专家组提议为“多囊卵巢综合征”更名

根据国立卫生研究院(NIH)召集的一个独立专家组的观点，多囊卵巢综合征(PCOS)一词令人困惑，需要进行修改，以更好地解释这一综合征在代谢、肾上腺和其他并发症方面的特征。

“这个名词侧重多囊卵巢的形态学特征，这既无必要，也不足以对这种综合征做出诊断。”专家组成员、明尼苏达州罗切斯特市梅奥医院的Robert A. Rizza博士在电话会议上说：“因此我们认为，是时候指定一个新名称来反映PCOS特征性的复杂代谢、下丘脑、 垂体、卵巢和肾上腺相互作用了。”

包括4名成员的专家组基于去年12月在NIH研讨会期间提出的证据，于1月23日发表了一份报告。

专家组并未提出PCOS的新名称，但表示，广大临床医生、研究者和患者很快就需要适应一个内涵更广的新标识。另一名专家组成员、密歇根大学妇产科教授兼主任Timothy R.B. Johnson医生指出，名称的修改可能仅仅是表面现象，更具描述性的标识将有助于向决策层强调这种综合征的重要性。

专家组还建议修改PCOS的诊断标准。目前，临床医生和研究者主要依赖于3种不同的分类系统，即NIH标准、鹿特丹标准和雄激素过多与PCOS(AE-PCOS)学会标准。而专家组建议使用内涵更广的鹿特丹标准，以识别特定的PCOS表型，如雄激素过多加排卵功能障碍、雄激素过多加多囊卵巢形态学变化、排卵功能障碍加多囊卵巢形态学变化或雄激素过多加排卵功能障碍加多囊卵巢形态学变化。Rizza博士说：“使用多个用于诊断PCOS的分类系统会引起混乱，并且会阻碍对这种疾病理解的进步。也会有损于临床医生与女性患者共同管理相关健康问题的能力。”专家组还呼吁，改良用于评估雄激素过多、卵巢功能障碍和多囊卵巢综合征形态学变化的方法和标准，以帮助提高诊断水平。

由于关于代谢功能异常和基础疾病病理生理学的作用还存在很多未被解决的问题，报告中还对未来研究提出了若干建议。专家组呼吁开展大型、 多种族的研究，以明确PCOS的遗传或后天病因。还需要进行多种族纵向研究，观察心血管和糖尿病并发症的作用。此外，还需要更多研究以确定PCOS是否与子宫内膜、乳腺和卵巢癌相关。还应侧重研究PCOS在妊娠中的作用，包括明确试图受孕女性中糖耐量异常的患病率，以及确定在受孕前或受孕后早期治疗糖耐量异常能否改变母体-胎儿结局。

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By: MARY ELLEN SCHNEIDER, Clinical Endocrinology News Digital Network

The term polycystic ovary syndrome, or PCOS, is confusing and needs to be changed to better explain the metabolic, adrenal, and other complications that are common in the condition, according to an independent panel of experts convened by the National Institutes of Health.

"It focuses on a criteria – namely the polycystic ovarian morphology – that is neither necessary nor sufficient to diagnose the syndrome," Dr. Robert A. Rizza, executive dean for research at the Mayo Clinic in Rochester, Minn., and a member of the panel, said at a teleconference. "We therefore believe it is time to assign a name that reflects the complex metabolic, hypothalamic, pituitary, ovarian, and adrenal interactions that characterize PCOS."

The four-member panel issued a report on Jan. 23 based on evidence presented during a workshop on PCOS held at the NIH last December.

The panel did not recommend a new name for PCOS but said that a broad group of clinicians, researchers, and patients should be able to quickly come up with a new label that is more inclusive. A name change may seem superficial, but a more descriptive label would help to highlight the importance of the syndrome for funding agencies, said Dr. Timothy R.B. Johnson, professor and chair of obstetrics and gynecology at the University of Michigan, Ann Arbor, and a member of the panel.

The expert panel also recommended changes to the criteria used to diagnose PCOS. Currently, clinicians and researchers rely on three different classification systems – the NIH Criteria, the Rotterdam Criteria, and the Androgen Excess and PCOS (AE-PCOS) Society Criteria. The panel instead recommended using the broad, inclusionary diagnostic Rotterdam Criteria to identify the specific phenotypes of PCOS, such as androgen excess plus ovulatory dysfunction, androgen excess plus polycystic ovarian morphology, ovulatory dysfunction plus polycystic ovarian morphology, or androgen excess plus ovulatory dysfunction plus polycystic ovarian morphology.

"The use of multiple classification systems to diagnose PCOS is confusing and delays progress in understanding of the disorder," Dr. Rizza said. "It also hinders the ability of clinicians to partner with women to address and manage the health issues that concern them."

The panel also called for improved methods and criteria to assess androgen excess, ovarian dysfunction, and polycystic ovarian morphology to help improve diagnosis.

The report also includes several recommendations for future research since there are still many unanswered questions about the role of metabolic dysfunction and the underlying pathophysiology of the condition.

The panel called for conducting large, multiethnic studies aimed at establishing the genetic or epigenetic causes of PCOS. Also needed are multiethnic longitudinal studies looking at the role of cardiovascular and diabetic complications. More research is needed to determine if PCOS is associated with endometrial, breast, and ovarian cancers.

Other studies should focus on the role of PCOS in pregnancy by establishing the prevalence of abnormal glucose tolerance in women trying to conceive and determining whether treatment of abnormal glucose tolerance prior to or early after conception alters maternal-fetal outcomes, the panel wrote.