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Scientists know this much about polycystic ovary syndrome: It is one of the most common causes of infertility. It's linked to diabetes and several other troubling health problems. It affects as many as 5 million U.S. women.
關(guān)于多囊卵巢綜合癥，科學(xué)家知道的也就是這些：它是不孕不育的最常見原因之一。它與糖尿病和另外多種惱人的健康問題有關(guān)。它影響著多達(dá)500萬的美國(guó)女性。
But the condition, also known as PCOS, largely remains a mystery. Researchers are trying to better understand the disorder, which is generally defined by an excess production of the hormone testosterone, irregular ovulation and cysts-fluid-filled sacs-within the ovaries. Some teams are trying to improve its treatment to lessen its impact on women's reproductive health and metabolism, or how the body uses or makes energy.
但多囊癥總體上還是一個(gè)迷。研究人員正在努力更好地理解這一病癥。它大體上被定義為睪丸激素分泌過多、排卵不規(guī)律、卵巢內(nèi)存在囊腫（積液囊）。有些團(tuán)隊(duì)希望改進(jìn)治療方案，減輕它對(duì)女性生殖健康和新陳代謝（身體使用或產(chǎn)生能量的過程）的影響。
'We really need better options,' says Esther Eisenberg, project scientist of the Reproductive Medicine Network, a research collaboration set up and funded through the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
尤尼斯・肯尼迪・施萊佛美國(guó)國(guó)家兒童健康與人類發(fā)育研究所(Eunice Kennedy Shriver National Institute of Child Health and Human Development)設(shè)立并資助的研究協(xié)作團(tuán)體“生殖醫(yī)學(xué)網(wǎng)絡(luò)”(Reproductive Medicine Network)項(xiàng)目科學(xué)家埃絲特・艾森伯格(Esther Eisenberg)說：“我們真的需要更好的選擇。”
Even the diagnosis of PCOS can be tricky because the syndrome doesn't look the same in everyone. What is called PCOS is likely a number of different diseases that manifest similar symptoms, such as acne, excess facial- and body-hair growth in reproductive-aged females, insulin resistance and abnormal menstrual periods, according to experts.
多囊癥的診斷有時(shí)候都很困難，因?yàn)檫@一綜合癥并不是在每個(gè)人身上都表現(xiàn)得一樣。據(jù)專家說，所謂多囊癥可能是一系列表現(xiàn)為相似癥狀的不同疾病，這些癥狀包括痤瘡、育齡婦女面部和身體毛發(fā)過旺、胰島素抵抗、月經(jīng)不調(diào)等。
Over 60% of women with PCOS are overweight or obese. Excess hair growth, called hirsutism, also can differ by ethnicity, as can body weight. Such demographic differences can cause doctors to have difficulty identifying PCOS in those patients. And since most girls have irregular periods when they first start menstruating, misdiagnosis may be more likely to occur with young adolescents.
六成以上多囊癥婦女都存在過重或肥胖的問題。毛發(fā)生長(zhǎng)過旺（稱為“多毛癥”）的情況可能因?yàn)榉N族的不同而不同，體重問題也是如此。這些人口學(xué)差異可能導(dǎo)致醫(yī)生在診斷這些病人的多囊癥時(shí)發(fā)生困難。由于大多數(shù)女孩在剛開始來月經(jīng)時(shí)都存在經(jīng)期不正常的問題，在青少年身上或許更有可能發(fā)生誤診。
Insulin resistance, an inability to properly process sugar, is common, regardless of body weight. This can greatly raise the risk in PCOS patients of developing diabetes. The uterine lining may build up excessively, which is related to the lack of ovulation, and endometrial cancer risk appears to be increased as well. And women with PCOS often have trouble conceiving because they may not ovulate regularly, and may be more likely to miscarry. There also are concerns about an increased risk of heart disease, although no definitive data support that notion.
