PCOS治疗的指南.ppt

,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Page,*,文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。,Click to edit Master title style,Topic 1,Topic 2,Topic 3,Topic 4,文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。,主要内容,思诺思,有效治疗失眠,2,PCOS,诊断、检查与挑战,3,PCOS,治疗,4,PCOS,临床表现,2,PCOS,概述,1,PCOS,长期管理,5,PCOS,概述,多囊,卵巢综合征,(polycystic ovary syndrome,，,PCOS,),持续,排卵障碍、高雄激素血症及胰岛素抵抗为特征的生殖内分泌常见,疾病,PCOS,临床,特点,表现异质性,严重,影响患者的生殖,功能,增加,雌激素,依赖性,肿瘤,、,相,关,代谢失调,发病风,险,占生育,年龄妇女,5,10,1,占无排卵,性不孕,50,70,1,国内,局部地区小规模流行病学调查，育龄妇女患病率分别,为,5,81,2,6,46,3,我国,尚缺少全国性、大样本、多中心研究,1 Glintborg D,，,Andersen M,An update on the pathogenesis,，,inflammation,，,and metabolism in hirsutism and polycystic ovary syndromeJ,Gynecol Endocrinol,，,2010,，,26(4),：,281296,2,凌艳嫦,倪仁敏,杨晓慧,等,.,新会区育龄妇女多囊卵巢综合征发病情况调查,.,中国社区医师,医学专业,2011,（,26,）：,317,319.,3,陈子江,赵君利,周凤荣,等,.,济南市汉族育龄妇女,PCOS,患病状况的,初步调查,.,现代妇产科进展,.2005,14,（,6,）：,442-444.,PCOS,为,常见,妇科,内分泌疾病,PCOS,病因,1,遗传因素,环境,因素,激素改变,雄激素,胰岛素,稀发排卵或无排卵,雌激素,糖尿病,代谢综合征,多毛症,痤疮,月经紊乱,不孕,心血管危险,心理问题：身体意象，自,卑,，抑郁，焦虑,1 Teede HJ,Misso ML,Deeks AA,et al;Guideline Development Groups.Assessment and management of polycystic ovary syndrome:summary of an evidence-based guideline.Med J Aust.2011 Sep 19;195(6):S65-112.,肥胖加剧,激素,变化,PCOS,近、远期危害不容忽视,近期,危害,远期危害,1,型糖尿病,稀发排卵或无排卵,内膜增生或,异常子宫出血,多毛、痤疮,心血管疾病,血压、血脂异常,不孕,子宫内膜癌,1,Eleni Kousta,George Tolis,Stephen Franks.Polycystic ovary syndrome.Revised diagnostic criteria and long-term health consequences.Hormones,2005,4(3):133-147.,肥胖,雄激素水平升高,胰岛素水平升高,主要内容,PCOS,诊断、检查与挑战,3,PCOS,治疗,4,PCOS,长期管理,5,PCOS,临床表现,2,PCOS,概述,1,临床表现,1,陈子江,张以文,刘嘉茵等,.(WS330-2011),多囊卵巢综合征诊断,.,中华人民共和国卫生行业标准,.,2,中华医学会妇产科学分会内分泌学组,.,多囊卵巢综合征的诊断和治疗专家共识,.,中华妇产科杂志,2008,43(7):553-555.,3 WHO-Western Pacific Region.The Asia-Pacific perspective:Redefining obesity and its treatment.WHO-WPR,2000.,PCOS,临床表现,主要内容,PCOS,治疗,4,PCOS,长期管理,5,PCOS,概述,1,PCOS,诊断、检查与挑战,3,PCOS,临床表现,2,国外,PCOS,诊断标准,1 Zawadski JK,Dunaif A.Diagnostic criteria for polycystic ovary syndrome;towards a rational approach.M/Dunaif A,Givens JR,Haseltiue F.Boston Blackwell Scientic,1992:377-384.,2 Rotterdam ESHRE,ASRM-Sponsored PCOS consensus workshop group.Hum Reprod.2004,19(1):41-47.,3 Azziz R,Carmina E,Dewailly D,et al.FertilSteril,2009,91(2):456-488.,中国,PCOS,标准,1,1,陈子江,张以文,刘嘉茵等,.