多囊性卵巢症候群與流產

Polycystic Ovary Syndrome and Miscarriage

姜禮盟(Li-Mong Chiang)

《北市醫學雜誌》 3卷4期 (2006/04) Pp. 331-338

https://doi.org/10.6200/TCMJ.2006.3.4.03

摘要

多囊性卵巢症候群所導致的內分泌及代謝異常，不但會引發慢性排卵功能失調、月經異常及不孕，即使懷孕也必須面對偏高的自然流產率，甚至變成習慣性流產。一般人懷孕後的自然流產率保守估計約為15%，多囊性卵巢症候群的婦女則約為25%至60%。由於定義及統計方式不同而有極大差異。面對如此高的流產率，要如何幫助這一群婦女是婦產科醫師必需面對的課題。多囊性卵巢症候群導致流產的機轉目前還不清楚，較難對症下藥。詳細的檢查以釐清病因，排除其他可矯治的因素後，可施行誘導排卵。以Metformin為首選藥物，可加上clomiphene。Metformin可在懷孕後停藥，也可以在整個懷孕期間使用，可降低流產率及妊娠糖尿病的發生率。流產的困擾，以及代謝異常可能導致的長期心血管風險，讓我們更應該正視多囊性卵巢症候群這個問題，從預防醫學的角度，為婦女儘早做適當的處理。

關鍵字

多囊性卵巢症候群 ； 自然流產 ； 復發性流產

並列摘要

Polycystic ovary syndrome (PCOS), a concept developed since 70 years ago, has now been known as a functional derangement with chronic anovulation of varied etiologies. It is a multi-system reproductive-metabolic disorder with clinical manifestations including hyperandrogenism, irregular menstruation, infertility, insulin resistance, hyperinsulinemia, and obesity. There is mounting evidence that women with PCOS have a higher spontaneous abortion rate that may in turn become recurrent miscarriage. The estimated abortion rate for women with PCOS is around 25-60% compared with 15% in non-PCOS women. The pathogenesis of this high abortion rate is not clear. Placental thrombosis caused by hyperinsulinemia induced PAI-1 elevation may be one of the possible mechanisms. Metformin is drug-of-choice for management of these patients. Clomiphene may be added for ovulation induction. Considering the large number of PCO patients and the above mentioned serious health problems for these patients, further study is indicated about this field in the view of preventive medicine.

並列關鍵字

Polycystic ovary syndrome PCOS ； spontaneous abortion ； recurrent miscarriage ； metformin