胰島素抵抗（無法有效處理糖分）是常見病征，與體重?zé)o關(guān)。它可以極大地提高多囊癥患者患上糖尿病的風(fēng)險(xiǎn)。子宮內(nèi)膜可能會(huì)過度生長(zhǎng)，而這與排卵缺乏有關(guān)。患子宮內(nèi)膜癌的風(fēng)險(xiǎn)似乎也會(huì)增加。多囊癥女性之所以存在生育困難，是因?yàn)樗齻兊呐怕芽赡懿灰?guī)律，流產(chǎn)的概率也可能更大。另外還有心臟病風(fēng)險(xiǎn)增加的擔(dān)憂，不過沒有確切數(shù)據(jù)支持這樣一種說法。
Researchers fear a general rise in obesity is causing a spike in PCOS, too, though they don't have enough longitudinal data to say definitively.
研究人員擔(dān)心，肥胖率的總體上升也在造成多囊癥患病率的猛增。不過他們沒有足夠的縱向數(shù)據(jù)來得出確切的結(jié)論。
PCOS appears to have a genetic component that may be triggered or influenced by environmental factors, like weight gain, later in life. But scientists are still trying to determine exactly what goes wrong. The symptoms of PCOS are at least in part due to excess androgens, the family of hormones to which testosterone belongs.
多囊癥似乎含有一種遺傳成分，這種成分可能會(huì)受到年齡增大時(shí)體重增加等環(huán)境因素的誘發(fā)或影響。但科學(xué)家仍在試圖明確究竟是什么地方出了問題。多囊癥的癥狀至少在一定程度上是因?yàn)樾奂に兀ㄖ赴úG丸激素在內(nèi)的一系列激素）過多。
The womb environment also appears critical to its development. Daniel Dumesic, a professor of reproductive endocrinology and infertility at the University of California, Los Angeles, and his colleagues found that by exposing mother monkeys with high doses of testosterone, their female offspring developed PCOS-like features after birth, including higher testosterone levels.
子宮環(huán)境似乎也是形成多囊癥的關(guān)鍵。加州大學(xué)洛杉磯分校(University of California, Los Angeles)生殖內(nèi)分泌與不孕不育教授丹尼爾・杜麥西克(Daniel Dumesic)及其同事發(fā)現(xiàn)，將母猴暴露于高劑量的睪丸激素，它們的雌性后代在出生之后出現(xiàn)了類似于多囊癥的特征，比如更高的睪丸激素水平。
They now are studying whether the bodies of women with PCOS, because of excess testosterone, store fat in tissues where it shouldn't be. Dr. Dumesic hypothesizes that this may impact the function of the ovary and perhaps fertility.
現(xiàn)在他們?cè)谘芯慷嗄野Y患者的身體是否會(huì)因?yàn)椴G丸激素而在本不應(yīng)儲(chǔ)存脂肪的組織中儲(chǔ)存脂肪。杜麥西克假想，這一點(diǎn)可能會(huì)影響卵巢功能和生育能力。
Christopher McCartney, a professor of medicine at the University of Virginia, is examining whether the high levels of testosterone could increase the body's secretion of another chemical, called luteinizing hormone, or LH, at puberty, contributing to the development of PCOS. LH, in turn, is needed for the ovaries to produce testosterone, so high levels of LH may be helping produce additional testosterone, leading to a vicious cycle, Dr. McCartney says.
弗吉尼亞大學(xué)(University of Virginia)醫(yī)學(xué)教授克里斯托弗・麥卡特尼(Christopher McCartney)正在檢驗(yàn)高水平的睪丸激素是否有可能增加體內(nèi)另一種化學(xué)物質(zhì)“促黃體生成素”在青春期的分泌，從而促進(jìn)多囊癥的形成。麥卡特尼說，促黃體生成素又是卵巢產(chǎn)生睪丸激素所需的物質(zhì)，所以高水平的促黃體生成素可能是在幫助形成過多的睪丸激素，構(gòu)成了一種惡性循環(huán)。
Why the syndrome increases the risk of diabetes remains unclear. One possibility is that because the body doesn't respond well to insulin, it overcompensates to make more of it, which leads to increased levels of luteinizing hormone and lower levels of follicle-stimulating hormone, as well as increased ovarian production of androgens.
