ω-3多不饱和脂肪酸在多囊卵巢综合征中的作用机制

doi:10.12280/gjszjk.20240596

摘要/Abstract

摘要：

多囊卵巢综合征（polycystic ovary syndrome，PCOS）是好发于青春期及育龄期女性的生殖内分泌紊乱性疾病，可诱发不孕症、代谢紊乱及心血管疾病等并发症，对患者生理及心理健康带来严重影响。ω-3多不饱和脂肪酸（omega-3 polyunsaturated fatty acid，ω-3 PUFA）是一类来源于植物油或海洋多脂鱼类的重要功能性高值脂肪酸，具有抗炎、抗氧化、抗血栓形成以及降低血脂等功效。近年研究发现，ω-3 PUFA可有效改善PCOS患者高雄激素血症，还可通过调节胰岛素抵抗、肥胖及血脂异常改善PCOS患者的代谢状态。此外，ω-3 PUFA还能有效抑制促炎细胞因子的生成，从而改善PCOS患者慢性炎症及氧化应激损伤状态，并且还能通过增加肠道健康菌群的丰度改善患者肠道菌群失调。ω-3 PUFA在PCOS中的应用还有待进一步研究。

关键词: 多囊卵巢综合征, 脂肪酸类, ω3, 脂肪酸类, 不饱和, 雄激素增多症, 胰岛素抵抗, 肥胖, 胃肠道微生物组

Abstract:

Polycystic ovary syndrome (PCOS) as a reproductive endocrine disorder is more common in the women of puberty and childbearing age, and can induce complications such as infertility, metabolic disorders and cardiovascular disease, which seriously affect the physiological and psychological health of patients. ω-3 polyunsaturated fatty acids (omega-3 PUFAs) are an important group of functional high-value fatty acids derived from vegetable oils or marine fatty fish, with anti-inflammatory, antioxidant, anti thrombotic, and lipid-lowering effects. In recent years, studies have found that supplementing with omega-3 PUFAs can improve hyperandrogenism in patients. It can also improve the metabolic status by regulating insulin resistance, obesity, and dyslipidemia in PCOS patients. In addition, omega-3 PUFAs can effectively inhibit the production of pro-inflammatory cytokines, thereby improving their chronic inflammation and oxidative stress damage status. They can also play an important role in improving the imbalance of gut microbiota in PCOS patients by increasing the abundance of healthy gut microbiota. The application of omega-3 PUFAs in the treatment of PCOS still needs further research.

Key words: Polycystic ovary syndrome, Fatty acids, omega-3, Fatty acids, unsaturated, Hyperandrogenism, Insulin resistance, Obesity, Gastrointestinal microbiome

卢凤娟, 丛晶, 王宇, 石百超, 关木馨, 张蓓, 吴效科. ω-3多不饱和脂肪酸在多囊卵巢综合征中的作用机制[J]. 国际生殖健康/计划生育杂志, 2025, 44(3): 215-219.

LU Feng-juan, CONG Jing, WANG Yu, SHI Bai-chao, GUAN Mu-xin, ZHANG Bei, WU Xiao-ke. The Action of ω-3 Polyunsaturated Fatty Acids in Polycystic Ovary Syndrome[J]. Journal of International Reproductive Health/Family Planning, 2025, 44(3): 215-219.

