功能性下丘脑性闭经合并雄激素过多患者的临床特征  

The clinical characteristics of functional hypothalamic amenorrhea with hyperandrogenism

作　　者：卢叶 周一凡 毛雅婷 战海峰 陈行 张菲菲 吴江南 李昕 Lu Ye;Zhou Yifan;Mao Yating;Zhan Haifeng;Chen Hang;Zhang Feifei;Wu Jiangnan;Li Xin(Department of Gynecologic Endocrinology and Reproductive Medicine,the Obstetrics and Gynecology Hospital of Fudan University,Shanghai 200011,China;Department of Women′s Health,Affiliated Maternity and Child Health Care Hospital of Nantong University,Nantong 226001,China;Department of Gynecology,Shanghai Jing′an Central Hospital of Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属妇产科医院妇科内分泌与生殖医学科,上海200011 [2]南通大学附属妇幼保健院妇女保健科,南通226001 [3]复旦大学附属静安区中心医院妇科,上海200040

出　　处：《中华医学杂志》2023年第14期1049-1054,共6页National Medical Journal of China

摘　　要：目的探究功能性下丘脑性闭经(FHA)合并雄激素过多患者的临床特征。方法回顾性分析2022年1—9月在复旦大学附属妇产科医院就诊的56例FHA患者,根据FHA初诊时是否具有雄激素过多的临床或生化表现,分为高雄激素组(17例)和非高雄激素组(39例)。比较高雄激素和非高雄激素组之间在人体测量学、生殖激素、抗米勒管激素(AMH)、超声表现、进食态度问卷和情绪量表之间的差异及各项指标与问卷量表分数相关性。结果56例FHA患者的年龄为15~32(23.36±4.90)岁,体质指数(BMI)为(18.91±2.49)kg/m^(2)。高雄激素组和非高雄激素组患者年龄分别为(21.76±4.40)和(24.05±5.00)岁(P=0.109),BMI分别为(19.14±3.15)和(18.81±2.18)kg/m^(2)(P=0.702)。39.3%(22例)的FHA患者有暴食经历,体脂不足者约占51.8%(29例),骨骼肌量不足者占53.6%(30例)。相比非高雄激素组,高雄激素组AMH(6.46比3.63 ng/ml,P=0.025)和催乳素(PRL)(278.78比149.46 mU/ml,P=0.002)更高。非高雄激素组广泛焦虑障碍量表(GAD-7)(r=0.455,P=0.005)、应用抑郁自评量表(PHQ-9)(r=0.664,P<0.001)评分均与进食态度自评问卷(EAT-26)评分相关,高雄激素FHA组中PHQ-9(r=0.091,P=0.766)和GAD-7(r=0.304,P=0.313)与EAT-26无相关性。结论部分FHA患者具有高雄激素临床表现,且存在AMH和PRL轻度升高、潜在多囊卵巢综合征(PCOS)的内分泌特征。Objective To explore the clinical and biochemical discriminants of hyperandrogenism in functional hypothalamic amenorrhea(FHA).Methods From January to September 2022,a total of 56 patients with FHA group in the Obstetrics and Gynecology Hospital of Fudan University outpatient clinic were included in this retrospective cross-sectional analysis.According to the clinical or biochemical features of hyperandrogenism,FHA patients can be divided into two subgroups,namely hyperandrogenic FHA and non-hyperandrogenic FHA.Explore the differences and its significances between hyperandrogenic FHA and non-hyperandrogenic FHA by comparing anthropometry,reproductive hormones,AMH,ultrasonic manifestation,the scores of eating attitude test,depression questionnaire and anxiety scale respectively and analyzing their correlations.Results The age of 56 FHA patients was 15-32(23.36±4.90)years,and body mass index(BMI)was(18.91±2.49)kg/m^(2).The age of hyperandrogenic FHA and non-hyperandrogenic FHA was(21.76±4.40)and(24.05±5.00)(P=0.109)years old respectively,and BMI was(19.14±3.15)and(18.81±2.18)kg/m^(2)(P=0.702).Compared to the non-hyperandrogenic FHA,the AMH(6.46 and 3.63 ng/ml,P=0.025)and PRL(278.78 and 149.46 mU/ml,P=0.002)levels were higher in hyperandrogenic FHA group.There was no significant difference between the hyperandrogenic and non-hyperandrogenic FHA group in body composition.GAD-7(r=0.455,P=0.005)and PHQ-9(r=0.664,P<0.001)were correlated with EAT-26 scores in non-hyperandrogenic FHA group,but no significant correlation was shown between PHQ-9(r=0.091,P=0.766)、GAD-7(r=0.304,P=0.313)and EAT-26 in hyperandrogenic FHA group.Conclusions Some patients with FHA had clinical manifestations of hyperandrogenism and mildly elevated AMH and PRL,with underlying PCOS endocrine characteristics.

关 键 词：功能性下丘脑性闭经 多囊卵巢综合征 临床特征 雄激素过多 

分 类 号：R711[医药卫生—妇产科学]