（优质医学）多囊卵巢综合征.ppt

1、多囊卵巢综合征与胰岛素抵抗,流行病学和定义,5-10% 慢性不排卵， 高雄激素水平， 不孕, 早期流产， 脂代谢异常和胰岛素抵抗 主要见于肥胖人群同时也见于正常体重者,PCOS的诊断,NIH diagnostic criteria(1990) The Rotterdam criteria (2003),NIH diagnostic criteria (1990),高雄激素表现(临床 and/or 生化) 慢性不排卵（除外卵巢特异性疾患，肾上腺疾患,甲状腺和垂体疾患。,The Rotterdam criteria (2003),高雄激素表现 慢性不排卵; 卵巢多囊样改变,an expert pa

2、nel of the Androgen Excess Society (AES) recommended that PCOS should be considered a disorder of androgen excess,the NIH diagnostic criteria should be used hyperandrogenism and infrequent or irregular ovulation, as well as hyperandrogenism, regular ovulation and PCO, also fulfill AES criteria for P

3、COS,Patients,临床 and/or 生化高雄 and 慢性排卵减少, 伴 or不伴多囊卵巢 临床 and/or 生化高雄 and 多囊卵巢, 但是正常月经周期 慢性不排卵 and 卵巢多囊样表现, 但没有高雄体征,病因学,遗传原因 类固醇生成原因 胰岛素分泌异常,病理,卵巢产生过量雄激素 胰岛素抵抗,治疗,生活方式 药物治疗 COCs （口服避孕药） 二甲双胍 胰岛素增敏剂,COCs,炔雌醇 35 g/抗雄激素醋酸环丙孕酮 2 mg 含有三代孕酮的口服避孕药 去氧孕烯 屈螺酮,胰岛素增敏剂,作用包括直接影响类固醇的产生和胰岛素增敏作用,胰岛素增敏剂对生殖的影响,Hyperandrog

4、enism,Metformin: total testosterone, androstenedione and the adrenal androgen, dehydroepiandrosterone sulfate 噻唑烷二酮药物不影响总睾酮水平但却显著降低雄烯二酮和脱氢表雄酮水平 显著改善多毛症,不排卵和不孕,对于PCOS妇女噻唑烷二酮药物以剂量依赖方式显著促进排卵 单独应用二甲双胍, or二甲双胍加克罗米芬要显著优于促排卵药物 （二甲双胍剂型和剂量会影响效果）,怀孕,Metformin pregnancy category B drugs to reduce spontaneous a

5、bortions reduce the risk of GDM thiazolidinediones pregnancy category C drugs,代谢异常,体重和脂肪组成,二甲双胍治疗能使体重中等程度降低并减少内脏脂肪，特别是与低热量饮食同时进行时这种作用最显著。但一些作用是剂量依赖的。,Cardiovascular Risk Factors,Metformin therapy resulted in significant decreases in systolic blood pressure and LDL-cholesterol levels, both metformin

6、and thiazolidinediones improve endothelial dysfunction in PCOS. Thiazolidinediones also improve fibrinolysis in PCOS,比较研究,二甲双胍和噻唑烷二酮药物,thiazolidinediones are more effective than metformin at lowering free or bioavailable testosterone levels and AUCs for insulin levels. There is, however, minimal evi

7、dence for a difference in clinical outcomes such as hirsutism with the two therapies, and thiazolidinediones may result in weight gain in women with PCOS,二甲双胍和口服避孕药,metformin improves insulin sensitivity and, unlike oral contraceptives, can also lower triglyceride levels. Oral contraceptives might worsen insulin sensitivity,副作用,metformin ：gastrointestinal distress,thiazolidinedione ：,weight gain, in part related to their mechanism of action as PPAR ligands, and fluid retention that could result in edema and dilutional an