多囊卵巢综合征（polycystic ovary syndrome， PCOS）是育龄期女性常见的内分泌代谢性疾病，高雄激素血症（hyperandrogenism， HA）是其核心病理特征之一。该文系统综述了PCOS高雄激素血症（polycystic ovary syndrome with hyperandrogenism， PCOS-HA）的发病机制，涵盖下丘脑-垂体-卵巢/肾上腺轴功能紊乱、胰岛素抵抗（insulin resistance， IR）与肥胖驱动、遗传与表观遗传调控等经典通路，同时创新性地纳入肠道菌群失调及中医“肾-天癸-冲任-胞宫轴”失衡等环节，并整合了膜细胞与颗粒细胞层面的分子机制及铁死亡、焦亡等新维度。治疗方面归纳了直接抑制雄激素、改善IR、调节神经内分泌与下丘脑-垂体-卵巢轴（hypothalamic-pituitary-ovarian axis， HPO axis）、调控肠道菌群等多种策略，涵盖西药、中药复方、针灸、生活方式干预及新兴靶点等综合治疗手段。该文着重将肠道菌群失调与铁死亡、焦亡等细胞死亡新机制纳入PCOS-HA的发病机制框架，并与经典理论并列，系统构建了从分子、细胞到整体、从现代医学到传统医学的多维度发病模型；在治疗部分，明确梳理了以调节肠道菌群和靶向新型细胞死亡通路为代表的新兴策略，为PCOS-HA的精准诊治提供了更具前瞻性的理论参考。

Polycystic ovary syndrome （PCOS） is a common endocrine and metabolic disorder affecting women of reproductive age， with hyperandrogenism （HA） being one of its core pathological features. This review systematically summarizes the pathogenesis of PCOS with hyperandrogenism （PCOS-HA）， including classical pathways such as dysregulation of the hypothalamic-pituitary-ovarian/adrenal axis， obesity-driven insulin resistance （IR）， and genetic and epigenetic regulation. Importantly， we incorporate emerging factors such as gut microbiota dysbiosis and the imbalance of the traditional Chinese medicine （TCM） "kidney-tiankui-chongren-uterus axis"， while also integrating molecular mechanisms at the membrane and granulosa cell levels， as well as novel cell death pathways like ferroptosis and pyroptosis.In terms of treatment， the review outlines multiple strategies， including direct androgen suppression， improvement of insulin resistance， neuroendocrine and hypothalamic-pituitary-ovarian （HPO） axis modulation， and regulation of gut microbiota. These approaches cover conventional pharmacotherapy， TCM herbal formulas， acupuncture， lifestyle interventions， and emerging therapeutic targets.The key highlights of this article include incorporating gut microbiota dysbiosis and novel cell death mechanisms （ferroptosis and pyroptosis） into the pathogenic framework of PCOS-HA alongside established theories， thereby constructing a multidimensional model spanning from molecular and cellular levels to whole-body systems， and bridging modern and traditional medicine； clearly delineating emerging therapeutic strategies—particularly those targeting gut microbiota and novel cell death pathways—in the treatment section， thus providing forward-looking theoretical guidance for the precise diagnosis and management of PCOS-HA.