Diagnostic and prognostic biomarkers in PCOS: Navigating insulin resistance, systemic inflammation, and endometrial receptivity.

摘要(中文译文)

※ 中文译文由 AI 辅助生成,仅供学术参考,请以英文原文为准。

多囊卵巢综合征（PCOS）是一种非常普遍且表型多样的内分泌疾病，其中胰岛素抵抗（IR）是主要代谢和生殖并发症的核心分子驱动因素，包括不孕、肥胖和长期心血管风险增加。本综述探讨了多囊卵巢综合征的复杂病理生理学，强调了慢性全身性低度炎症、肠道微生物组失调和氧化应激如何相互作用，使高胰岛素血症和高雄激素血症恶化。它还强调了新兴诊断和预后生物标志物在改善风险分层和患者管理方面的临床价值。全身生物标志物，如促炎细胞因子、由肠通透性增加引起的循环内毒素血症以及包括miR-146a在内的表观遗传调节因子，可以为代谢恶化的轨迹提供预后见解。同时，子宫内膜生物标志物，包括葡萄糖转运蛋白GLUT4、HOXA10等植入相关基因和TNF-α等炎症介质，可以支持评估受损的子宫容受性、预测辅助生殖技术（ART）结果和流产风险分层。通过绘制肠道免疫代谢轴内的关键相互作用并详细说明局部子宫内膜功能障碍，本综述提出了一个将靶向生物标志物分析纳入临床实践的框架，以实现个性化的、基于生物标志物的干预措施，旨在恢复PCOS患者的生育能力和代谢健康。

Abstract

Polycystic ovary syndrome (PCOS) is a highly prevalent and phenotypically diverse endocrine disorder in which insulin resistance (IR) serves as a central molecular driver of major metabolic and reproductive complications, including infertility, obesity, and increased long-term cardiovascular risk. This review examines the complex pathophysiology of PCOS, emphasizing how chronic systemic low-grade inflammation, gut microbiome dysbiosis, and oxidative stress interact to worsen hyperinsulinemia and hyperandrogenemia. It also highlights the clinical value of emerging diagnostic and prognostic biomarkers to improve risk stratification and patient management. Systemic biomarkers, such as pro-inflammatory cytokines, circulating endotoxemia arising from increased intestinal permeability, and epigenetic regulators including miR-146a, may provide prognostic insight into the trajectory of metabolic deterioration. In parallel, endometrial biomarkers, including the glucose transporter GLUT4, implantation-associated genes such as HOXA10, and inflammatory mediators like TNF-α, can support evaluation of impaired uterine receptivity, prediction of assisted reproductive technology (ART) outcomes, and stratification of miscarriage risk. By mapping key interactions within the gut-immune-metabolic axis and detailing localized endometrial dysfunction, this review proposes a framework for integrating targeted biomarker profiling into clinical practice to enable personalized, biomarker-informed interventions aimed at restoring fertility and metabolic health in patients with PCOS.

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