多层螺旋CT配合阴道超声评价血清硫酸脱氢表雄酮水平与多囊卵巢综合征排卵障碍的相关性

Multi-layered screw CT coordinated by transvaginal ultrasound for evaluating relationship between polycystic ovarian syndrome induced ovulatory obstacle and level of dehydroepiandrosterone sulfate

目的应用经多层螺旋CT配合阴道超声评价硫酸脱氢表雄酮(DHE-AS)水平与多囊卵巢综合征(PCOS)排卵障碍的相关性。方法选取2009年3月至2015年5月在该院诊治的198例排卵障碍患者为研究对象,将其中96例PCOS排卵障碍患者设为PCOS组(DHE-AS阳性组58例,DHE-AS阴性组38例),将102例非PCOS排卵障碍患者设为非PCOS组;同时选取因男方因素就诊而排卵正常的100例不孕症患者为对照组。应用多层螺旋CT检测患者卵巢多囊样改变临床表征,阴道彩色多普勒超声诊断仪监测患者排卵情况;采用放射免疫法测定血清DHE-AS水平。结果 PCOS组、非PCOS组和对照组患者血清DHE-AS的检测平均值分别为(1 055.71±169.58)、(795.84±137.72)、(274.15±49.56)ng/m L,PCOS组的测定值显著高于非PCOS组和对照组,差异均有统计学意义(P<0.05);DHE-AS阳性组患者的平均排卵周期、卵泡未破裂黄素化发生率和黄体生成素峰形成率[(108.72±23.56)d、24.14%(14/58)和46.55%(27/58)]均明显高于DHEAS阴性组[(14.58±3.94)d、7.89%(3/38)、26.32%(10/38)],而提前排卵率、排卵率和卵泡未破裂黄素化平均发生周期[3.45%(2/58)、10.34%(6/58)、(3.57±1.38)d]均明显低于DHE-AS阴性组[26.32%(10/38)、92.11%(35/38)、(18.95±4.24)d],差异均有统计学意义(P<0.05);Pearson相关分析结果显示,DHE-AS水平与平均排卵周期、卵泡未破裂黄素化发生率和黄体生成素峰形成率呈正相关(r=0.471、0.684、0.360,P=0.017、0.006、0.034);与提前排卵率、排卵率和卵泡未破裂黄素化平均发生周期呈负相关(r=-0.371、-0.753、-0.556,P=0.032、0.002、0.014)。结论过高水平的DHE-AS是导致PCOS排卵障碍的重要因素。

Objective To evaluate the relationship between polycystic ovarian syndrome （PCOS） induced ovulatory ob-stacle and the level of dehydroepiandrosterone sulfate （DHE-AS） by using multi-layered screw CT coordinated by transvaginal ul-trasound. Methods 198 cases of ovulatory obstacle in our hospital from March 2009 to May 2015 were selected as the research subjects,among them 96 cases of PCOS induced ovulatory obstacle as the PCOS group （DHE-AS positive group,58cases,DHE-AS negative group,38 cases） and 102 cases of non-PCOS-induced ovulatory obstacle as the non-PCOS group,at the same time 100 infertile women with normal ovulation due to male factors were selected as the control group;the clinical manifestations of PCOS were detected by multi-layered screw CT and the ovulation situation was monitored by transvaginal color Doppler ultrasound. The DHE-AS level was detected by radioimmunity method. Results The mean values of DHE-AS in the PCOS group,non-PCOS group and control group were （1 055.71±169.58）,（795.84±137.72）,（274.15±49.56）ng/mL respectively. The detection value in the PCOS group was significantly higher than that in the non-PCOS group and control group,the differences were statistically sig-nificant （P〈0.05）;the average ovulation cycle,follicular unruptured luteinized occurrence rate and luteinizing hormone peak for-mation rate in the DHE-AS positive group were（108.72±23.56）d,24.14%（14/58） and 46.55%（27/58） respectively,which were significantly higher than（14.58±3.94）d,7.89%（3/38） and 26.32%（10/38） in the DHE-AS negative group,while the rate of ahead ovulation,ovulation rate and follicular unruptured luteinized average cycle were 3.45%（2/58）,10.34%（6/58） and（3.57±1.38）d, which were obviously lower than 26.32%（10/38）,92.11%（35/38） and（18.95±4.24） d in the DHE-AS negative group,the differ-ences were statistically significant（P〈0.05）;the Pearson correlation analysis results showed that the DHE-AS level was positively correlated with average ovulation cycle and follicular unruptured luteinized occurrence rate （r=0.471,0.684,0.360,P=0.017,0.006, 0.034）,and was negatively correlated with the luteinizing hormone peak formation rate, rate of ahead ovulation ,ovulation rate and follicular non-rupture luteinized average cycle（r=-0.371,-0.753,-0.556,P=0.034,0.032,0.002,0.014）. Conclusion The exces-sive high level of DHE-AS is an important factor leading to the PCOS induced ovulation obstacle.