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多囊卵巢综合征(PCOS)发病机制复杂多样，其主要的临床表现为稀发排卵、闭经，甚至不孕，常常伴有多毛及痤疮等，而且与肥胖、胰岛素抵抗(IR)及抑郁发生密切相关，严重影响育龄女性健康。肠道微生态障碍被认为可能通过炎症和氧化应激等方面介导PCOS的发生发展，同时通过补充益生菌(包括合生元)及粪便移植(FMT)来调整肠道微生态环境可以积极缓解PCOS患者高雄激素血症(HA)、糖脂代谢异常及中枢免疫异常等临床症状，成为治疗PCOS的新思路。本文将主要从肠道菌群在PCOS发病的介导，临床症状的改善，以及应用潜力等方面进行阐述。
Abstract：Polycystic ovary syndrome(PCOS) is an endocrine and metabolic disorder with complex etiology, the main clinical manifestations of which are oligoovulation, amenorrhea, and even infertility, often accompanied by hirsutism and acne, and is closely related to obesity, insulin resistance(IR) and depression, seriously affecting the health of women of childbearing age. Intestinal microbiome disorders are believed to be likely to mediate the occurrence and the development of PCOS through inflammation and oxidative stress. Adjusting the intestinal microecological environment through supplementation of probiotics(including synbiotics) and fecal transplantation(FMT) can actively alleviate the clinical symptoms of hyperandrogenemia(HA),glucose and lipid metabolism and central immune abnormalities in PCOS patients, providing a new idea for the treatment of PCOS. This review mainly focuses on the mediation role of intestinal flora on PCOS in the pathogenesis, the improvement of clinical symptoms, and its potential application.
[1] Shi M,Huang W,Shu L,et al.Research on polycystic ovary syndrome:a bibliometric analysis from 2009 to 2019[J].Gynecol Endocrinol,2021,37:121-125.
[2] Sadeghi HM,Adeli I,Calina D,et al.Polycystic ovary syndrome:A comprehensive review of pathogenesis,management,and drug repurposing[J].Int J Mol Sci,2022,23:583.
[3] 李春竹，邢川，何冰.多囊卵巢综合征的遗传学研究进展[J].疑难病杂志，2021,20:103-106.
[4] Bahri Khomami M,Teede HJ,Joham AE,et al.Clinical management of pregnancy in women with polycystic ovary syndrome:An expert opinion[J].Clin Endocrinol(Oxf),2022,97:227-236.
[5] Gu Y,Zhou G,Zhou F,et al.Gut and vaginal microbiomes in PCOS:Implications for women’s health[J].Front Endocrinol(Lausanne),2022,13:808508.
[6] Zhang M,Hu R,Huang Y,et al.Present and future:Crosstalks between polycystic ovary syndrome and gut metabolites relating to gut microbiota[J].Front Endocrinol(Lausanne),2022,13:933110.
[7] Tremellen K,Pearce K.Dysbiosis of gut microbiota(DOGMA)--a novel theory for the development of polycystic ovarian syndrome[J].Med Hypotheses,2012,79:104-112.
[8] Liu J,Liu Y,Li X.Effects of intestinal flora on polycystic ovary syndrome[J].Front Endocrinol(Lausanne),2023,14:1151723.
[9] 王西，张龙华，蒋丽萍.PCOS伴肥胖患者肠道菌群失调与炎症状态、胰岛素抵抗的关系[J].中国妇幼健康研究，2023,34:64-67.
[10] Ding H,Zhang J,Zhang F,et al.Resistance to the insulin and elevated level of androgen:A major cause of polycystic ovary syndrome[J].Front Endocrinol(Lausanne),2021,12:741764.
[11] Qi X,Yun C,Sun L,et al.Gut microbiota-bile acid-interleukin-22 axis orchestrates polycystic ovary syndrome[J].Nat Med,2019,25:1225-1233.
[12] Helli B,Kavianpour M,Ghaedi E,et al.Probiotic effects on sperm parameters,oxidative stress index,inflammatory factors and sex hormones in infertile men[J].Hum Fertil(Camb),2022,25:499-507.
[13] Liu Y,Yu Z,Zhao S,et al.Oxidative stress markers in the follicular fluid of patients with polycystic ovary syndrome correlate with a decrease in embryo quality[J].J Assist Reprod Genet,2021,38:471-477.
[14] Azizi-Kutenaee M,Heidari S,Taghavi SA,et al.Probiotic effects on sexual function in women with polycystic ovary syndrome:A double blinded randomized controlled trial[J].BMC Womens Health,2022,22:373.
[15] Masjedi F,Keshtgar S,Agah F,et al.Association between sex steroids and oxidative status with vitamin D levels in follicular fluid of non-obese PCOS and healthy women[J].J Reprod Infertil,2019,20:132-142.
[16] Sun Y,Li S,Liu H,et al.Association of GPx1 P198L and CAT C-262T genetic variations with polycystic ovary syndrome in chinese women[J].Front Endocrinol(Lausanne),2019,10:771.
[17] Li M,Chi X,Wang Y,et al.Trends in insulin resistance:Insights into mechanisms and therapeutic strategy[J].Signal Transduct Target Ther,2022,7:216.
[18] Pandey AK,Gupta A,Tiwari M,et al.Impact of stress on female reproductive health disorders:Possible beneficial effects of shatavari(Asparagus racemosus)[J].Biomed Pharmacother,2018,103:46-49.
[19] Ostadmohammadi V,Jamilian M,Bahmani F,et al.Vitamin D and probiotic co-supplementation affects mental health,hormonal,inflammatory and oxidative stress parameters in women with polycystic ovary syndrome[J].J Ovarian Res,2019,12:5.
[20] Li T,Zhang T,Gao H,et al.Tempol ameliorates polycystic ovary syndrome through attenuating intestinal oxidative stress and modulating of gut microbiota composition-serum metabolites interaction[J].Redox Biol,2021,41:101886.
[21] 王静，张冰洁，杨佳苗，等.多囊卵巢综合征患者雄激素过多与异常糖耐量的关系[J].中华糖尿病杂志，2019,11:466-471.
[22] Witchel SF,Azziz R,Oberfield SE.History of polycystic ovary syndrome,premature adrenarche,and hyperandrogenism in pediatric endocrinology[J].Horm Res Paediatr,2022,95:557-567.
[23] Barroso A,Santos-Marcos JA,Perdices-Lopez C,et al.Neonatal exposure to androgens dynamically alters gut microbiota architecture[J].J Endocrinol,2020,247:69-85.
[24] 梁瑾斓.多囊卵巢综合症患者的肠道菌群分析及与雄激素水平相关性分析[D].广州：南方医科大学，2019.
[25] Torres PJ,Skarra DV,Ho BS,et al.Letrozole treatment of adult female mice results in a similar reproductive phenotype but distinct changes in metabolism and the gut microbiome compared to pubertal mice[J].BMC Microbiol,2019,19:57.
[26] Karamali M,Eghbalpour S,Rajabi S,et al.Effects of probiotic supplementation on hormonal profiles,biomarkers of inflammation and oxidative stress in women with polycystic ovary syndrome:A randomized,double-blind,placebo-controlled trial[J].Arch Iran Med,2018,21:1-7.
[27] Elnashar A.An evidence based approach for diagnosis of adolescent polycystic ovarian syndrome[J].Middle East Fertil Soc J,2016,21:194-195.
[28] 曾宇，赵琳.多囊卵巢综合征糖、脂代谢异常的研究进展[J].大连医科大学学报，2022,44:263-268.
[29] Ramezani Tehrani F,Montazeri SA,Hosseinpanah F,et al.Trend of cardio-metabolic risk factors in polycystic ovary syndrome:A population-based prospective cohort study[J/OL].PLoS One,2015,10:e0137609.
[30] 卢凤娟，丛晶，王宇，等.多囊卵巢综合征子宫内膜容受性障碍机制研究进展[J].生殖医学杂志，2022,31:862-866.
[31] He F,Li Y.The gut microbial composition in polycystic ovary syndrome with insulin resistance:Findings from a normal-weight population[J].J Ovarian Res,2021,14:50.
