医源性早发性卵巢功能不全防治与临床管理指南解读

doi:10.3969/j.issn.1006-7795.2026.04.001

首都医科大学学报

医源性早发性卵巢功能不全防治与临床管理指南解读

张明珍¹,阮祥燕^1,2*,谷牧青1,杜娟¹,程姣姣¹,Alfred O. Mueck^1,2

首都医科大学附属北京妇产医院/北京妇幼保健院内分泌科，北京 100026；2.德国图宾根大学妇产医院妇女健康部与妇女健康研究中心，图宾根 D-72076

收稿日期:2026-04-09 修回日期:2026-05-19 出版日期:2026-08-21
通讯作者: 阮祥燕 E-mail:ruanxiangyan@ccmu.edu.cn
基金资助:
中国人体健康科技促进会临床医学科研专项，早发性卵巢功能不全（POI）全国多中心临床研究（JKHY2020003）,高端外国专家引进计划项目“北京妇科内分泌疑难病研究会诊中心的建立”（G2022001018）,国家外国专家个人类项目全国女性卵巢保护与抗衰促进工程项目建设（S20240230）。

Interpretation of the guidelines for the prevention, treatment and clinical management of iatrogenic premature ovarian insufficiency in clinical practice

Zhang Mingzhen¹, Ruan Xiangyan^1,2*, Gu Muqing¹, Du Juan¹, Cheng Jiaojiao¹, Alfred O. Mueck^1,2

1.Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing 100026, China ；2.Department of Women's Health, Research Centre for Women's Health and University Women's Hospital of Tuebingen, University Hospitals of Tuebingen, Tuebingen D-72076, Germany

Received:2026-04-09 Revised:2026-05-19 Online:2026-08-21
Supported by:
This work was supported by China Association for Promotion of Health Science and Technology Special Fund Project for Scientific Research (JKHY2020003),High-end Foreign Experts Introduction Program Project (G2022001018), National Foreign Experts Individual Project, Construction of National Female Ovarian Preservation and Anti-aging Promotion Project (S20240230).

摘要/Abstract

摘要： 随着肿瘤及难治性疾病诊疗水平的不断提升，患者的长期生存率显著提高。但化学药物治疗（以下简称化疗）、放射治疗（以下简称放疗）及盆腔手术所引发的医源性早发性卵巢功能不全（premature ovarian insufficiency, POI）成为影响女性幸存者全生命周期健康的重要问题。本文基于最新循证医学证据，对《医源性早发性卵巢功能不全临床治疗与管理指南（2025年版）》与《卵巢组织冻存移植防治医源性早发性卵巢功能不全临床应用指南》进行系统解读。两部指南共同强调：医源性POI的防治应贯穿疾病诊疗全过程。卵巢组织冻存是临床新的最有前景的生育力保护方法，是青春期前女童与放疗、化疗无法延迟的育龄女性卵巢功能与生育力保护的唯一选择；促性腺激素释放激素激动剂（gonadotropin-releasing hormone agonist, GnRHa）不能替代成熟的生育力保护技术；慢速冻存为卵巢组织冻存国际指南推荐的标准方法，玻璃化冻存目前仍属于临床研究；临床医生应在启动癌症治疗前尽早向患者或其监护人告知不孕不育与卵巢功能衰退风险，建议其咨询生育力保护，并及时安排转会诊；一旦发生POI，应尽早诊断、激素等综合治疗与长期管理，以降低POI患者远期全因死亡率。

关键词: 医源性早发性卵巢功能不全, 生育力保护, 卵巢组织冻存, 激素治疗, 知情告知, 指南解读

Abstract: With continuous progress a comprehensive analysis in the diagnosis and treatment of malignancies and refractory diseases, long-term survival rates have improved significantly. However, iatrogenic premature ovarian insufficiency (POI) induced by chemotherapy, radiotherapy, and pelvic surgery has become a critical issue affecting the whole-life-cycle health of female survivors. Based on the latest evidence-based medical data, this article presents a comprehensive analysis of the Practice Guideline for the Treatment and Management of Iatrogenic Premature Ovarian Insufficiency (2025) and the Practice Guideline on Ovarian Tissue Cryopreservation and Transplantation in the Prevention and Treatment of Iatrogenic Premature Ovarian Insufficiency. Both guidelines emphasize that the prevention and management of iatrogenic POI should be integrated throughout the entire course of diagnosis and treatment. Ovarian tissue cryopreservation has emerged as a promising fertility preservation strategy and is currently the only option for preserving ovarian function and fertility in prepubertal girls and reproductive-aged women who cannot delay chemotherapy or radiotherapy. Gonadotropin-releasing hormone agonists (GnRHa) cannot replace established fertility preservation techniques. International guidelines currently endorse slow freezing as the standard method for ovarian tissue cryopreservation, while vitrification is still regarded as an experimental clinical procedure. Clinicians should inform patients or their guardians of the risks of infertility and ovarian insufficiency as early as possible before initiating cancer treatment, recommend consultation on fertility preservation, and arrange timely referrals. Once POI occurs, early diagnosis, hormone-based comprehensive treatment, and long-term management are essential to reduce long-term all-cause mortality in affected patients.

Key words: iatrogenic premature ovarian insufficiency, fertility preservation, ovarian tissue cryopreservation, hormone therapy, informed consent, guideline interpretation

中图分类号:

张明珍, 阮祥燕, 谷牧青, 杜娟, 程姣姣, Alfred O. Mueck. 医源性早发性卵巢功能不全防治与临床管理指南解读 [J]. 首都医科大学学报, doi: 10.3969/j.issn.1006-7795.2026.04.001.

Zhang Mingzhen, Ruan Xiangyan, Gu Muqing, Du Juan, Cheng Jiaojiao, Alfred O. Mueck. Interpretation of the guidelines for the prevention, treatment and clinical management of iatrogenic premature ovarian insufficiency in clinical practice[J]. Journal of Capital Medical University, doi: 10.3969/j.issn.1006-7795.2026.04.001.

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医源性早发性卵巢功能不全防治与临床管理指南解读

Interpretation of the guidelines for the prevention, treatment and clinical management of iatrogenic premature ovarian insufficiency in clinical practice

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