medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2021-13-102-111medsovet-6404Research ArticleРепродуктивное здоровье и ВРТReproductive health and ARTСиндром поликистозных яичников: современные представления патогенеза, диагностики и леченияPolycystic ovarian syndrome: current understanding of pathogenesis, diagnosis and treatmenthttps://orcid.org/0000-0002-5270-2915ЗайдиеваЗ. С.ZaydiyevaZ. S.

Зайдиева Зуля Семеновна, к.м.н., заведующая консультативно-диагностическим отделением

129336, Россия, Москва, ул. Таймырская, д. 6

Zulya S. Zaydiyeva, Cand. Sci. (Med.), Head of Consultative and Diagnostic Department

6, Taymyrskaya St., Moscow, 129336, Russia

dr.zaydieva@mail.ruhttps://orcid.org/0000-0001-5650-3377УруймаговаА. Т.UruymagovaA. T.

Уруймагова Ада Тимуровна, аспирант

117997, Россия, Москва, ул. Академика Опарина, д. 4

Ada T. Uruymagova, Postgraduate Student

4, Academician Oparin St., Moscow, 117997, Russia

ada.uruimagova@yandex.ruРодильный дом Городской клинической больницы №40РоссияBirth Centre of City Clinical Hospital No. 40Russian FederationНациональный медицинский исследовательский центр акушерства, гинекологии и перинатологии имени академика В.И. КулаковаРоссияKulakov National Medical Research Center of Obstetrics, Gynecology and PerinatologyRussian Federation202116102021013102111Copyright © Зайдиева З.С., Уруймагова А.Т., 20212021Зайдиева З.С., Уруймагова А.Т.Zaydiyeva Z.S., Uruymagova A.T.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/6404

Обзорная статья посвящена одному из наиболее распространенных полигенных эндокринопатий женщин репродуктивного возраста – синдрому поликистозных яичников (СПКЯ). Рассмотрены современные критерии, использующиеся для правильной постановки диагноза по четырем фенотипам СПКЯ: классический (фенотип А) – биохимическая и/или клиническая гиперандрогения, олиго-/ановуляция, поликистозная морфология яичников по УЗИ; ановуляторный (фенотип B) – олиго-/ ановуляция, биохимическая и/или клиническая гиперандрогения; овуляторный (фенотип C) – биохимическая и/или клиническая гиперандрогения, поликистозная морфология яичников по УЗИ; неандрогенный (фенотип D) – олиго-/ановуляция, поликистозная морфология яичников по УЗИ. В статье представлены основные теории патогенеза СПКЯ: периферическая, центральная, инсулиновая, генетическая, а также рассмотрены эпигенетические факторы. СПКЯ – многофакторное заболевание, при котором гены отвечают за механизмы развития процесса, а средовые факторы через эпигенетику воздействуют на генетический материал. Фенотипы СПКЯ играют немаловажную роль в клинической практике, поскольку позволяют индивидуализировать подход при подборе терапии в каждом конкретном случае с учетом патогенеза заболевания и прогнозировать его течение в дальнейшем. Рассмотрены основные варианты терапевтических подходов к лечению пациенток с СПКЯ с учетом мультифакторности заболевания, заинтересованности пациентки в беременности. В статье приводятся современные методы коррекции гиперандрогении, ановуляции, особое внимание уделяется необходимости прогестероновой терапии.

Review article is devoted to one of the most common polygenic endocrinopathies in women of reproductive age, polycystic ovarian syndrome (PCOS). We review the current criteria used to make a correct diagnosis based on four phenotypes of PCOS: Frank (phenotype A) – biochemical and/or clinical hyperandrogenism, oligo-/anovulation, polycystic ovarian morphology according to ultrasound; anovulatory (phenotype B) – oligo-/anovulation, biochemical and/or clinical hyperandrogenism; ovulatory (phenotype C) – biochemical and/or clinical hyperandrogenism, polycystic ovarian morphology according to ultrasound; non-androgenic (phenotype D) – oligo-/anovulation, polycystic ovarian morphology according to ultrasound. This article presents the main theories of PCOS pathogenesis: peripheral, central, insulin, genetic, and also considers epigenetic factors. PCOS is a multifactorial disease in which genes are responsible for the mechanisms of the process, and environmental factors through epigenetics affect the genetic material. PCOS phenotypes play an important role in clinical practice, as they allow an individualised approach to the selection of therapy in each case, taking into account the pathogenesis of the disease and predicting its course in the future. The main therapeutic options for treating patients with PCOS, taking into account the multifactorial nature of the disease and the patient's interest in pregnancy, are reviewed. The article presents modern methods for the correction of hyperandrogenism and anovulation, with special emphasis on the need for progesterone therapy.

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The authors declare that there are no conflicts of interest present.