[32] Huang Y,Lou X,Jiang C,et al.Gut microbiota is correlated with gastrointestinal adverse events of metformin in patients with type 2 diabetes[J].Front Endocrinol(Lausanne),2022,13:1044030.
[33] Zhang Q,Hu N.Effects of metformin on the gut microbiota in obesity and type 2 diabetes mellitus[J].Diabetes Metab Syndr Obes,2020,13:5003-5014.
[34] Bryrup T,Thomsen CW,Kern T,et al.Metformin-induced changes of the gut microbiota in healthy young men:Results of a non-blinded,one-armed intervention study[J].Diabetologia,2019,62:1024-1035.
[35] Yde CC,Jensen HM,Christensen N,et al.Polydextrose with and without bifidobacterium animalis ssp.lactis 420 drives the prevalence of akkermansia and improves liver health in a multi-compartmental obesogenic mice study[J/OL].PLoS One,2021,16:e0260765.
[36] Cozzolino M,Vitagliano A,Pellegrini L,et al.Therapy with probiotics and synbiotics for polycystic ovarian syndrome:a systematic review and meta-analysis[J].Eur J Nutr,2020,59:2841-2856.
[37] 赵璟，叶慧，胡丽莉，等.PCOS不孕患者体质量指数与焦虑、总体幸福感的相关性研究[J].生殖医学杂志，2023,32:228-233.
[38] Tay CT,Teede HJ,Loxton D,et al.Psychiatric comorbidities and adverse childhood experiences in women with self-reported polycystic ovary syndrome:An Australian population-based study[J].Psychoneuroendocrinology,2020,116:104678.
[39] Liang Z,Di N,Li L,et al.Gut microbiota alterations reveal potential gut-brain axis changes in polycystic ovary syndrome[J].J Endocrinol Invest,2021,44:1727-1737.
[40] Li ZH,Jiang YY,Long CY,et al.The gut microbiota-astrocyte axis:Implications for type 2 diabetic cognitive dysfunction[J].CNS Neurosci Ther,2023,29:59-73.
[41] Xu MY,Guo CC,Li MY,et al.Brain-gut-liver axis:Chronic psychological stress promotes liver injury and fibrosis via gut in rats[J].Front Cell Infect Microbiol,2022,12:1040749.
[42] Wang X,Eguchi A,Yang Y,et al.Key role of the gut-microbiota-brain axis via the subdiaphragmatic vagus nerve in demyelination of the cuprizone-treated mouse brain[J].Neurobiol Dis,2023,176:105951.
[43] Schmidt C.Mental health:Thinking from the gut[J].Nature,2015,518:S12-15.
[44] 韩昕宇，韩斯斯，吴天强，等.肠道菌群与多囊卵巢综合征并发抑郁症关系的研究进展[J].中国微生态学杂志，2023,35:110-115,120.
[45] Armanini D,Boscaro M,Bordin L,et al.Controversies in the pathogenesis,diagnosis and treatment of PCOS:Focus on insulin resistance,inflammation,and hyperandrogenism[J].Int J Mol Sci,2022,23:4110.
[46] 钱旭，吴薇，徐斌.二甲双胍的不良反应及其机制研究进展[J].现代药物与临床，2023,38:1278-1288.
[47] Hamamah S,Gheorghita R,Lobiuc A,et al.Fecal microbiota transplantation in non-communicable diseases:Recent advances and protocols[J].Front Med(Lausanne),2022,9:1060581.
[48] Wilson AS,Koller KR,Ramaboli MC,et al.Diet and the human gut microbiome:An international review[J].Dig Dis Sci,2020,65:723-740.
基本信息:
中图分类号:R711.75
引用信息:
[1]方洁,刘海燕.肠道菌群与多囊卵巢综合征发生发展的研究进展[J].生殖医学杂志,2024,33(03):396-400.
基金信息:
河北省中医药管理局局科技计划项目(2021316)
2023-07-03
2023
2023-09-10
2024-01-31
2024
1
2024-03-15
2024-03-15