力地证明了PCOS的病机以肾虚为本,而痰湿证与脾虚证与PCOS-IR密切相关。故在治疗方面,中医强调益肾,健脾,化浊,通脉。近年来的研究数据有力地证明中医中药治疗的介入对PCOS患者IR的改善有效。然而中医中药对于PCOS患者IR远期并发症的防治效果尚待研究。
With a prevalence of 5%-10%, polycystic ovary syndrome (PCOS) is one of the most common endocrine diseases affecting women in adolescence and at reproductive age.The features of PCOS are chronic anovulation or few ovulations which results in irregular menstruation or amenorrhea、polycystic ovaries increased in size and hyperandrogenism. In addition, it is also characterized by insulin resistance (IR) andβ-cell dysfunction. PCOS has a long history of more than seventy years since its discovery. As the progress of modern medicine great changes have taken place in the knowledge of diagnosis and pathogenesis of PCOS, though it is not definitely clear of the pathogenesis of it, more and more research have proved that there is a significant relationship between the incidence of PCOS and insulin resistance (IR).It has been known that IR plays an important role in the complication of PCOS. In terms of reproduction, the fallen of pregnancy rate of patients with PCOS is closely related with Armand IR also give rise to the higher prevalence rate of spontaneous abortion during pregnancy and gestational diabetes in patients with PCOS than in the general population. Besides, these patients'higher risk of suffering from endometrial cancer is also bound up with IR. At the same time, these patients'incidence of metabolic syndrome (MS) is increased. Metabolic syndrome has a significant relationship with cardiovascular risk and IR is the important tie of them. According to this, PCOS is not only a reproductive problem but a complex endocrine disease relating to other system with important health implications, which will has a bad influence on patients'long-term health condition, and IR plays a vital role in it. At present,extensive researches on the IR of PCOS patients made by many scholars of modern medicine point out that it is effective to improve PCOS patients'endocrine condition and their reproduction by the improvement of their insulin resistance. To achieve this aim, lifestyle adjustment can be an efficient measure. Besides, oral hypoglycemic drug is also one of the effective methods to treat the insulin resistance of patients with PCOS. Research shows that taking oral hypoglycemic drugs in pregnancy can reduce the incidence of pregnancy complications, but it is still necessary to do further study on its application in pregnancy. Although in classical books of traditional Chinese medicine, there is no such kind of disease named PCOS in record, the symptoms of PCOS can be seen respectively in chapters of "delayed menstruation", "scant menstruation", "amenorrhea" and "infertility". As to the causes and mechanism of PCOS-IR, traditional Chinese medicine has its original idea, which commonly regards the causes and mechanism of it as kidney deficiency pattern and pattern of spleen deficiency with dampness encumbrance. Studies on syndrome types of TCM in patients with PCOS-IR have proved this opinion. Therefore, in treatment, traditional Chinese medicine stresses on replenishing the kidney, fortifying the spleen, resolving the turbidity, and unblocking the meridian. In recent years, some convincing evidences have showed in studies data that the treatment of traditional Chinese medicine can improve the insulin resistance (IR) of patients with PCOS. However, further study on the prevention and treatment by traditional Chinese medicine of the complications of patients with PCOS-IR is still needed.
With a prevalence of 5%-10%, polycystic ovary syndrome (PCOS) is one of the most common endocrine diseases affecting women in adolescence and at reproductive age.The features of PCOS are chronic anovulation or few ovulations which results in irregular menstruation or amenorrhea、polycystic ovaries increased in size and hyperandrogenism. In addition, it is also characterized by insulin resistance (IR) andβ-cell dysfunction. PCOS has a long history of more than seventy years since its discovery. As the progress of modern medicine great changes have taken place in the knowledge of diagnosis and pathogenesis of PCOS, though it is not definitely clear of the pathogenesis of it, more and more research have proved that there is a significant relationship between the incidence of PCOS and insulin resistance (IR).It has been known that IR plays an important role in the complication of PCOS. In terms of reproduction, the fallen of pregnancy rate of patients with PCOS is closely related with Armand IR also give rise to the higher prevalence rate of spontaneous abortion during pregnancy and gestational diabetes in patients with PCOS than in the general population. Besides, these patients'higher risk of suffering from endometrial cancer is also bound up with IR. At the same time, these patients'incidence of metabolic syndrome (MS) is increased. Metabolic syndrome has a significant relationship with cardiovascular risk and IR is the important tie of them. According to this, PCOS is not only a reproductive problem but a complex endocrine disease relating to other system with important health implications, which will has a bad influence on patients'long-term health condition, and IR plays a vital role in it. At present,extensive researches on the IR of PCOS patients made by many scholars of modern medicine point out that it is effective to improve PCOS patients'endocrine condition and their reproduction by the improvement of their insulin resistance. To achieve this aim, lifestyle adjustment can be an efficient measure. Besides, oral hypoglycemic drug is also one of the effective methods to treat the insulin resistance of patients with PCOS. Research shows that taking oral hypoglycemic drugs in pregnancy can reduce the incidence of pregnancy complications, but it is still necessary to do further study on its application in pregnancy. Although in classical books of traditional Chinese medicine, there is no such kind of disease named PCOS in record, the symptoms of PCOS can be seen respectively in chapters of "delayed menstruation", "scant menstruation", "amenorrhea" and "infertility". As to the causes and mechanism of PCOS-IR, traditional Chinese medicine has its original idea, which commonly regards the causes and mechanism of it as kidney deficiency pattern and pattern of spleen deficiency with dampness encumbrance. Studies on syndrome types of TCM in patients with PCOS-IR have proved this opinion. Therefore, in treatment, traditional Chinese medicine stresses on replenishing the kidney, fortifying the spleen, resolving the turbidity, and unblocking the meridian. In recent years, some convincing evidences have showed in studies data that the treatment of traditional Chinese medicine can improve the insulin resistance (IR) of patients with PCOS. However, further study on the prevention and treatment by traditional Chinese medicine of the complications of patients with PCOS-IR is still needed.
引文
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