文章介绍了多囊卵巢综合征（PCOS）在中国育龄女性中的患病率以及全球范围内对该疾病的理解不足。文章还重点介绍了一项关于PCOS患者饮食失调的研究，研究人员发现无论体重指数（BMI）如何，PCOS患者都比同龄人更容易出现饮食失调，具体类型包括神经性贪食症、暴食障碍和紊乱饮食。这项研究受到国际多囊卵巢综合征评估和管理循证指南制定工作的推动，研究结果将为指南的修订提供参考，影响多囊女性患者的筛查指标和医疗系统的日常管理。
指出了这项研究的重要性及其对诊疗指南修订的影响，强调了在多学科协作、全生命周期管理方面的转变。
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在中国，育龄女性多囊卵巢综合征（polycystic ovary syndrome，PCOS，下文简称“多囊”）的患病率已经达到了 10.1%；世界卫生组织（WHO）估计，多囊影响着 8%~13% 的育龄女性。这一疾病在女性群体中非常普遍，但大众对其的理解却相当匮乏，全世界高达 70% 的患病女性至今仍未能被确诊。许多患者困于月经不规律、内分泌失调、毛发增生、身体成分改变、痤疮乃至不孕症，多囊还会引起代谢相关的一系列并发症，如 2 型糖尿病和肥胖等。作为一种慢性疾病，多囊的病因目前尚不清楚，也无法治愈，只能通过改变生活方式、药物和辅助生育技术改善症状。在医院，患者确诊后最常收到的治疗建议之一是减重。但如今，一些科学家正对此类建议提出质疑，他们认为这些建议有以偏概全之嫌，不仅无益，有时甚至会有潜在的危害。美国威斯康星大学（University of Wisconsin）医学与公共卫生学院生殖内分泌与不孕症科的副教授劳拉·库尼（Laura Cooney）表示，作为一种常见却复杂的疾病，多囊有许多种不同的诊断标准，不同患者的症状和病情也存在较大差异。因此，多年来，我们既难以诊断多囊，也难以对其开展适当的针对性研究。目前常见的三项诊断标准包括：月经不规律，出现雄激素升高的体征或症状（血液中的睾酮水平升高、面部或身体部位的异常毛发增生、脱发或痤疮），以及一项非常具体的超声检查结果，即卵巢上出现大量卵泡，这也是该病名为“多囊”的原因。确诊多囊须要至少满足三者中的其中两个。多囊卵巢
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库尼一直以来对与多囊相关的抑郁或焦虑等心理健康问题感兴趣。在过往的研究中，她发现多囊女性中度至重度焦虑和抑郁的水平较高，此类情绪障碍与饮食失调、身体形象以及其他影响多囊女性生活状态的因素密切相关，在这一逻辑线的指引下，库尼进一步揭示了多囊与进食障碍之间的关联。近日，库尼团队将他们的初步研究结果发表在了《临床内分泌与代谢杂志》（The Journal of Clinical Endocrinology & Metabolism）上，通过荟萃分析，库尼团队发现，无论体重指数（BMI）如何，多囊患者都会比同龄人更容易出现饮食失调。具体到失调的类型，多囊患者更可能患有神经性贪食症（bulimia nervosa）、暴食障碍（binge eating disorder）和紊乱饮食（disordered eating），但神经性厌食症（anorexia nervosa）的患病几率则与对照组无异。这项研究实际上受到了《2023 多囊卵巢综合征评估和管理国际循证指南》（International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome 2023）制订工作的推动。指南制定小组须要针对多囊的多个不同主题进行荟萃分析，以整合新的循证证据，促使单一妇科诊疗模式向多学科协作、全生命周期、多方案、动态更新的诊疗模式转变。库尼被指派进行多囊与饮食失调的荟萃分析，这些研究结果最终将为诊疗指南的修订提供参考，尤其会影响到多囊女性患者的筛查指标，推动医疗系统将饮食失调问题纳入多囊患者的日常管理等。多囊与进食障碍之所以存在关联，背后的原因错综复杂。很多人认为这种关联仅与 BMI 有关，即超重和肥胖。没错，患有多囊女性的超重和肥胖率的确比未患多囊的女性更高，但这项新研究却颠覆了以往的判断……[查看全文]
People with PCOS Face Increased Eating Disorder Risks
Rachel Feltman: Polycystic ovary syndrome, or PCOS, affectsin the U.S. alone. But in spite of how common PCOS is, it’s also quite poorly understood. Many people with the condition remain undiagnosed as they grapple with irregular periods, changes in their hair growth and body composition, acne and even infertility. If and when they do manage to get a diagnosis, they’re often told to focus on lifestyle changes like weight loss to mitigate symptoms. Now some researchers are pushing back against this generalized advice, which they say isn’t just unhelpful but sometimes actively harmful.
In a recent meta-analysis researchers showed that people with PCOS have a higher prevalence of eating disorders than their peers—regardless of their body mass index, or BMI, a common though flawed measurement based on a person's height and weight.
For Scientific American’s Science Quickly, I’m Rachel Feltman. I’m joined today by Laura Cooney, a co-author in the recent study. She’s an associate professor in the Division of Reproductive Endocrinology and Infertility at the University of Wisconsin School of Medicine and Public Health.
Laura, thank you so much for joining us today.
Laura Cooney: Thank you so much. It’s great to be here.
Feltman: So let’s start with something basic: What is PCOS, and how has our understanding and definition of it changed in recent years?
Cooney: Yeah, so PCOS is actually incredibly common—it impacts probably about 10 percent, at a minimum, of women in the reproductive ages. And what’s really difficult is it’s a complex disorder with lots of different kind of criteria. So not all women with PCOS are the same, which has made it hard over the years for us to both diagnose PCOS and to do, you know, appropriate studies on it.
The three current criteria are irregular periods, any evidence of elevated androgen—so this could be blood levels of testosterone, or it could be abnormal hair growth on the face or other parts of the body—and then [a] very specific ultrasound finding, where there’s lots of follicles on the ovaries. This is one of the more complicated things for patients to understand because the name is “polycystic,” but it’s not really that they have a lot of cysts on their ovaries; it’s just that they have a lot of follicles, and each of those follicles has an immature egg. But if they’re not getting their periods, they’re not ovulating and releasing those eggs.
So those are the three criteria, and to be diagnosed with PCOS you have to have two out of those three.
Feltman:
