多囊卵巢综合征无排卵患者子宫内膜超声形态学及组织学变化  

Features of morphometry of ultrasound and endometrial histology in the anovulatory polycystic ovary syndrome women

作　　者：张二红[1] 梁晓燕[2] 杜静[2] 李穗萍[2] 胡瑞德[2] 徐艳文[2] 庄广伦[2] 

机构地区：[1]中山大学附属第三医院不育与性医学科,510063 [2]中山大学附属第一医院生殖中心,广州510080

出　　处：《中华妇产科杂志》2006年第6期380-383,共4页Chinese Journal of Obstetrics and Gynecology

基　　金：国家自然科学基金资助项目(30300372);广东省自然科学基金资助项目(31690);广东省科技计划重点项目基金资助项目(2002C31301)

摘　　要：目的探讨多囊卵巢综合征(PCOS)无排卵患者子宫内膜超声形态学的变化特点,及组织学变化与激素水平的关系。方法采用B超观察76例PCOS无排卵患者(PCOS组)及32例排卵正常的不孕患者(对照组)的子宫内膜;按照Gonen等的分型方法,将子宫内膜分为A型(即低回声三线型)、B型(即均质中等回声)、C型(即强回声)3型;采用免疫组化技术,检测子宫内膜腺上皮细胞增殖相关核抗原Ki67及降钙素的表达;采用透射电镜观察子宫内膜超微结构;采用酶联免疫发光法,检测血清中黄体生成激素及孕酮等的水平。结果PCOS组子宫内膜为A型者23例,B型者34例、C型者17例,另2例患者因内膜厚度<5mm,未进行分型。A型患者的内膜间质发育异常比率为9%(2/23),B型和C型为43%(22/51)两者比较,差异有统计学意义(P<0·05)。PCOS组分泌期内膜腺上皮细胞Ki67表达为(14±6)%,对照组为(9±7)%,两组比较,差异有统计学意义(P<0·05)。PCOS组增生期子宫内膜腺上皮细胞中细胞器增多;分泌期显示分泌反应不良。结论PCOS无排卵患者子宫内膜呈现增生和分泌表现异常,其内膜超声形态学的强回声表现,可能与局灶性内膜间质发生异常组织学改变有关。Objective To investigate the relationship between ultrasonographic features of endometrium and the relation of histological staging of the endometrium and sexual hormone levels in anovulatory polycystic ovary syndrome （PCOS） women. Methods Seventy-six anovulatory PCOS patients and 32 women with normal ovulation were enrolled in this study. Ultrasonographic examination, and transmission electron microscope were used to observe endometrium. The expressions of nulear antigen associated with cell proliferation Ki-67 and calcitonin were analyzed by immunohistochemistry. The sexual hormone levels were measured by chemiluminescent microparticle immunoassay. Results In 11 patients the endometrium showed secretory change out of 76 anovulatory PCOS patients. The frequency of secretory change of the endometrium was not increased with the increase of menses-biopsy interval （ P 〉 0. 05 ）. The frequency of abnormal stroma was significantly lower in tripleline endometria than those in non-tripleline endometria （9% vs 43%, P 〈 0. 05 ）. Compared with the control group, the anovulatory PCOS group showed a significant higher expression of Ki-67 in the glandular cell of the secretory phase endometrium（ P 〈 0. 05 ）. In the proliferative endometrium, anovulatory PCOS group had more cell organelles than those of the control group. The endometrium showed insufficient secretory changes in the anovulatory PCOS patients. Conclusions Proliferative and secretory stage of the endometrium in the anovulatory PCOS group show abnormal features. The abnormal stroma may contribute to the hyperechonic images of the endometrium in the anovulatory PCOS patients.

关 键 词：多囊卵巢综合征 无排卵 子宫内膜 超声检查 

分 类 号：R711.75[医药卫生—妇产科学] R697.32[医药卫生—临床医学]