多囊卵巢综合征合并卵巢储备功能低下病人的内分泌特征

Endocrine characteristics of diminished ovarian reserve in Chinese women with polycystic ovary syndrome

目的了解中国多囊卵巢综合征(polycystic ovary syndrome,PCOS)合并卵巢储备功能低下(diminished ovarian reserve,DOR)病人的发生率及内分泌特征。方法选取2015年1月至2017年1月就诊的多囊卵巢综合征病人338例及同期就诊的单纯DOR病人68例,记录所有研究对象的年龄、月经情况,测量其身高、体质量、腰围、臀围,测定基础血清卵泡刺激素(follicle stimulation hormone,FSH)、黄体生成素(luteinizing hormone,LH)、雌二醇(estradiol,E2)、睾酮(testosterone,T)、抗苗勒管激素(antiMüllerian hormone,AMH)及基础窦卵泡数(baseline antral follicle count,b AFC)。对PCOS合并DOR病人、单纯PCOS及单纯DOR病人的各指标进行方差分析。结果 1)PCOS合并DOR的病人发生率为16.9%。2)在PCOS合并DOR病人中,基础FSH>10IU/L且<40IU/L、FSH/LH>3、基础E2>80pg/m L、b AFC≤4的发生率分别为38.6%、35.1%、35.1%及36.8%。3)PCOS合并DOR病人基础FSH及睾酮浓度与单纯PCOS及单纯DOR病人之间的差异均具有统计学意义(P<0.05),PCOS合并DOR病人基础E2、FSH/LH、AMH与单纯PCOS之间的差异有统计学意义(P<0.05),而与单纯DOR之间的差异无统计学意义(P>0.05)。4)在单纯PCOS组,AMH与睾酮呈正相关(P<0.01)。在PCOS合并DOR组,AMH与FSH呈负相关,与LH呈正相关(P<0.01)。在单纯DOR组,AMH与年龄、FSH、LH、FSH/LH均呈负相关(P<0.01)。结论 PCOS合并DOR病人的内分泌特征既不同于单纯PCOS组,也不同于单纯DOR病人。

Objective To assess the prevalence of diminished ovarian reserve （DOR） in patients with polycystic ovary syndrome （PCOS） in China, and to investigate the endocrine characteristics of these patients.Methods Totally 338 PCOS women and 68 simple DOR women, who came to Department of Gynecological Endocrinology in Beijing Obstetrics and Gynecology Hospital between January 2015 and January 2017 were recruited.Age and menstruation of these patients were recorded.Body height, body weight, waist circumference, hip circumference, basal follicle stimulating hormone （FSH）, luteinizing hormone （LH）, estradiol （E2）, testosterone（T）,anti-M＆252;llerian hormone （AMH） and baseline antral follicle count （bAFC） of these patients were measured.The differences of indices between PCOS with DOR,simple PCOS and simple DOR were analyzed with analysis of variance.Results （1） The prevalence of DOR in our Chinese PCOS patients was 16.9%.（2）In PCOS with DOR patients, the prevalence of basal FSH value〉10IU/L, FSH/LH ratio〉3,basal estradiol （E2）〉80 pg/mL and baseline antral follicle count （bAFC） fewer than four were 38.6%,35.1%,35.1% and 36.8%,respectively.The basal FSH and testosterone in PCOS with DOR patients were different from both simple PCOS and simple DOR patients（P〈0.05）.The basal estradiol, FSH/LH ratio,AMH in PCOS with DOR patients had significant differences from simple PCOS patients（P〈0.05）,while had no difference from simple DOR patients.（4）In simple PCOS patients,AMH had a positive correlation with testosterone（P〈0.01）.In PCOS with DOR patients, AMH had a negative correlation with FSH（P〈0.01）,while had a positive correlation with LH（P〈0.01）.In simple DOR patients, AMH had a negative correlation with age,FSH,LH and FSH/LH ratio（P〈0.01）.Conclusion The endocrine characteristics of PCOS with DOR patients are different from simple PCOS patients as well as simple DOR patients.