Синдром поликистозных яичников и ожирение: современная парадигма

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Синдром поликистозных яичников представляет собой гетерогенное эндокринное заболевание, которым страдают женщины детородного возраста. Патогенез синдрома поликистозных яичников на сегодняшний день до конца не изучен, его парадигма рассматривает генетическую детерминированность манифестации гормональных и метаболических нарушений, которые принято считать критериями верификации заболевания (гиперандрогения, олиго/ановуляция и/или поликистозная трансформация яичников при ультразвуковом исследовании. В данном обзоре рассмотрены основные пути взаимодействия гиперандрогении, инсулинорезистентности и ожирения и их роль в патогенезе синдрома поликистозных яичников, а также возможные методы лечения данной категории пациенток. В обзоре анализируется роль гиперандрогении, и инсулинорезистентности в реализации генетического сценария синдрома поликистозных яичников и выясняются причины, почему женщины с синдромом поликистозных яичников часто демонстрируют наличие «метаболического трио» - гиперинсулинемии, резистентности к инсулину и сахарного диабета 2 типа. Отмечается, что ожирение не входит в критерии постановки диагноза синдрома поликистозных яичников, но эпидемиологические данные подтверждают наличие взаимосвязи между этими заболеваниями. Ожирение, особенно висцеральное, которое часто встречается у женщин с синдромом поликистозных яичников, усиливает и ухудшает метаболические и репродуктивные исходы при синдроме поликистозных яичников, а также увеличивает резистентность к инсулину и компенсаторную гиперинсулинемию, что, в свою очередь, стимулирует адипогенез и подавляет липолиз. Ожирение повышает чувствительность тека-клеток к стимуляции лютеонизирующим гормоном и усиливает функциональную гиперандрогению яичников, повышая выработку андрогенов яичниками. Избыток массы тела ассоциирован с большим количеством воспалительных адипокинов, которые, в свою очередь, способствуют росту резистентности к инсулину и адипогенез. Ожирение и инсулинорезистентность усугубляют симптомы гиперандрогении, образуя порочный круг, способствующий развитию синдрома поликистозных яичников. Приведенные данные позволяют сделать вывод, что альтернативой лекарственным средствам (метформин, тиазолидиндионоы аналоги глюкагоноподобного пептида-1) может стать бариатрическая хирургия, показавшая положительные результаты лечения пациенток с синдромом поликистозных яичников и ожирением.

Об авторах

М. Б. Хамошина

Российский университет дружбы народов

Email: iu.pavlova@yandex.ru
ORCID iD: 0000-0003-1940-4534
г. Москва, Российская Федерация

Ю. С. Артеменко

Российский университет дружбы народов

Автор, ответственный за переписку.
Email: iu.pavlova@yandex.ru
ORCID iD: 0000-0003-2116-1420
г. Москва, Российская Федерация

А. А. Байрамова

Российский университет дружбы народов

Email: iu.pavlova@yandex.ru
ORCID iD: 0000-0001-6391-940X
г. Москва, Российская Федерация

В. А. Рябова

Научно-исследовательский институт общей патологии и патофизиологии

Email: iu.pavlova@yandex.ru
ORCID iD: 0000-0003-4292-6728
г. Москва, Российская Федерация

М. Р. Оразов

Российский университет дружбы народов

Email: iu.pavlova@yandex.ru
ORCID iD: 0000-0002-1767-5536
г. Москва, Российская Федерация

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© Хамошина М.Б., Артеменко Ю.С., Байрамова А.А., Рябова В.А., Оразов М.Р., 2022

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