下丘脑炎症在多囊卵巢综合征中的调节机制

doi:10.12280/gjfckx.20220804

摘要/Abstract

摘要：

多囊卵巢综合征（polycystic ovary syndrome，PCOS）是引起育龄期女性生殖障碍和代谢异常的常见妇科疾病，临床表现具有异质性。下丘脑炎症是一种以小胶质细胞激活为主要病理改变的低度炎性病变，被认为是PCOS代谢、生殖及临床异质性的病理和生理基础。研究表明，下丘脑在调节并维持机体代谢稳态和生殖功能中发挥重要作用；通过下丘脑炎症的诱发途径，提出了碳水化合物和饱和脂肪酸的共同过量摄入是其主要诱因。此外，下丘脑炎症在PCOS相关代谢紊乱和生殖障碍的发生、发展中具有重要作用及其潜在诱发途径，提示下丘脑各神经元以及中枢与外周之间异常的信号转导是诱发PCOS相关病理改变的关键途径，这些途径有望为临床治疗PCOS提供新思路、新靶点。

关键词: 多囊卵巢综合征, 下丘脑-垂体系统, 炎症, 代谢, 胰岛素抗药性

Abstract:

Polycystic ovary syndrome (PCOS) is a common gynecological disease among women of reproductive age. It causes reproductive disorders and metabolic abnormalities, which has heterogeneous clinical manifestations. Hypothalamic inflammation is a low-grade inflammatory disease with microglial activation as the main pathological change, which is considered as the pathological and physiological basis of PCOS metabolism, reproduction and clinical heterogeneity. Recent researches have clarified the crucial role of the hypothalamus in regulating and maintaining metabolic homeostasis and reproductive function. Through the induction pathway of hypothalamic inflammation, it is proposed that the common excessive intake of carbohydrates and saturated fatty acids is the main inducement. Furthermore, the important role of hypothalamic inflammation in the occurrence and development of PCOS related metabolic and reproductive disorders and the potential inducing pathways were described, and the abnormal signal transduction among hypothalamic neurons and between the center and periphery were considered as the key pathways to induce PCOS related pathological changes. These pathways are expected to provide new ideas and targets for clinical treatment of PCOS.

Key words: Polycystic ovary syndrome, Hypothalamo-hypophyseal system, Inflammation, Metabolism, Insulin resistance

孙畅, 潘紫萌, 赵珊珊, 李婧, 匡洪影. 下丘脑炎症在多囊卵巢综合征中的调节机制[J]. 国际妇产科学杂志, 2023, 50(1): 109-115.

SUN Chang, PAN Zi-meng, ZHAO Shan-shan, LI Jing, KUANG Hong-ying. Regulation Mechanism of Hypothalamic Inflammation in Polycystic Ovary Syndrome[J]. Journal of International Obstetrics and Gynecology, 2023, 50(1): 109-115.

图/表 1

图1 下丘脑炎症参与调节PCOS相关代谢异常及生殖障碍机制图注：HCHF 高碳水高脂肪饮食（high carbohydrate high fat diet），Cx(H2O)y 碳水化合物，SFAs饱和脂肪酸（saturated fatty acids），AVPV 前侧腹室周核（anteroventral periventricular nucleus），POA 视前区（preoptic area），PVN 室旁核（paraventricular nucleus），ARC 弓状核（arcuate nucleus），Kiss1 亲吻肽神经元1（kisspeptin neuron 1），GnRH 促性腺激素释放激素（gonadotropin releasing hormone），AgRP 刺鼠相关蛋白（agouti-related protein），POMC 阿黑皮素原神经元（proopiomelanocortin neuron），LH 黄体生成素（luteinizing hormone），FSH 卵泡刺激素（follicle-stimulating hormone）。

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