多囊卵巢综合征合并不孕与子宫内膜病变关系的临床探讨

Clinical study on the relationship between polycystic ovary syndrome combined with infertility and endometrial lesions

目的:探讨多囊卵巢综合征(PCOS)合并不孕与子宫内膜病变的关系及诊刮术在PCOS合并不孕患者中的临床意义。方法:PCOS合并不孕患者(观察组)68例,输卵管因素不孕患者(对照组)43例,分析两组诊刮术病理结果及内分泌代谢的差异。结果:①观察组病理诊断子宫内膜器质性病变55例:其中子宫内膜癌1例、子宫内膜不典型增生3例、子宫内膜复杂型增生症5例、子宫内膜单纯型增生症38例、增生期子宫内膜15例(合并子宫内膜息肉8例)、分泌期子宫内膜6例。对照组43例中增生期子宫内膜36例(合并子宫内膜息肉5例);分泌期子宫内膜7例。②观察组体质指数(BMI)、腰臀比(WHR)、空腹血糖、血脂、空腹胰岛素(FINS)、胰岛素曲线下面积(AUCI)及血雌激素(E2)、睾酮(T)水平均高于对照组(P<0.05)。结论:PCOS合并不孕患者子宫内膜异常增生及癌变率高,肥胖、胰岛素抵抗(IR)、高雄激素与高雌激素是子宫内膜病变的重要因素,应重视诊刮术在此类患者中的应用。

Objective： To explore the relationship between polycystie ovary syndrome （PCOS） combined with infertility and endo- metrial lesions, analyze the clinical significance of endocervical curettage for patients with PCOS combined with infertility. Methods： A total of 68 patients with PCOS combined with infertility were selected as observation group, and 43 patients with tubal infertility were selected as control group; the pathological results after endocervical curettage and the differences of endocrine metabolism in the two groups were ana- lyzed. Results： In observation group, 55 patients with endometrial organic diseases were diagnosed by pathological examination, including one patient with endometrial cancer, three patients with atypical hyperplasia of endometrium, five patients with endometrial complex hyper- plasia, 38 patients with simple endometrial hyperplasia, 15 patients with endometrium during proliferative phase （8 patients were combined with endometrial polyp）, and 6 patients with endometrium during secretory phase. In control group, 36 patient were found with endometrium during proliferative phase （5 patients were combined with endometrial polyp）, 7 patient were found with endometrium during secretory phase. BMI, waist hip rate （WHR） , fasting blood glucose, blood lipid, fasting insulin, area under the curve of insulin, and the levels of estrogen and testosterone in observation group were significantly higher than those in control group （ P 〈 0. 05 ） . Conclusion： The patients with PCOS combined with infertility had high incidences of endometrial hyperplasia and endometrial cancer, obesity, insulin resistance, high androgen level, and high estrogen level are important factors of endometrial lesions, more attention should be paid to the application of endo- cervical curettage in these patients.