卵泡发育不良的临床分析

Ovarian Follicular Maldevelopment in Infertile Women

目的探讨卵泡发育不良（ＦＭ）的表现及其结局。方法对２９６例不孕患者中的ＦＭ患者８０例（ＦＭ组）及２０例正常排卵者（对照组）进行连续宫颈评分、Ｂ超监测卵泡发育、放射免疫法测定血雌二醇（Ｅ２）值等检查，并行腹腔镜和子宫内膜活体组织检查。结果（１）在不孕妇女中ＦＭ发生率为２７０％；（２）ＦＭ组宫颈评分最高分为７３±１８分（ｘ±ｓ，下同），对照组为１３２±１８分；月经中期血Ｅ２水平，ＦＭ组为３００±１００ｐｍｏｌ／Ｌ，对照组为９００±４００ｐｍｏｌ／Ｌ，两组比较，差异有显著性（Ｐ＜０．０１）；（３）Ｂ超检查显示，ＦＭ组卵泡模糊，常为多个小卵泡；（４）腹腔镜检查ＦＭ组约２／３以上病例卵巢上可见黄体，但无排卵裂孔，约１／３病例无黄体；（５）ＦＭ组子宫内膜呈分泌改变者占５６７％，呈增生期改变者占３３３％左右。结论（１）ＦＭ是不孕的一个重要原因；（２）ＦＭ结局有二，一为卵泡闭锁，另一为未成熟卵泡黄素化。

Objective To study the manifestation and outcome of ovarian follicular maldevelopment (FM) in infertile women. Methods Among 296 infertile women, 80 cases with FM were taken as study group and 20 with normal ovulation as control Serial B ultrasonography, cervical mucus scoring, serum estradiol (E 2) assay and laparoscopy, endometrium histology were monitored in both groups. Results The incidence of FM in infertile women was 27.0%, B ultrasonography showed many small and obscure outlined follicles in the ovarian. The maximum and mean cervical mucus socres in FM group were <9 and 7.3±1.8, significantly lower than those in control (>10, 13.2±1.8) ( P <0.01). So were the midcycle serum E 2 levels (300±100 pmol/L vs 900±400 pmol/L, P <0.001). No stigma was found in two third of FM patients and no corpus luteum in about one third. Proliferative endometrium was shown in 34.0% of the FM group. Conclusion (1)FM with an incidence of 27.0% might be an important cause of infertility. (2) FM results finally in follicular atresia or multiple immature luteinized follicles.