多囊癥增加糖尿病風(fēng)險(xiǎn)的原因仍舊不明。有一種可能性是，因?yàn)樯眢w對(duì)胰島素的反應(yīng)不敏感，作為補(bǔ)償它便過多地生成胰島素。過多的胰島素會(huì)導(dǎo)致促黃體生成素水平提高、促卵泡生成素水平下降、卵巢雄激素分泌增加。
Together, these slow or prevent ovulation, according to Richard Legro, a professor of obstetrics and gynecology and public health sciences at Penn State University College of Medicine in Hershey, Pa.
據(jù)賓州赫希市賓夕法尼亞州立大學(xué)醫(yī)學(xué)院(Penn State University College of Medicine)婦產(chǎn)科與公共衛(wèi)生學(xué)教授理查德・勒格羅(Richard Legro)說，這些因素會(huì)一起延緩或阻止排卵。
'It's likely that the menstrual and reproductive dysfunction is a harbinger of later metabolic abnormalities like diabetes,' Dr. Legro says.
勒格羅說：“月經(jīng)和生殖障礙可能是糖尿病之類后期代謝異常的先兆。”
Treatments include hormonal contraceptives to prompt ovaries to stop producing testosterone and other hormones, plus anti-androgen medications like flutamide, usually used to treat prostate cancer, and insulin sensitizers for metabolic issues. Metformin, which isn't an insulin sensitizer but is used to treat high blood sugar, is given as well on a case-by-case basis. Some of these treatments carry risks and most, with the exception of metformin, can't be used when women are trying to get pregnant.
治療辦法包括服用激素避孕藥，促使卵巢停止產(chǎn)生睪丸激素和其他激素，服用通常用于治療前列腺癌的氟他胺等抗雄激素藥物，以及針對(duì)代謝問題服用胰島素增敏劑。本身不是增敏劑但用于治療高血糖的二甲雙胍也可酌情讓病人服用。這些治療方法中的一部分存在風(fēng)險(xiǎn)，除了二甲雙胍之外，大多數(shù)治療方法都不能在婦女準(zhǔn)備懷孕的時(shí)候使用。
Lourdes Ibáñez, a professor of pediatrics at the University of Barcelona, has been studying combination treatments for PCOS. She found that metformin, an insulin sensitizer called pioglitazone and flutamide taken together performed better than oral contraceptives. Oral contraceptives appeared to actually worsen the girls' metabolic abnormalities.
巴塞羅納大學(xué)(University of Barcelona)兒科教授洛德斯・伊瓦涅斯(Lourdes Ibanez)一直在研究多囊癥的組合治療。她發(fā)現(xiàn)，二甲雙胍、胰島素增敏劑“?格列酮”和氟他胺一起服用的效果好于口服避孕藥。口服避孕藥似乎還加重了女孩的代謝異常。
Six months after the 18-month treatment, no one in the combination therapy group has relapsed but 50% of those in the oral contraceptive groups have, according to a paper Dr. Ibáñez published in 2013 in the Journal of Clinical Endocrinology & Metabolism.
根據(jù)伊瓦涅斯2013年發(fā)表在《臨床內(nèi)分泌和代謝雜志》(Journal of Clinical Endocrinology & Metabolism)上的論文，經(jīng)過18個(gè)月的治療并觀察六個(gè)月之后，組合治療組里面無人復(fù)發(fā)，而口服避孕藥組里面50%的人復(fù)發(fā)。
She is also studying whether the symptoms of PCOS can be prevented in girls at high risk for the condition. She conducted a tiny pilot study of 38 girls who were born with a low birth weight and had precocious puberty, which are often precursors to PCOS.
她也正在研究能不能阻止患多囊癥風(fēng)險(xiǎn)較高的女孩出現(xiàn)多囊癥癥狀。她對(duì)38名出生體重低、性早熟（常常是多囊癥的先兆）的女孩展開了一項(xiàng)微型試點(diǎn)研究。
She began treating them with metformin between ages 8 to 12. At 18 years old, the rate of detectable symptoms in the treated group was 5%, compared with 50% of those in the untreated group. She hopes to run a larger trial to further explore the possibility of prevention.