参考文献 35

[1]	Alesi S, Ee C, Moran LJ, et al. Nutritional Supplements and Complementary Therapies in Polycystic Ovary Syndrome[J]. Adv Nutr, 2022, 13(4):1243-1266. doi: 10.1093/advances/nmab141.
[2]	黄和, 任波, 孙小曼. ω-3多不饱和脂肪酸健康机制及应用研究进展[J]. 食品科学技术学报, 2024, 42(5):1-12. doi: 10.12301/spxb202400679.
[3]	中华医学会妇产科学分会内分泌学组及指南专家组. 多囊卵巢综合征中国诊疗指南[J]. 中华妇产科杂志, 2018, 53(1):2-6. doi: 10.3760/cma.j.issn.0529-567x.2018.01.002.
[4]	Jovanovic S, Dietrich D, Becker J, et al. Microbial production of polyunsaturated fatty acids - high-value ingredients for aquafeed, superfoods, and pharmaceuticals[J]. Curr Opin Biotechnol, 2021, 69:199-211. doi: 10.1016/j.copbio.2021.01.009.
[5]	Cunnane SC, Trushina E, Morland C, et al. Brain energy rescue: an emerging therapeutic concept for neurodegenerative disorders of ageing[J]. Nat Rev Drug Discov, 2020, 19(9):609-633. doi: 10.1038/s41573-020-0072-x. pmid: 32709961
[6]	田梦醒, 胡仁崇, 金鑫. ω-3多不饱和脂肪酸应用于多囊卵巢综合征疗效的Meta分析[J]. 生殖医学杂志, 2022, 31(5):671-680. doi: 10.3969/j.issn.1004-3845.2022.05.016.
[7]	Ma X, Weng X, Hu X, et al. Roles of different n-3/n-6 PUFA ratios in ovarian cell development and steroidogenesis in PCOS rats[J]. Food Funct, 2019, 10(11):7397-7406. doi: 10.1039/c9fo01730e. pmid: 31657414
[8]	Phelan N, O′Connor A, Kyaw Tun T, et al. Hormonal and metabolic effects of polyunsaturated fatty acids in young women with polycystic ovary syndrome: results from a cross-sectional analysis and a randomized, placebo-controlled, crossover trial[J]. Am J Clin Nutr, 2011, 93(3):652-662. doi: 10.3945/ajcn.110.005538. pmid: 21270384
[9]	Nadjarzadeh A, Dehghani-Firouzabadi R, Daneshbodi H, et al. Effect of Omega-3 Supplementation on Visfatin, Adiponectin, and Anthropometric Indices in Women with Polycystic Ovarian Syndrome[J]. Reprod Infertil, 2015, 16(4):212-220.
[10]	Salek M, Clark C, Taghizadeh M, et al. N-3 fatty acids as preventive and therapeutic agents in attenuating PCOS complications[J]. EXCLI J, 2019, 18:558-575. doi: 10.17179/excli2019-1534. pmid: 31611740
[11]	Huang Y, Zhang X. Meta-analysis of the efficacy of ω-3 polyunsaturated fatty acids when treating patients with polycystic ovary syndrome[J]. Medicine(Baltimore), 2023, 102(39):e35403. doi: 10.1097/MD.0000000000035403.
[12]	Rafraf M, Mohammadi E, Asghari-Jafarabadi M, et al. Omega-3 fatty acids improve glucose metabolism without effects on obesity values and serum visfatin levels in women with polycystic ovary syndrome[J]. J Am Coll Nutr, 2012, 31(5):361-368. doi: 10.1080/07315724.2012.10720443. pmid: 23529993
[13]	Lu L, Li X, Lv L, et al. Associations between omega-3 fatty acids and insulin resistance and body composition in women with polycystic ovary syndrome[J]. Front Nutr, 2022, 9:1016943. doi: 10.3389/fnut.2022.1016943.
[14]	吴聪, 葛科立, 路宗博, 等. n-3多不饱和脂肪酸对小鼠血液外泌体中miRNA的调节和抑制肥胖作用[J]. 食品科学, 2021, 42(7):176-184. doi: 10.7506/spkx1002-6630-20200411-149.
[15]	Oner G, Muderris II. Efficacy of omega-3 in the treatment of polycystic ovary syndrome[J]. J Obstet Gynaecol, 2013, 33(3):289-291. doi: 10.3109/01443615.2012.751365. pmid: 23550861
[16]	Nadjarzadeh A, Dehghani Firouzabadi R, Vaziri N, et al. The effect of omega-3 supplementation on androgen profile and menstrual status in women with polycystic ovary syndrome: A randomized clinical trial[J]. Iran J Reprod Med, 2013, 11(8):665-672. pmid: 24639805
[17]	Guo F, Gong Z, Fernando T, et al. The Lipid Profiles in Different Characteristics of Women with PCOS and the Interaction Between Dyslipidemia and Metabolic Disorder States: A Retrospective Study in Chinese Population[J]. Front Endocrinol(Lausanne), 2022, 13:892125. doi: 10.3389/fendo.2022.892125.
