卵泡发育不良综合征患者的临床特征

Clinical characteristics of follicular maldevelopment syndrome.

目的探讨卵泡发育不良综合征患者的临床特征。方法采用B超和组织病理学及化学发光技术对175例卵泡发育不良不孕患者卵泡的生长模式、子宫内膜和性激素水平变化进行观察,同时选择正常排卵不孕患者155例作为对照。结果两组患者月经周期、卵泡期、黄体期以及窦卵泡数和基础血清卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)水平比较均无显著性差异(均为P>0.05)。研究组卵泡中、晚期最大卵泡平均直径明显小于对照组(P<0.001);卵泡晚期最大卵泡日平均生长速度及血清FSH、E2水平均低于对照组(分别为P<0.001,P<0.001,P<0.05)。研究组中有排卵者黄体中期E2及孕激素(P)水平均明显低于对照组(均为P<0.05),子宫内膜分泌不良的发生率亦明显高于对照组(P<0.001)。研究组中卵泡发育最终走向停滞、闭锁或未成熟卵泡排卵。结论卵泡发育不良综合征患者具有以下临床特点:①月经周期、卵泡期及黄体期正常;②卵泡在早期发育正常,中、晚期生长缓慢;③基础血清FSH、LH、E2水平正,卵泡晚期FSH、E2和黄体中期E2、P均分泌不足;④卵泡生长结局为发育停滞、闭锁或未成熟卵泡排卵并多伴有黄体功能不全。

Objective To investigate the clinical characteristics of follicular maldevelopment syndrome(FMS).Methods The growth character of ovarian follicles,the concentration of sex hormone and the changes of endometrium were observed by vaginal B-mode ultrasound,histopathological method and chemiluminescenc,respectively,in 175 infertile women with FMS and 155 infertile women with normal ovulation were selected as control group.Results No difference was found between the two groups in menstrual cycle,follicular phase,luteal phase,the numbers of ovarian follicles,and the basal concentration of serum follicle stimulating hormone(FSH),luteinizing hormone(LH) and estradiol(E_2)( P>0.05).The average dimension of the mid to late maximal follicles was smaller in study group than that in control group ( P<0.001),the daily growth speed of the late maximal follicles,the concentration of serum FSH and E_2 were respectively lower in study group than those in control group ( P<0.001, P<0.001 and P<0.05).The concentrations of serum E_2 and progestogen(P) of ovulatory patients were lower in study group than those in control group ( P<0.05),however,the occurrence rate of endometrium hyposecretion was much higher in study group than that in control group( P<0.001 ).In study group,follicular finally developed into follicular atresia,follicular stasis or ovulation of non-maturating follicles.Conclusion In the patients with FMS,①The patients with FMS are normal in menstrual cycle,follicular phase and luteal phase,②The growth speed of ovarian follicles is normal at the early antral follicular phase,but it is slower at the mid to late follicular phase.③The basal concentration of serum FSH,LH and E_2 are within the normal range,but the concentration of FSH and E_2 at the late antral follicular phase and the concentration of serum E_2 and P at the mid luteal phase are lower.④The results of follicular development are follicular atresia,folliclar stasis and ovulation of non-maturating follicles with luteal phase inadequacy.