高雄激素血症对多囊卵巢综合征子宫内膜容受性的影响及其中医药干预机制

Impact of hyperandrogenism on endometrial receptivity in polycystic ovary syndrome and intervention mechanisms of traditional Chinese medicine

摘要

多囊卵巢综合征 (PCOS) 是育龄期女性常见的生殖内分泌疾病, 其特征为排卵障碍和高雄激素血症 (HA), 严重影响患者的生育能力。 促排卵治疗可显著改善 PCOS 患者的排卵功能, 但部分患者在恢复排卵后仍面临不孕或流产问题, 因此改善 PCOS 患者子宫内膜容受性 (ER) 是当前治疗的关键难点。 研究表明, HA 是导致 PCOS 患者 ER 下降的关键因素, 其机制可能与激素分泌紊乱、 炎症与氧化应激、 血管生成异常及血液高凝状态有关, 并涉及代谢综合征、 细胞自噬、 铁死亡等多种病理生理环节。 中医药在 “调经、 种子、 安胎” 方面具有独特优势, 现代研究证实, 中医药可通过多途径、 多靶点改善 PCOS-HA 患者的 ER。 本研究就 HA 影响 ER 的机制及中医药的干预策略与研究进展进行综述。

Abstract

Polycystic ovary syndrome (PCOS) is a common reproductive endocrine disorder in women of reproductive age, characterized by ovulatory dysfunction and hyperandrogenism (HA), which severely affects the fertility of patients. Ovulation induction treatment can significantly improve the ovulation status of patients with PCOS, but even after ovulation is restored, many patients still cannot conceive or maintain pregnancy normally. Therefore, how to improve the endometrial receptivity (ER) of patients with PCOS is a current challenge. Many studies have shown that HA is an important cause of decreased ER in patients with PCOS, which may be closely related to abnormal hormone secretion, systemic inflammation and oxidative stress, abnormal angiogenesis and hypercoagulable state, and involves multiple pathophysiological links such as metabolic syndrome, autophagy, and ferroptosis. Traditional Chinese medicine (TCM) has outstanding effects in “regulating menstruation, promoting fertility, and ensuring fetal safety”. Modern research has confirmed that TCM can improve the ER of patients with PCOS and HA through multiple pathways and targets. This study reviews the mechanism by which HA affects ER and the intervention strategies and research progress of TCM.

关键词

多囊卵巢综合征 / 高雄激素血症 / 子宫内膜容受性 / 中医药疗法 / 胰岛素抵抗 / 炎症 / 氧化应激 / 血栓前状态

Key words

polycystic ovary syndrome / hyperandrogenism / endometrial receptivity / traditional Chinese medicine therapy / insulin resistance / inflammation / oxidative stress / prethrombotic state

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基金资助

北京市高层次创新创业青年骨干人才春蕾计划项目(G202534297)

首都医科大学附属北京妇产医院/北京妇幼保健院中青年学科骨干培养专项(FCYY202103)