(WS330-2011),多囊卵巢综合征诊断,.,中华人民共和国卫生行业标准,.,2011-07-01 ACOG practice bulletin/International Journal of Gynecology&Obstetrics,2003(80):355-48.,2,Hormones,2005,4(3):133-147.,3,Acta Obstet Gynecol Scand,1,992 71:599-604.,4 Hum Reprod.2004,19(1):41-47.,PCOS,长期管理,是临床治疗中,不可或缺,的一部分,远期危害,PCOS,是一种慢性疾病，需要长期管理,PCOS,长期管理,生活方式管理,是长期管理的基础,胰岛素抵抗,1,高胰岛素血症,1,胰岛素增敏剂：,双胍类：二甲双胍,噻唑噻唑烷二酮类：罗格列酮、吡格列酮,新一代胰岛素促敏剂：,Dchiro-inositol,1 ACOG practice bulletin/International Journal of Gynecology&Obstetrics 2003(80):355-48.,2 Gangale MF,Miele L,Lanzone A,et al.Long-term metformin treatment is able to reduce the prevalence of metabolic syndrome and its hepatic involvement in young hyperinsulinaemic overweight patients with polycystic ovarian syndrome.Clin Endocrinol(Oxf).2011 Oct;75(4):520-7.,运动和饮食控制,胰岛素异常管理,长期,(12,个月,),应用二甲双胍,2,：,高胰岛素血症、超重的,PCOS,患者的适应证,特别适于合并非酒精性脂肪性肝病（,NAFLD,）的患者,对于未来,20-30,年间具有较高的,MS,和肝脏疾病发生风险的年轻,PCOS,患者具有更重要的意义,痤疮、多毛,异常子宫出血,内膜增生或癌变,血脂异常,口服避孕药物：,达英,-35,地塞米松,安体舒通,Wei Ching Tan.Acta Obstet Gynecol Scand 2001;80:689-96,高雄血症管理,达英,-35,长期管理高雄血症有效,长期应用,达英,-35,1,：,显著改善,高雄血症临床症状，随着服用时间增加，改善率,逐步提高,，有效治疗,PCOS,1 Falsetti L,Galbignani E.Long-term treatment with the combination ethinylestradiol and cyproterone acetate in polycystic ovary syndrome.Contraception.1990;42(6):611-9.,一项纳入,66,例,PCOS,患者，,36,周期不间断服用,达英,-35,研究,代谢参数,单位,基值,36,周期,正常值,血糖,mg/dl,84.24.8,85.65.6,75-110,胆红素,mg/dl,0.40.08,0.390.09,0.3-1.2,谷草转氨酶,U/L,18.93.6,19.53.5,10-35,谷丙转氨酶,U/L,14.94.2,14.33.5,10-50,-,谷氨酰转移酶,U/L,6.41.6,6.51.9,0-40,碱性磷酸酶,U/L,50.89.4,52.69.1,30-85,总胆固醇,mg/dl,178.818.4,185.320.2,200,HDL-,胆固醇,mg/dl,71.29.2,75.98.5,*,50,LDL-,胆固醇,mg/dl,91.115.4,86.810.2,150,HDL/LDL,0.78,0.87,长期应用,达英,-35,1,：,不影响,血糖、肝功能指数和血脂中总胆固醇、,LDL-,胆固醇及,HDL/LDL,指标,显著升高,HDL-,胆固醇水平，提示其有,心血管保护收益,适合具有临床高雄激素症状的患者,长期,服用,1 Falsetti L,Galbignani E.Long-term treatment with the combination ethinylestradiol and cyproterone acetate in polycystic ovary syndrome.Contraception.1990;42(6):611-9.,达英,-35,长期管理高雄血症安全,*,P0.01,Thank You!,