她在她們八歲到12歲的時(shí)候開始用二甲雙胍治療。在18歲的時(shí)候，治療組出現(xiàn)可觀測(cè)癥狀的比例為5%，未治療組的比例為50%。她希望開展一場(chǎng)規(guī)模更大的試驗(yàn)，以進(jìn)一步探索預(yù)防多囊癥的可能性。
Scientists also have focused on improving fertility in women with PCOS. With clomiphene citrate, the most commonly used agent for ovulation induction in women with PCOS, only about half the women who ovulate end up having babies, according to NICHD's Dr. Eisenberg.
科學(xué)家也一直在集中精力改善多囊癥婦女的生育能力。據(jù)艾森伯格說，在服用多囊癥患者最常用的排卵誘導(dǎo)劑枸櫞酸氯米芬（克洛米芬）的情況下，只有大約一半成功排卵的婦女最后生了孩子。
Dr. Eisenberg, Penn State's Dr. Legro and the Reproductive Medicine Network have been running a clinical trial to improve fertility. In a presentation to the American Society for Reproductive Medicine in October, they showed that early results indicate a medication called letrozole, a drug commonly used for in vitro fertilization, appears to result in more live births than clomiphene.
艾森伯格、賓大的列格羅以及生殖醫(yī)學(xué)網(wǎng)絡(luò)已經(jīng)在做一次旨在提高生育率的臨床試驗(yàn)。他們?cè)?013年10月份向美國(guó)生殖醫(yī)學(xué)會(huì)(American Society for Reproductive Medicine)做報(bào)告的時(shí)候表示，初步結(jié)果表明，常常用于體外授精的來曲唑產(chǎn)生的活胎數(shù)量似乎高于枸櫞酸氯米芬。
One of those success stories was Lindsey Maloney, from Fredericksburg, Va. She had so much facial hair she started waxing it off in the fifth grade and always struggled with her weight because of insulin resistance. She had her period only once in the seventh grade and was first diagnosed with PCOS at 15.
弗吉尼亞州弗雷德里克斯堡的琳賽・馬洛尼(Lindsey Maloney)便是成功例子之一。由于面部毛發(fā)過多，她在上五年級(jí)的時(shí)候便開始動(dòng)手脫毛；而因?yàn)橐葝u素抵抗，她又總是因?yàn)轶w重問題而煩惱。她只在上七年級(jí)的時(shí)候有過一次例假，15歲時(shí)第一次診出多囊癥。
When Ms. Maloney, now a 29-year-old school counselor, got engaged to her now-husband, her fertility worried her. When the couple heard about Dr. Legro's study, Ms. Maloney enrolled and drove three hours to Hershey once a month for drugs to help her ovulate. She was randomly assigned to the letrozole group, she says.
馬洛尼現(xiàn)年29歲，是一名中學(xué)輔導(dǎo)員。在跟現(xiàn)在的丈夫訂婚時(shí)，她因?yàn)樽约旱纳芰Χ鴵?dān)憂。夫妻二人聽說列格羅的研究時(shí)，馬洛尼加入了研究，每個(gè)月開車三小時(shí)到赫希去服用幫助她排卵的藥物。她說，她被隨機(jī)分配到服用來曲唑的小組。
They now have a 2-year-old girl, Briley. Ms. Maloney and her husband are trying for a second child on their own and haven't had any luck yet.
現(xiàn)在他們的女兒布里利(Briley)已經(jīng)兩歲了。馬洛尼和丈夫正在嘗試自行孕育第二個(gè)孩子，目前尚未成功。
Ms. Maloney has been taking metformin since she was a teenager, sees an endocrinologist every three months and buys supplements and organic foods without hormones in them, but her symptoms have remained, she says.
馬洛尼說，她從十幾歲以來一直在服用二甲雙胍，每三個(gè)月都要看一次內(nèi)分泌科醫(yī)生，她還購買補(bǔ)充劑和沒有激素的有機(jī)食品，但癥狀依然沒有消失。
'It's not just on your ovaries. It's a whole mess of endocrine problems that you have,' she says.
她說：“不只是卵巢的問題，而是一大堆內(nèi)分泌問題。”
