Kontrol' massy tela – klyuch k uspekhu lecheniya bol'nykh s sindromom polikistoznykh yaichnikov
https://doi.org/10.14341/brh200717-18
Abstract
Синдром поликистозных яичников (Спя) — клинический синдром, ассоциированный с хронической ановуляцией, нарушениями менструального цикла и овариальной гиперандрогенией в отсутствие иных причин гиперпродукции андрогенов (2003) [1].Важнейшими патогенетическими звеньями ановуляции при Спя являются инсулинорезистентность и потенцирующее ее ожирение. Снижение чувствительности периферических тканей (прежде всего мышечной и жировой) к действию нормальных концентраций инсулина приводит к сопутствующей хронической компенсаторной гиперинсулинемии — состоянию, типичному для больных с Спя. В общей популяции гиперинсулинемия встречается у10—25% людей, и доля таких людей возрастает в соответствии с увеличением индекса массы тела — Имт (см. рисунок) [2]. Наиболее неблагоприятно увеличение количества висцеральной жировой ткани. Общая закономерность заключается в прогрессивном увеличении числа людей с инсулинорезистентностью и компенсаторной гиперинсулинемией при нарастании массы тела.
References
1. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod 2004; 19: 41—47.
2. Ferrannini E., Natali A., Bell P. on behalf of the European Group for the Study of Insulin Resis-tance (EGIR). Insulin resistance and hypersecretion in obesity. J Clin Invest 1997; 100: 1166—1173.
3. Dunaif A., Segal K.R., Futterweit W. Profound peripheral insulin resistance, independent of obesity, in PCOS. Diabetes 1989; 38:1165—1174.
4. Guidelines for the Development and Implementation of Clinical Practice Guidelines, 1998.
5. Krauss R.M., Winston M., Fletcher B.J. Obesity: impact on cardiovascular disease. Circulation. 1998; 98: 1472—1476.
6. Despres J.P., Lemieux I., Prud’homme D. Treatment of obesity: need to focus on high risk ab-dominally obese patients. BMJ 2001; 322: 716—720.
7. Guzick D.S., Wing R., Smith D. Endocrine consequences of weight loss in obese, hyperandrogenic, anovulatory women. Fertil Steril 1994; 61: 598—604.
8. Pasquali R., Gambineri A. Effect of long-term treatment with metformin added to hypocaloric diet on body composition, fat distribution, and androgen and insulin levels in abdominally obese women with and without the PCOS. JCE&M 2000; 85 (8): 2767— 2774.
9. Clark A.M., Thornley B., Tomlinson L. Weight loss in obese infertile women results in improvement in reproductive outcome for all forms of fertility treatment. Hum Reprod 1998; 13: 1502—1505.
10. Пищулин А.А. Синдром поликистозных яичников: патогенез, диагностика, лечение: Автореф. дис. … д-ра мед. наук 2002.
11. Pasquali R., Casimirri F., Vicennati V. Weight control and its beneficial effect on fertility in women with obesity and polycystic ovary syndrome Hum Reprod 1997; 12: 82—87.
12. Kiddy D. S., Hamilton-Firley D., Bush A. Improvement in endocrine and ovarian function during dietary treatment of obese women with PCOS. Clin Endocrinol (oxf) 1992; 36: 105—111.
13. Huber-Bucholz M.M., Carey D., Norman R.J. Restoration of reproductive potential by lifestyle modification in obese PCOS. JCE&M 1999; 84: 1470—1474.
14. Andersen P. Increased insulin sensitivity and fibrinolytic capacity after dietary intervention in obese women with polycystic ovary syndrome. Metabolism. 1995; 44 (5): 611—616.
15. Jensen M.D. Potential Role of New Therapies in Modifying Cardiovascular Risk in Overweight Patients with Metabolic Risk Factors. Obesity, 2006; 14: 143S—149S.
16. Halford J.C., Harrold J.A., Lawton C.L. Serotonin (5-HT) drugs: effects on appetite expression and use for the treatment of obesity. Curr Drug Targets 2005; 6: 201—213.
17. Van Gaal L.F., Rissanen A.M., Scheen A.J. RIOEurope Study Group. Effects of the cannabinoid-1 receptor blocker rimonabant on weight reduction and cardiovascular risk factors in overweight patients: 1-year experience from the RIO-Europe study. Lancet 2005; 365: 1389—1397.
18. Despres J.P., Golay A., Sjostrom L. Rimonabant in Obesity-Lipids Study Group. Effects of rimonabant on metabolic risk factors in overweight patients with dyslipidemia. N Engl J Med 2005; 353: 2121— 2134.
19. Pi-Sunyer F.X., Aronne L.J., Heshmati H.M. Effect of rimonabant, a cannabinoid-1 receptor blocker, on weight and cardiometabolic risk factors in overweight or obese patients: RIO-North America: a randomized controlled trial. JAMA 2006; 295: 761—775.
20. Scheen A.J. Rimonabant in patients with type 2 diabetes: results from the RIO-Diabetes trial). 65th Annual Scientific Sessions of the American Diabetes Association San Diego. CA 2005.
21. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001; 285: 2486—2497.
22. Lord J.M., Flight I.H., Norman R.J. Metformin in PCOS: systematic review and meta-analysis BMJ 2003; 327: 951.
23. Morin-Papunen L.C., Vauhkonen I., Koivunen R.M. et al. Endocrine and metabolic effects of metformin vs.ethinyl estradiol-cyproterone acetate in obese women with PCOS: a randomized study. JCE&M 2000; 85: 3161—3168.
24. Diamanti-Kandarakis E., Kouli C., Tsianateli T., Bergiele A. Therapeutic effects of metformin on insulin resistance and hyperandrogenism in PCOS. Eur J Endocrinol 1998; 138: 269—274.
25. Moghetti P., Castello R., Negri C. Metformin effects on clinical features, endocrine and metabolic profiles, and insulin sensitivity in polycystic ovary syndrome: a randomized, double-blind, placebocontrolled 6-month trial, followed by open, longterm clinical evaluation. JCE&M 2000; 85: 139— 146.
26. Harborne L., Fleming R., Lyall H. et al. Descriptive review of the evidence for the use of metformin in PCOS. Lancet 2003; 361: 1894—901.
27. Charles A., Vague P., Morange P. et al. Effect of weight change and metformin on fibrinolysis and the von Willebrand factor in obese nondiabetic subjects. The BIGPROl Study. Diabetes Care 1998; 11: 1967—1972.
28. Okuno A., Tamemoto H. et al. Troglitazone increases the number of small adipocytes without the change of white adipose tissue mass in obese Zucker rats. Diabetes 1998; 101: 1354—1361.
29. Дедов И.И., пищулин А.А., яровая И.С., Акмаев Р.И. Опыт применения пиоглитазона (Актоса) в лечении синдрома поликистозных яичников. Пробл. эндокр. 2005; 1: 15—19.
30. Glueck C.J., Moreira A., Goldenberg N. Pioglitazone and metformin in obese women with PCOS not optimally responsive to metformin. Hum Reprod. 2003 Aug; 18 (8): 1618-25.
Review
For citations:
Chebotnikova T.V., Butrova S.A., Mel'nichenko G.A. Kontrol' massy tela – klyuch k uspekhu lecheniya bol'nykh s sindromom polikistoznykh yaichnikov. Bulletin of Reproductive Health. 2007;(1):7-18. (In Russ.) https://doi.org/10.14341/brh200717-18
Views:
383
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND 4.0).
Email this article 
