卵巢面积测量在诊断多囊卵巢综合征中的价值探讨

The diagnostic value of ultrasonic parameters measuring ovarian stroma to polycystic ovary syndrome

目的比较应用超声检测卵巢间质面积（SA）、卵巢总面积（TA）的3种不同方法,探讨卵巢间质超声参数对多囊卵巢综合征（PCOS）的诊断价值。方法对63例PCOS患者（PCOS组）和23例有正常排卵的不孕患者（对照组）行经阴道超声检查,用3种方法测量卵巢SA、TA,计算SA/TA,比较不同方法间测值的差异。方法1分别测量卵巢及间质的纵、横径,面积=纵径×横径;方法2在同一切面分别用轨迹球手动包络卵巢及间质外缘自动生成面积（轨迹法）;方法3采用椭圆形面积公式计算,面积=π×长径×短径/4。测定黄体生成素（LH）、卵泡刺激素（FSH）及睾酮（T）水平,计算LH/FSH,分析卵巢间质超声参数与性激素的相关性。比较PCOS组与对照组上述各项指标间的差异。结果①3种方法计算SA、TA分别为SA1（3.6±1.2）cm2、SA2（2.7±0.9）cm2、SA3（2.8±0.9）cm2、TA1（7.9±2.1）cm2、TA2（6.1±1.5）cm2、TA3（6.2±1.7）cm2,3种不同方法测值差异有统计学意义（P〈0.001）,SA/TA值3种不同方法间差异无统计学意义（P〉0.05）。②PCOS组TA、SA、SA/TA分别为（6.06±0.20）cm2、（2.76±0.10）cm2、0.46±0.01,对照组分别为（4.17±0.34）cm2、（1.16±0.17）cm2、0.29±0.02,两组间差异均有统计学意义（P〈0.001）。PCOS组LH、FSH、LH/FSH、T分别为（12.19±6.50）mIU/ml、（7.19±1.52）mIU/ml、1.73±0.82、（0.78±0.23）ng/ml,对照组分别为（7.60±9.75）mIU/ml、（14.41±19.40）mIU/ml、0.68±0.50、（0.35±0.13）ng/ml;PCOS组LH/FSH、T高于对照组,差异有统计学意义（P〈0.001,P〈0.01）,LH高于对照组（P〈0.05）。③PCOS组TA、SA与T、LH/FSH呈正相关（P〈0.001）,SA/TA与T呈正相关（P〈0.01）,与LH/FSH无相关关系（P〉0.05）。结论检测卵巢SA、TA的3种方法中,轨迹法更加实用、简便。在用不同方法计算时,SA/TA相对固定,可以作为诊断PCOS较好的超声参数之一。

Objective To comparing the application value using ultrasonic parameters measuring ovarian stroma area（SA）,total ovarian area（TA）and SA/TA ratio in diagnosis polycystic ovary syndrome（PCOS）.Methods SA,TA and SA/TA ratio were measured by transvaginal ultrasound and serum levels of follicle stimulating hormone（FSH）,luteinizing hormone（LH）,testosterone（T）and LH/FSH ratio were assayed in 63 PCOS women,comparing with 23 infertility women without PCOS.SA,TA and SA/TA ratio were measured with three methods,respectively,and to find differences from the three methods.The results were described as following：method 1 using area of oblong to calculate,method 2 outlining the margin of ovary and ovarian stroma to automatically calculate area,method 3 using area of oval to calculate.Results ①Using three methods of calculation for area,SA and TA of method 1 were significantly higher than those of the other two methods（P〈0.001）,while there were no statistically differences between those of method 2 and method 3（P〉0.05）.Also,there were no statistically differences within SA/TA ratios in three methods（P〉0.05）.②Patients with PCOS showed significantly higher ovarian SA and SA/TA ratio compared to those of the control group [（2.76±0.10）cm2 vs（1.16±0.17）cm2,P〈0.001;0.46±0.01 vs 0.29±0.02,P〈0.001].③SA/TA ratio was related to serum levels of T（P〈0.01）.TA,SA was related to serum levels of T and LH/FSH ratio（P〈0.001）.Conclusions In the three methods,the method that outlining the margin of ovary and ovarian stroma to automatically calculate area is easy to practice and demonstrates good accuracy and repeatment.SA/TA ratio is an objective and quantitative ultrasonic parameter in the diagnosis of PCOS.