不同月经模式多囊卵巢综合征患者性激素及代谢水平差异的研究  

Differences in Sexual Hormones and Levels of Metabolism in Polycystic Ovary Syndrome Patients with Different Menstrual Patterns

作　　者：傅若金 顾卓伟[1,3] 路瑶 高华[1,3] 狄文 FU Ruojin;GU Zhuowei;LU Yao(Department of Obstetrics and Gynecology,School of Medicine,Shanghai Jiaotong University,Shanghai 200127,China;Center for Reproductive Medicine,Renji Hospital,School of Medicine,Shanghai Jiaotong University,Shanghai 200127,China;Shanghai Key Laboratory of Gynecologic Oncology,Shanghai 200127,China;Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics,Shanghai 200135,China)

机构地区：[1]上海交通大学医学院附属仁济医院妇产科,上海200127 [2]上海交通大学医学院附属仁济医院生殖医学中心,上海200127 [3]上海市妇科肿瘤重点实验室,上海200127 [4]上海市辅助生殖与优生重点实验室,上海200135

出　　处：《实用妇产科杂志》2020年第1期48-52,共5页Journal of Practical Obstetrics and Gynecology

基　　金：上海市重中之重临床重点学科-妇产科学(编号:2017ZZ02016)

摘　　要：目的:探讨不同月经模式多囊卵巢综合征(PCOS)患者激素及代谢水平的差异。方法:选择2016年11月至2018年11月仁济医院妇科门诊PCOS患者438例,根据月经模式分为月经频发组(9例)、月经规律组(26例)、月经稀发或闭经组(379例)、不规则出血组(24例),并对其基础性激素及糖、脂代谢水平进行分析;同时对月经稀发或闭经组中月经不同稀发程度(36~90天、91~180天、>180天)间患者的代谢和激素水平进行比较。结果:①PCOS患者中月经稀发或闭经比例最高,占86.53%。②不同月经模式4组患者间黄体生成素/卵泡刺激素(LH/FSH)、抗苗勒管激素(AMH)、游离雄激素指数(FAI)、胰岛素抵抗指数(HOMA-IR)、总胆固醇(TC)水平比较,差异有统计学意义(P<0.05)。其中月经稀发或闭经组的LH/FSH、AMH、FAI、HOMA-IR、TC水平和月经频发组的AMH及TC水平及不规则子宫出血组的LH/FSH、FAI、AMH及HOMA-IR水平均高于月经规律组,差异均有统计学意义(P<0.05)。③不同月经稀发程度患者间比较,其中91~180天组的体质量指数(BMI)、LH/FSH、睾酮(T)、FAI、HOMA-IR水平和>180天组的BMI、T、FAI、HOMA-IR、TG水平均明显高于36~90天组,差异均有统计学意义(P<0.05)。结论:不同月经模式的PCOS患者间,高雄激素及糖、脂代谢水平存在明显差异。月经稀发程度严重者(月经周期>3月),其高雄及糖、脂代谢异常程度更高。临床中应注意不同PCOS患者的特点,在不同月经模式下,依据其性激素和代谢水平给予个体化治疗。Objective:To investigate the difference of sexual hormones and levels of metabolism in polycystic ovary syndrome(PCOS)patients with different menstrual patterns.Methods:438 PCOS patients who visited the gynecological clinic of Renji Hospital from November 2016 to November 2018 were selected,and was divided into frequent menstruation group(n=9),regular menstruation group(n=26),oligomenorrhea or amenorrhoea group(n=379)and irregular bleeding group(n=24).The levels of basic sexual hormones and metabolism of glucose and lipid were measured.And the same indicators were compared in patients with different degree of oligomenorrhea(36~90 day、91~180 day、>180 day)in oligomenorrhea or amenorrhoea group.Results:①Among the different menstrual patterns of PCOS patients,the proportion of oligomenorrhea or amenorrhea was the highest,accounting for 86.53%of the patients.②There were significantly statistical differences in the levels of LH/FSH,AMH,FAI,HOMA-IR and TC among four groups with different menstrual patterns(P<0.05).The level of LH/FSH,AMH,FAI,HOMA-IR,TC in oligomenorrhea or amenorrhoea group,the level of AMH and TC in frequent menstruation group and the level of LH/FSH,FAI,AMH and HOMA-IR in irregular bleeding group were higher than those in the regular menstruation group.There was significantly statistical difference(P<0.05).③Compared with patients with different degree of oligomenorrhea,the levels of BMI,LH/FSH,T,FAI,HOMA-IR in 91 to 180 days group and the levels of BMI,T,FAI,HOMA-IR,TG in 180 days group was significantly higher than that in 36 to 90 days group.There was significantly statistical difference(P<0.05).Conclusions:There are significant differences in the levels of hyperandrogen,glucose and lipid metabolism among PCOS patients with different menstrual patterns.The degree of oligomenorrhea was more serious(menstrual cycle>3 months),and the degree of abnormal metabolism of glucose and lipid was higher.In clinic,attention should be paid to the characteristics of different PCOS patients and individual

关 键 词：多囊卵巢综合征 月经模式 高雄激素血症 代谢综合征 抗苗勒管激素 

分 类 号：R737.31[医药卫生—肿瘤]