女性高雄激素病因诊断的临床路径思索  

Exploration of the clinical pathway for etiological diagnostics of androgen excess in female

作　　者：张婷婷[1] 徐阳[2] Zhang Tingting;Xu Yang(Department of Endocrinology,Peking University First Hospital,Beijing 100034,China;Reproductive Genetics Center of Obstetrics and Gynecology,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院内分泌科,北京100034 [2]北京大学第一医院妇产科生殖遗传中心,北京100034

出　　处：《中华医学杂志》2023年第14期1016-1021,共6页National Medical Journal of China

基　　金：2019中国糖尿病英才研究项目(2018-N-01);中央高水平医院临床科研业务费(北京大学第一医院院内交叉临床研究专项)(2022CR04)

摘　　要：高雄激素是临床常见的内分泌代谢问题,影响女性全生命周期健康,其诊断和治疗需要多学科联合。女性高雄激素的病因诊断要根据不同年龄阶段的病因构成特点,从病史、体格检查、雄激素等内分泌激素测定、功能试验、影像学以及基因检测等方面综合判断。高雄激素病因诊断的总体原则是首先确定患者是否具有临床和(或)生化高雄激素,其次判断是否符合多囊卵巢综合征(PCOS)的诊断标准,然后再判定是否为特定疾病,最后未发现明确病因者再用质谱法检测验证雄激素水平,除外假性升高后,可诊断为特发性多毛或特发性高雄激素血症。探索女性高雄激素病因诊断的临床路径对指导女性高雄激素规范化和精准化诊疗有重要参考意义。Androgen excess is a common endocrine and metabolic problem in clinical practice,which affects the health of women throughout their life cycle.Usually,its diagnosis and treatment need multidisciplinary cooperation.The etiological diagnosis of female hyperandrogenism should be based on the etiological characteristics at different ages and should be comprehensively evaluated from medical history,physical examination,determination of androgen and other endocrine hormones,functional tests,imaging,and genetic testing,etc.The general principle of androgen excess cause diagnosis is first to determine whether the patient has clinical and/or biochemical androgen excess,then determine whether she conforms to the diagnostic criteria of polycystic ovary syndrome(PCOS),and then determine whether it is a specific disease or not.Finally,mass spectrometry should be adopted for verifying the androgen levels in those without clear causes found to exclude pseudo-elevation,thus it can be diagnosed as idiopathic androgen excess.Exploring the clinical pathway for the etiological diagnosis of female hyperandrogenism has important reference significance for guiding the standardized and accurate diagnosis and treatment of female hyperandrogenism.

关 键 词：多囊卵巢综合征 高雄激素 病因诊断 临床路径 内分泌疾病 

分 类 号：R711.75[医药卫生—妇产科学]