不同分型多囊卵巢综合征患者的超声特征及其与内分泌指标的相关性  

The ultrasound and endocrine profile and their correlations in obese and non-obese women with polycystic ovary syndrome

作　　者：陈慧[1] 詹维伟[2] 陈晨[1] 杨志芳[2] 刘振华[2] 毛建平[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院妇产科,200025 [2]上海交通大学医学院附属瑞金医院超声科,200025

出　　处：《中华医学超声杂志（电子版）》2013年第9期763-768,共6页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：上海市科委浦江人才计划(11PJ1406600)

摘　　要：目的比较不同分型多囊卵巢综合征(PCOS)患者超声特征及内分泌指标差异并分析其相关性。方法 2012年6—12月上海交通大学医学院附属瑞金医院收治的PCOS患者105例,以体重指数≥25kg/m2为肥胖,分为肥胖型PCOS组(OB-PCOS组)32例和非肥胖型PCOS组(NOB-PCOS组)73例。经腔内超声检查测量并比较PCOS患者卵巢卵泡数、卵巢体积、卵巢间质动脉阻力指数(RI)、子宫动脉RI等超声参数;检测并比较OB-PCOS组与NOB-PCOS组患者空腹血糖(FPG)、空腹血浆胰岛素(FINS)、黄体生成素(LH)、卵泡刺激素(FSH)、黄体生成素与卵泡刺激素比值(LH/FSH)、孕酮(P)、雌二醇(E2)、游离睾酮(FT)、泌乳素(PRL)、性激素结合球蛋白(SHBG)、胰岛素抵抗指数(HOMA-IR)等内分泌指标浓度。分析各超声参数与各内分泌指标之间的相关性。结果 OB-PCOS组患者卵巢体积较NOB-PCOS组患者卵巢体积明显增大,且差异有统计学意义[(12.25±4.89)mlvs(10.73±2.30)ml,t=2.20,P<0.05],2组患者卵巢卵泡数、子宫动脉RI、卵巢间质动脉RI差异均无统计学意义。OB-PCOS组患者FINS浓度、HOMA-IR均明显高于NOB-PCOS组患者,且差异均有统计学意义[(14.82±6.45)mU/Lvs(8.04±4.57)mU/L,3.91±3.30vs1.64±1.20,t=4.87、3.47,P均<0.01];NOB-PCOS组患者FSH浓度明显高于OB-PCOS组患者,且差异有统计学意义[(5.95±1.91)U/Lvs(4.65±1.88)U/L,t=-2.77,P<0.01];OB-PCOS组患者FT浓度高于NOB-PCOS组患者,但差异无统计学意义;2组PCOS患者LH、LH/FSH、P、E2、PRL、FPG、SHBG浓度的差异均无统计学差异。PCOS患者卵巢卵泡数与LH/FSH、FT浓度呈正相关(r=0.35、0.38,P均<0.01),卵巢体积与LH/FSH、BMI、HOMA-IR、FPG浓度呈正相关(r=0.27,P<0.05;r=0.25,P<0.05;r=0.40,P<0.01;r=0.32,P<0.01),卵巢间质动脉RI与SHBG浓度呈正相关(r=0.28,P<0.05);PCOS患者其余超声参数与内分泌指标之间均无相关性。OB-PCOS组患者子宫动脉RI与PRL浓度呈负相关(r=-0.58,P<0.05),卵巢体积与HOMA-IR呈正Objective To study the different ultrasonic features in patients of polycystic ovary syndrome (PCOS) with or without obesity based on body mass index (BMI), and to investigate whether certain hormonal factors correlate with ovarian morphology and blood flow, and to discuss the role of ultrasound combined with hormone test in the diagnosis of obese PCOS. Methods One hundred and five women with PCOS were recruited. Patients were divided into two groups according to BMI;obese PCOS group (OB-PCOS, n=32, BMI≥25 kg/m2) and non-obese PCOS (NOB-PCOS, n=73, BMI<25 kg/m2). The ultrasonic parameters of follicle number (FN), ovarian volume (Vol), resistance index (RI) of ovarian stromal blood, RI of uterine artery and serum levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), the ratio of luteinizing hormone and follicle-stimulating hormone (LH/FSH), progesterone (P), estradiol (E2), free testosterone (FT), prolactin (PRL), sex hormoe binding globulin (SHBG), fasting plasma glucose (FPG), fasting insulin (FINS), the extent of insulin resistance and hyperandrogenism (HOMA-IR) were measured and compared. The correlation of the ultrasonic parameters and hormonal factors were analyzed. Results The Vol of OB-PCOS group was significantly higher than NOB-PCOS group [(12.25±4.89) ml vs (10.73±2.30) ml, t=2.20, P < 0.05]. FN and uterine artery RI of OB-PCOS group had a rising trend and RI of ovarian interstitial was on a reducing trend compared with NOB-PCOS group. But the differences were not statistically significant. The levels of FINS and HOMA-IR in OB-PCOS group [(14.82±6.45) mU/L and (3.91±3.30)] were significantly higher than those in NOB-PCOS group [(8.04±4.57) mU/L and (1.64±1.20)] (t=4.87, 3.47, respectively, both P < 0.01). And FSH in NOB-PCOS group was significantly higher than OB-PCOS group [(5.95±1.91) U/L vs (4.65±1.88) U/L, t=-2.77, P<0.01]. In POCS patients, FN was significantly associated with LH/FSH (r=0.35, P<0.01), and FT (r=0.38, P<0.01). Vol was significantly associated with LH/FSH,

关 键 词：卵巢疾病 肥胖症 超声检查 内分泌学 

分 类 号：R711.75[医药卫生—妇产科学]