体质量下降与功能性下丘脑性闭经的关系

Relationship between weight loss and functional hypothalamic amenorrhea

目的探讨体质量下降与功能性下丘脑性闭经(FHA)的关系。方法因节食和/或运动导致体质量下降后月经异常患者234例;其中,诊断为FHA患者156例(FHA组),非FHA患者78例(非FHA组)。按体质量下降后的BMI,156例FHA患者分为低体重组(BMI<18.5kg/m^(2),107例)、正常体重组(18.5kg/m^(2)≤BMI<24.0kg/m^(2),48例)和超重组(BMI≥24.0kg/m^(2),1例)。按体质量下降百分比的三分位数,156例FHA患者分为低组(<9.43%,35例)、中组(9.43%~,58例)和高组(≥16.58%,63例)。按每月体质量下降百分比的三分位数,156例FHA患者分为低组(<2.93%,45例)、中组(2.93%~,51例)和高组(≥6.05%,60例)。采用多因素logistic回归模型和限制性立方样条分析患者体质量下降后BMI、体质量下降百分比和每月体质量下降百分比与FHA关联强度的剂量-反应关系。结果体质量下降后,低体重组发生FHA的风险是正常体重组的3.93倍[95%CI(2.12~7.30)],超重组较正常体重组发生FHA的风险下降93%[95%CI(0.01~0.59)]。体质量下降百分比高、中组发生FHA的风险分别为低组的5.35倍[95%CI(2.57~11.10)]和3.94倍[95%CI(1.96~7.94)]。每月体质量下降百分比高组发生FHA的风险是低组的3.02倍[95%CI(1.44~6.32)]。体质量下降后的BMI、体质量下降百分比和每月体质量下降百分比与FHA的关联强度均呈线性剂量-反应关系,即体质量下降后发生FHA的风险随着减重后BMI增加而减小,随着体质量下降百分比和每月体质量下降百分比上升而增大(线性检验P<0.05)。结论正在减肥或准备减肥的女性减重后的BMI应尽量控制在18.5~24.0kg/m^(2)的正常范围;同时还需注意减重的速度不要过快,幅度也不能过大。减肥后一旦出现排卵障碍性异常子宫出血应及时就医,避免FHA出现及严重并发症的发生。

Objective To explore the relationship between weight loss and functional hypothalamic amenorrhea(FHA).Methods A total of 234patients with abnormal menstruation after weight loss by diet and/or exercise were assigned into two groups of FHA(with FHA,156cases)and N-FHA(without FHA,78cases).According to the BMI after body mass decline,156FHA patients were divided into three groups of low BMI(BMI<18.5kg/m^(2),107cases),normal BMI(18.5kg/m^(2)≤BMI<24.0kg/m^(2),48cases)and overweight(BMI≥24.0kg/m^(2),1case).According to the percentage of body mass decline,156FHA patients were divided by three-digit into three groups of low(<9.43%,35cases),middle(9.43%-,58cases)and high(≥16.58%,63cases).According to the percentage of body mass decline per month,156FHA patients were divided by three-digit into three groups of low(<2.93%,45cases),middle(2.93%-,51cases)and high(≥6.05%,60cases).Multivariate logistic regression model and restrictied cubic spline were used to analyze the doseresponse relationship between the FHA correlation intensity and the BMI after body mass decline,the percentage of body mass decline and the percentage of body mass decline per month.Results The risk for FHA in low BMI group was 3.93times[95%CI(2.12-7.30)]higher than that in normal BMI group,and the risk for FHA in overweight group was 93%lower than that in normal weight group[95%CI(0.01-0.59)].The risk for FHA was 5.35times[95%CI(2.57-11.10)]and 3.94times[95%CI(1.96-7.94)]higher in high and middle groups than that in low group.The risk for FHA in the group with high percentage of monthly weight loss was 3.02times[95%CI(1.44-6.32)]higher than that in the group with low percentage of monthly weight loss.The BMI after body mass decline,percentage of body mass decline and monthly body mass decline all showed a linear dose-response relationship in the intensity of association with FHA.The risk for FHA after weight loss decreased as the increase of BMI after body mass decline,increased as the increases of the percentage of weight loss and the percentage of monthly weight loss(P linear<0.05).Conclusion The BMI should be controlled as much as possible in the normal range of 18.5to 24.0kg/m^(2) in the women undergoing losing weight.An attention should be paid to the speed of weight loss,in which the speed of decline of body mass should not be too fast,and the extent of weight losing should not be too big.Once abnormal uterine bleeding-ovulatory dysfunction occurs after weight loss,medical attention should be sought in time to avoid FHA and serious complications.