ASRM精彩内容：PCOS的患病率、发病率趋势！

美国生殖医学会（ASRM）年会是生殖医学领域规模最大、最具影响力的年度国际学术会议之一，覆盖生殖医学领域所有专业。2022年ASRM年会已经召开，生殖医学论坛精选了众多会议精华内容进行了翻译，希望给大家带来最新鲜、最前沿的生殖医学资讯。

Objective

目的

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age, yet incidence and prevalence rates are poorly defined and vary widely. In a population-based US study, we estimated PCOS incidence and prevalence over time, and by age and race.

多囊卵巢综合征（PCOS）是育龄妇女最常见的内分泌疾病，其患病率和发病率尚不明确，且差异很大。在一项以人群为基础的美国研究中，我们按照年龄、种族估计了PCOS的发病率和患病率。

Materials and Methods

材料和方法

A retrospective cohort study of patients enrolled in Kaiser Permanente Washington in 2006-2019 was conducted. All members identified as female, aged 16-40 years with at least 3 years enrollment and at least one healthcare encounter during that time were eligible for inclusion. Individuals were excluded if they had a history of oophorectomy or hysterectomy. PCOS cases were identified using International Classification of Diseases (ICD) diagnosis codes (ICD-9 256.4 or ICD-10 E28.2). Those with a PCOS diagnosis prior to study entry were excluded from incidence rate estimation. Incidence rates were age-adjusted by direct standardization to the 2010 US census data. Secular trends in incidence overall, by age and by race were assessed using Poisson regression. Prevalent cases were defined as patients with a PCOS diagnosis anytime in or prior to 2019. Chart review was performed to validate incident cases identified by ICD codes using Rotterdam 2003 criteria.

对2006-2019年在华盛顿凯撒医疗机构登记的患者进行回顾性队列研究。纳入标准：女性，年龄16-40岁，时间至少3年，在此期间至少经历一次医疗保健，均有纳入资格。有卵巢切除术或子宫切除术病史的患者将被排除在外。PCOS病例识别采用国际疾病分类（ICD）诊断代码（ICD-9 256.4或ICD10 E28.2）。那些在研究开始前被诊断为PCOS的患者被排除在发病率估计之外。根据2010年美国人口普查数据对发病率进行年龄标化。使用 Poisson回归评估年龄和种族整体的长期发病率趋势。患病病例定义为2019年或之前任何时候诊断为PCOS的患者。采用2003年鹿特丹标准进行图表审查，以验证ICD代码识别的病例。

Results

结果

Among 351,171 eligible patients who contributed 586,470 person-years, 2,491 incident PCOS cases were identified. Mean age at diagnosis was 26.9 (SD 6.8) years and mean BMI was 34.8 (SD 9.1) kg/m2. Overall incidence rates were similar over time between 40.3 and 50.5 per 10,000 person-years. However, diagnosis rates increased over time in individuals ages 16-20 years from 31.0 to 51.9 per 10,000 person-years (p=0.01) and decreased among those ages 26-30 years from 82.8 to 45.0 per 10,000 person-years (p=0.02). Compared to other race groups, Hispanic individuals appeared to have higher PCOS incidence rates but the differences were not statistically significant. A small decreasing temporal trend in incidence rates was only observed among White individuals (p=0.01). Among the 58,241 patients who contributed person-time in 2019, 3,036 (5.2%) had a PCOS ICD diagnosis code. Chart review of 700 incident cases diagnosed in 2011-2019 classified 60% as probable or definite incident, 14% as possible incident and 17% as prevalent PCOS.

在586470人中有351171例患者中符合条件，2491例PCOS病例。诊断时的平均年龄为26.9±6.8岁，平均BMI为34.8±9.1kg/m2 。不同年份PCOS总体发病率相似，为40.3-50.5/10000。然而，16-20岁个体的诊断率从每31.0/10000上升到51.9/10000（p＝0.01），而26-30岁个体的诊断率从82.8/10000下降到45.0/10000（p＝0.02）。与其他种族组相比，西班牙裔个体似乎有更高的PCOS发病率，但差异没有统计学意义。仅在白人个体中观察到发病率有小幅下降趋势（p=0.01）。在2019年的58241例患者中，根据ICD编码识别3036例(5.2%)PCOS患者。对2011-2019年诊断的700例发病患者进行的图表回顾将60%归类为较大可能或确定的发病，14%归类为可能发病，17%归类为患有PCOS。

Conclusions

结论

Among a cohort of non-selected women in the US, not relying on patient self-report, we observed fairly constant rates of incident PCOS diagnoses over time (although estimates were conflated by prevalent cases). PCOS prevalence (5.2%) based on ICD codes was higher than prior published US nation-wide estimates (2.9%) [1]. Incident diagnoses increased through time in younger age groups and decreased in older age groups. Race did not appear to have a major impact on temporal rates.

在不依赖患者自我报告的非选择的美国女性队列中。我们观察到随着时间的推移，PCOS诊断的发病率相当稳定（尽管估计被流行病例合并）。基于ICD代码的PCOS患病率（5.2%）高于之前公布的美国全国性估计数（2.9%）。在较年轻的年龄组中，发病诊断随着时间的推移而增加，而在较年长的年龄组中则减少。种族现象似乎对时间患病率没有很大影响。

Impact Statement

影响陈述

In recent years, PCOS diagnosis rates have increased among younger individuals. This may be related to shifting practice patterns with greater awareness among practitioners of the impact of PCOS on long term health outcomes or improved prevention efforts. Increasing obesity rates may also be a factor driving the earlier ages at diagnosis.

近年来，年轻患者的PCOS诊断率有所上升。这可能与改变实践模式有关，从业人员更加了解PCOS对长期健康结果的影响或改善预防工作。肥胖率的增加也可能是导致发病年龄早的一个因素。

文章来源：

PREVALENCE, INCIDENCE AND TRENDS IN POLYCYSTIC OVARY SYNDROME (PCOS) DIAGNOSISYu, Onchee et al.Fertility and Sterility, Volume 118, Issue 4, e192