Modern Pediatrics. Ukraine. (2022). 4(124): 65-72. doi 10.15574/SP.2022.124.65
Сорокман Т. В., Хлуновська Л. Ю., Попелюк Н. А.
Буковинский государственный медицинский университет, г. Черновцы, Украина

Для цитирования: Sorokman TV, Khlunovska LYu, Popelyuk NO. (2022). Polycystic ovary syndrome in adolescence — a look at the problem. Modern Pediatrics. Ukraine. 4(124): 65-72. doi 10.15574/SP.2022.124.65.
Статья поступила в редакцию 28.01.2022 г., принята в печать 20.04.2022 г.

Цель — представить обзор данных литературы по этиологии и патогенезу синдрома поликитозных яичников (СПКЯ) у подростков. Проведен обзор научной литературы по СПКЯ по ключевым словам «синдром поликистозных яичников — polycystic ovary syndrome, PCOS», «синдром Штейна Левенталя — Stein-Leventhal syndrome», «функциональная яичниковая гиперандрогения, или функциональный яичниковый гиперандрогенизм», гиперандрогенная хроническая ановуляция — hyperandrogenic chronic anovulation»; «яичниковый дисметаболический синдром — ovarian dysmetabolic syndrome» с использованием в качестве поисковой системы PubMed.
В настоящее время СПКЯ рассматривается как гетерогенный и сложный синдром, сопровождающийся нарушениями функции яичников (отсутствием или нерегулярностью овуляции, повышенной секрецией андрогенов и эстрогенов), поджелудочной железы (гиперсекреция инсулина), коры надпочечников (гиперсекреция андрогенов), гипоталамуса, гипофиза, имеет негативные репродуктивные и метаболические последствия. Распространенность СПКЯ у подростков по разным критериям составляет от 8% до 17%. Потенциальный риск развития СПКЯ составляют низкая или высокая масса тела при рождении, детское ожирение, пренатальный андрогенизм, метаболический синдром, генетические мутации в хромосоме 18. Наиболее достоверными критериями СПКЯ у юных пациенток являются: сочетание ультразвуковой (морфологической) картины яичников (соотношение половых гормонов и гиперандрогении), динамика становления менструального цикла (аменорея) на фоне дисметаболических нарушений (ожирение, гиперинсулинизм, нарушение толерантности к глюкозе). Дополнительным диагностическим критерием может являться уровень антимюллерового гормона.
Выводы. Клинически СПКЯ является гетерогенным синдромом, проявляющимся во все периоды жизни. Основным физиологическим и патологическим механизмом СПКЯ является избыток андрогенов, нарушающий развитие фолликулов и способствующий отложению абдоминальной жировой ткани, вызывая инсулинорезистентность и компенсаторный гиперинсулинизм. Воздействие на плод гиперинсулинемической и гиперандрогенной среды матки приводит к эпигенетическим изменениям, которые, в дополнение к генетическому фону, склонны к развитию метаболических нарушений у потомков женщин с СПКЯ. Это рациональная основа для поиска СПКЯ в раннем возрасте, что позволит своевременно диагностировать его уже в подростковом возрасте. Не все аспекты подробно освещены в этом обзоре из-за ограниченного объема. Проблемные вопросы клинически значимых маркеров СПКЯ и их предикторов у пациенток подросткового возраста требуют углубленного изучения.
Ключевые слова: синдром поликистозных яичников, девочки-подростки.
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