Современные аспекты менеджмента пациенток с синдромом поликистоза яичников

Авторы

DOI:

https://doi.org/10.14739/2310-1210.2020.6.218474

Ключевые слова:

синдром поликистоза яичников, патогенез, фенотипы, диагностика, лечение

Аннотация

 

В обзоре приведены сведения по этиопатогенезу, диагностике и менеджменту синдрома поликистоза яичников (СПЯ) в соответствии с действующими международными руководствами и по данным современной научной литературы. Актуальность проблемы обусловлена распространенностью синдрома у женщин репродуктивного возраста – 8–13 %, в структуре ановуляторного бесплодия – до 80 %.

Этиология синдрома окончательно не выяснена, клинические проявления СПЯ – одни из наиболее распространенных в структуре нарушений репродуктивного здоровья, приводят к нарушениям функционирования почти всех органов и систем организма. Поэтому синдром рассматривают как мультисистемную проблему, что предполагает необходимость комплексного подхода к коррекции этого состояния со стороны гинекологов, репродуктологов, эндокринологов, кардиологов, дерматологов и семейных врачей. В международном руководстве (2018 р.) актуальными для постановки диагноза СПЯ остаются Роттердамские критерии.

Для диагностики актуальна классификация СПЯ по фенотипам, что может помочь в оценке уровня рисков и профиля возможных сопутствующих нарушений, а также при разработке рационального индивидуального плана обследования и лечения пациентки. Оптимальный диагностический алгоритм постановки диагноза СПЯ на первом этапе включает определение индекса свободного тестостерона (общий тестостерон, глобулин, связывающий половые гормоны, индекс свободного тестостерона). На втором этапе обследования женщин с СПЯ исключают патологии щитовидной железы (определяют тиреотропный гормон, антитела к тиреоглобулину, антитела к пероксидазе), проводят УЗИ, определяют наличие/отсутствие гиперпролактинемии (пролактинома), врожденной функции коры надпочечников (недостаточность 21-гидроксилазы), синдрома Иценко–Кушинга, акромегалии, вирилизующих опухолей. На третьем этапе оценивают гликемический статус.

Менеджмент должен быть мультидисциплинарным, направленным на коррекцию способа жизни, психоэмоциональных расстройств, диеты, а фармакологическая терапия зависит от характера метаболических и гормональных нарушений.

Своевременная диагностика, профилактика, раннее начало терапии СПЯ может способствовать сохранению фертильного потенциала, профилактике гиперпластических и неопластических процессов эндометрия, поздних осложнений этого синдрома.

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