[18]	Rodriguez D, Lavie CJ, Elagizi A, et al. Update on Omega-3 Polyunsaturated Fatty Acids on Cardiovascular Health[J]. Nutrients, 2022, 14(23):5146. doi: 10.3390/nu14235146.
[19]	Wang L, Luo M, Yu X, et al. Assessing the clinical diagnostic value of anti-Müllerian hormone in polycystic ovarian syndrome and its correlation with clinical and metabolism indicators[J]. J Ovarian Res, 2024, 17(1):78. doi: 10.1186/s13048-024-01405-4. pmid: 38600539
[20]	蒋玲玲, 阮祥燕, 李妍秋, 等. 多囊卵巢综合征患者体成分对肝、肾功能和血脂的影响[J]. 首都医科大学学报, 2024, 45(4):623-628. doi: 10.3969/j.issn.1006-7795.2024.04.010.
[21]	Yang K, Zeng L, Bao T, et al. Effectiveness of Omega-3 fatty acid for polycystic ovary syndrome: a systematic review and meta-analysis[J]. Reprod Biol Endocrinol, 2018, 16(1):27. doi: 10.1186/s12958-018-0346-x.
[22]	Zhou J, Zuo W, Tan Y, et al. Effects of n-3 polyunsaturated fatty acid on metabolic status in women with polycystic ovary syndrome: a meta-analysis of randomized controlled trials[J]. J Ovarian Res, 2023, 16(1):54. doi: 10.1186/s13048-023-01130-4. pmid: 36932420
[23]	严谨, 王超, 王瑞静, 等. 氧化应激在多囊卵巢综合征中的研究进展[J]. 生殖医学杂志, 2023, 32(3):459-463. doi: 10.3969/j.issn.1004-3845.2023.03.026.
[24]	夏晴, 王大勇, 葛方亮, 等. 慢性低度炎症在多囊卵巢综合征排卵障碍中的作用机制[J]. 中国医药导报, 2024, 21(14):1-5. doi: 10.20047/j.issn1673-7210.2024.14.01.
[25]	Yuan J, Wen X, Jia M. Efficacy of omega-3 polyunsaturated fatty acids on hormones, oxidative stress, and inflammatory parameters among polycystic ovary syndrome: a systematic review and meta-analysis[J]. Ann Palliat Med, 2021, 10(8):8991-9001. doi: 10.21037/apm-21-2018. pmid: 34488386
[26]	Tosatti J, Alves MT, Candido AL, et al. Influence of n-3 fatty acid supplementation on inflammatory and oxidative stress markers in patients with polycystic ovary syndrome: a systematic review and meta-analysis[J]. Br J Nutr, 2021, 125(6):657-668. doi: 10.1017/S0007114520003207.
[27]	王晶, 戴若冰, 葛含婷, 等. 多囊卵巢综合征与肠道菌群失调中西医结合研究进展[J]. 中国中西医结合杂志, 2024, 44(1):120-126. doi: 10.7661/j.cjim.20230608.276.
[28]	Wang L, Zhou J, Gober HJ, et al. Alterations in the intestinal microbiome associated with PCOS affect the clinical phenotype[J]. Biomed Pharmacother, 2021, 133:110958. doi: 10.1016/j.biopha.2020.110958. pmid: 33171400
[29]	石百超, 常惠, 王宇, 等. 肠道菌群在多囊卵巢综合征中的作用机制[J]. 国际生殖健康/计划生育杂志, 2024, 43(3):238-243. doi: 10.12280/gjszjk.20240078.
[30]	Costantini L, Molinari R, Farinon B, et al. Impact of Omega-3 Fatty Acids on the Gut Microbiota[J]. Int J Mol Sci, 2017, 18(12):2645. doi: 10.3390/ijms18122645.
[31]	Wang T, Sha L, Li Y, et al. Dietary α-Linolenic Acid-Rich Flaxseed Oil Exerts Beneficial Effects on Polycystic Ovary Syndrome Through Sex Steroid Hormones-Microbiota-Inflammation Axis in Rats[J]. Front Endocrinol(Lausanne), 2020, 11:284. doi: 10.3389/fendo.2020.00284.
[32]	Zhang H, Zheng L, Li C, et al. Effects of gut microbiota on omega-3-mediated ovary and metabolic benefits in polycystic ovary syndrome mice[J]. J Ovarian Res, 2023, 16(1):138. doi: 10.1186/s13048-023-01227-w. pmid: 37443082
[33]	Bartelt A, Heeren J. Adipose tissue browning and metabolic health[J]. Nat Rev Endocrinol, 2014, 10(1):24-36. doi: 10.1038/nrendo.2013.204. pmid: 24146030
[34]	高慧慧, 钱贝冉, 倪艳, 等. 多囊卵巢综合征发病机制研究进展[J]. 四川大学学报(医学版), 2024, 55(4):1049-1054. doi: 10.12182/20240760208.
[35]	Heidari H, Hajhashemy Z, Saneei P. A meta-analysis of effects of vitamin E supplementation alone and in combination with omega-3 or magnesium on polycystic ovary syndrome[J]. Sci Rep, 2022, 12(1):19927. doi: 10.1038/s41598-022-24467-0. pmid: 36402830