北京及周边地区早发性卵巢功能不全的病因学研究

Etiology of premature ovarian insufficiency in Beijing and surrounding areas

目的早发性卵巢功能不全(premature ovarian insufficiency,POI)不仅影响女性的生育能力,而且早绝经相关慢性病和早死风险大大增高,研究其病因学/危险因素的规律,对于POI的防治极为重要。方法选取2016年12月至2018年5月,在首都医科大学附属北京妇产医院内分泌科就诊的149例早发性卵巢功能不全患者。收集信息包括年龄、确诊为POI时年龄、从初诊到确诊为POI时的时间、月经史,盆腔手术史、放化疗史,是否患腮腺炎等感染史,甲状腺功能异常疾病史、系统性红斑狼疮等免疫性疾病史等,测定身高、体质量、腰围、臀围、血清卵泡刺激素(follicle stimulation hormone,FSH)、雌二醇(estradiol,E2)、抗苗勒管激素(anti-Müllerian hormone,AMH)、抑制素B(inhibin B,INHB)以及染色体核型等指标。将FSH值按25~40 IU/L和>40IU/L将患者分为两组,进行一般情况、内分泌学指标、病因学的统计学分析。结果不同FSH组的年龄、体质量指数(body mass index,BMI)、腰臀比(waist hip ratio,WHR)、诊断为POI时的年龄、从初诊到确诊为POI的时间、INHB等之间差异无统计学意义(P>0.05)。FSH>40 IU/L组的E2值(36.60±33.39)mg/L、AMH值(0.09±0.20)ng/m L低于FSH 25~40 IU/L的E2值(66.80±56.70)mg/L、AMH值(0.41±0.77)ng/m L。149例POI患者病因中特发性占53.7%(80例),染色体异常占5.4%(8例),医源性因素占17.4%(26例),感染病史(如腮腺炎等)占21.5%(32例),免疫异常因素占2.0%(3例);FSH 25~40 IU/L组、>40IU/L组,其病因学/危险因素之间差异无统计学意义(P>0.05)。结论 POI的发生除特发性因素外,医源性是很重要的病因,提示对医源性POI的防治至关重要。

Objective Premature ovarian insufficiency （POI） not only affects women s fertility, but also significantly increases the risk of early menopause-related chronic diseases and early death. Studying the etiology/risk factors is very important for the prevention and treatment of POI. Methods From December 2016 to May 2018, 149 patients diagnosed with POI at the Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University were selected. We collected patients informations including the age, the age of diagnosis with POI, time from hospital visit to confirming POI, menstruation, history of pelvic surgery, radiotherapy and chemotherapy history, history of mumps infection, history of thyroid dysfunction, history of immune diseases such as systemic lupus erythematosus （SLE）. Body height, weight, waist circumference, hip circumference, follicle stimulating hormone （FSH）,estradiol （E 2 ）, anti-müllerian hormone （AMH）, inhibin B （INHB）, and karyotype analysis were measured. The 149 patients were divided into two groups according to FSH values 25-40 IU/L and FSH〉40 IU/L for statistical analysis of general characteristics, endocrine parameters and etiology. Results For Age, BMI, WHI, age at diagnosis of POI, time from hospital visit to confirming POI, and INHB, there was no statistically significant difference （ P 〉0.05）. For E 2 and ANH, there was a significant difference between groups （ P 〈0.05）. The E 2 value （36.60±33.39） mg/L and AMH value （0.09±0.20） in the FSH〉40 IU/L group were lower than the E 2 values （66.80±56.70） mg/L and the AMH value （0.41±0.77）ng/mL in the FSH 25-40 IU/L group. Among 149 patients with POI, 53.7% （80 cases） were idiopathic, 5.4% （8 cases） were chromosomal abnormalities, 17.4% （26 cases） were iatrogenic, and 21.5% （32 cases） had a history of infection （mumps et.）, 2.0% （3 cases） were immune abnormalities;FSH 25~40 IU/L group,FSH〉40 IU/L group, there was no significant difference in the etiology/risk factors between groups （ P 〉0.05）. Conclusion In addition to idiopathic factor, the more important cause of POI is iatrogenic cause, indicating that the prevention and treatment of iatrogenic POI is of utmost importance.