生殖醫學於多囊性卵巢症候群之新進展

New Development of Reproductive Medicine in Polycystic Ovary Syndrome

多囊性卵巢症候群是育齡期女性最常見的一種內分泌疾病。2003 年於荷蘭鹿特丹舉辦的會議上所修訂過的最新診斷標準，為患者應至少符合下列三項條件中的兩項，包括：慢性無排卵、外觀或是生化學上高雄性賀爾蒙的表現以及骨盆腔超音波上可看到多囊性卵巢的型態。雖然如此，對於如此的診斷標準仍然存在很多的爭議。基本上，雄性激素偏高的表現還是被認為是多囊性卵巢症候群的核心表現型。由於不同的飲食習慣、遺傳背景以及環境因素等影響，多囊性卵巢症候群的婦女其胰島素抗阻的表現如肥胖及代謝症候群的盛行率，在不同種族的多囊性卵巢症候群會有很大的差異。但是因為多囊性卵巢症候群的婦女有較高肥胖及胰島素抗阻的比率，其未來罹患第二型糖尿病及心血管疾病的機會，目前認為還是會增加。而且，其胰島素抗阻與高雄性賀爾蒙也會影響其排卵功能造成不孕及相關的相關併發症如早期流產，妊娠糖尿病，高血壓，卵巢過度刺激症候群與多胞胎的風險增加。減重，運動，飲食管控，加上metformin 的治療，則可以降低發生併發症的風險。

Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in women of reproductive age. PCOS is characterized by chronic anovulation, menstrual irregularities, evidence of hyperandrogenism (either clinical, manifested as hirsutism, acne, male pattern balding, or biochemical, manifested by elevated serum adrenal and/or ovarian androgen concentration). Fifty percent of all patients with PCOS are overweight or obese, and the presence of obesity affects the clinical manifestations of PCOS. Basically, the hyperandrogenism was considered as a core manifestation for women with PCOS. However, because of the effects of different dietary culture, genetic background and environment factors, there has been a very big difference of the phenotypic expression of insulin resistance and the prevalence of metabolic syndrome in women with PCOS among the different ethnicities. The high prevalence of insulin resistance and obesity in women with PCOS increase its future risks of type II diabetes and cardiovascular diseases. Furthermore, the hyperandrogenism and insulin resistance in PCOS may lead to the ovulatory dysfunction and the subsequent sequaelas as infertility, early miscarriage, gestational diabetes, hypertension, ovarian hyperstimulation syndrome and high order pregnancies. Weight reduction, exercise, diet control and metformin treatment were reported to reduce the risk of associated complications.