多囊卵巢综合征卵巢超声影像学特征及其与内分泌代谢异常的相关性分析

Ultrasonographic features of polycystic ovarian syndrome and their correlations with metabolic and endocrine abnormalities

目的研究多囊卵巢综合征(PCOS)患者卵巢的超声影像学特征,并分析PCOS卵巢超声影像学特征与内分泌代谢异常的相关关系。方法2006年8月至2007年3月在复旦大学附属妇产科医院对396例PCOS患者(PCOS组)和50例基础体温(BBT)双相的不孕症患者(正常对照组)采用经阴道二维超声和彩色多普勒超声测定卵巢的卵泡数(FN)、卵巢体积(2D-OV)、卵巢间质动脉搏动指数(PI)和阻力指数(RI);其中87例PCOS患者和所有对照者测定了卵巢间质面积(SA)和卵巢总面积(TA)。研究对象均测定相关内分泌代谢指标。结果PCOS组2D-OV、FN、SA/TA均显著高于对照组;PCOS组卵巢间质动脉PI、RI均显著低于对照组。PCOS组SA、TA、2D-OV与黄体生成素(LH)/卵泡刺激素(FSH)比值和睾酮(T)呈正相关;PCOS组卵巢间质动脉PI、RI与BMI、稳态模型的胰岛素抵抗指数(HOMA-IR)呈负相关。结论PCOS卵巢的超声影像学特征性为卵巢体积增大,小卵泡数目增多,卵巢间质面积增大,间质回声增强,卵巢间质血流丰富。不同分型的PCOS以上改变有程度差异。PCOS卵巢超声影像学参数与内分泌代谢指标具有相关性。

Objective To analyze the ultrasonographic features of ovaries in women with polycystic ovarian syndrome （ P- COS） with respect to obesity and insulin resistance, and to study their relationships with metabolic and endocrine abnormalities, Methods From Aug, 2006 to Mar. 2007 in the Obstetrics and Gynecology Hospital of Fudan University. A total of 396 cases with PCOS were enrolled, Fifty infertile subjects with biphasic basal body temperature served as controls. O- varian follicle number （FN）, ovarian volume （OV）, ovarian stroma area （SA）, ovarian total area （TA）, SA/TA ratio, pulsatility index （OVPI） and resistance index （OVRI） of ovarian stroma artery were measured by transvaginal two-dimensional （2D） ultrasonography. Serum follicle stimulating hormone （FSH）, lutinizing hormone （LH）, testosterone （T）, and fasting insulin and glucose were determined. Results Patients with PCOS showed significantly higher OV, SA, TA and SA/TA, but lower OVPI and OVRI than those of the control group. SA, TA and OV were positively correlated with LH/FSH and T. OVPI and OVRI were negatively correlated with BMI and HOMA-IR. Conclusion Patients with PCOS have increased ovarian volume, increased follicle number,increased central ovarian stroma, increased ovarian stroma echo and increased ovarian stroma artery blood flow. The differences of ultrasonographic features between PCOS patients with regard to obesity and insulin resistance are significant.