卵巢超声检查在多囊卵巢综合征患者内分泌功能评估中的应用价值

The application value of ovarian ultrasound examination in the evaluation of endocrine function in patients with polycystic ovary syndrome

目的 探讨卵巢超声检查在多囊卵巢综合征(PCOS)患者内分泌功能评估中的应用价值。方法 采用回顾性分析法,纳入2021年6月—2023年6月在杭州市临平区中西医结合医院进行检查的PCOS患者(PCOS组,208例)和健康体检女性(对照组,100例)进行研究。所有研究对象均行经阴道卵巢超声检查,检查指标包括卵泡数、卵巢间质面积(SA)、卵巢面积(TA)、卵巢体积(V)及卵巢血流参数等。同时采集空腹静脉血,检测血清内分泌指标。对比两组的超声参数[阻力指数(RI)和搏动指数(PI)]、血清内分泌指标[黄体生成素(LH)、卵泡刺激素(FSH)、睾酮(T)、雌二醇(E_(2))]及胰岛素抵抗指数(HOMA-IR)的差异,并分析PCOS患者超声指标与内分泌指标的相关性。结果 与对照组相比,PCOS组的TA[(4.50±0.63)cm^(2)vs.(3.78±0.47)cm^(2)]、V[(9.59±2.13)ml vs.(5.40±0.61)ml]及SA[(1.40±0.35)cm^(2)vs.(0.57±0.14)cm^(2)]水平更高,卵泡数更多[(13.05±3.09)个vs.(9.42±1.74)个],差异均有统计学意义(t=10.148、19.280、22.837及10.938,均P<0.05)。与对照组相比,PCOS组的卵巢间质PI[(0.74±0.17)vs.(0.97±0.23)]、RI[(0.49±0.14)vs.(0.57±0.12)]值更低,差异均有统计学意义(t=9.871、4.911,均P<0.05);子宫动脉PI[(1.13±0.42)vs.(1.10±0.31)]、RI[(2.60±0.74)vs.(2.46±0.20)]水平接近,差异均无统计学意义(t=0.636、1.858,均P>0.05)。与对照组相比,PCOS组的血清LH[(16.04±3.82)U/L vs.(6.53±1.23)U/L]、LH/FSH[(2.91±0.87)vs.(1.10±0.18)]、T[(126.23±18.65)pmol/L vs.(34.47±7.29)pmol/L]、E_(2)[(0.39±0.07)nmol/L vs.(0.24±0.06)nmol/L]及HOMA-IR[(3.91±0.76)vs.(1.46±0.22)]水平更高,FSH[(5.89±0.65)U/L vs.(6.24±0.37)U/L]水平更低,差异均有统计学意义(t=24.280、20.577、47.456、18.41、31.583及5.006,均P<0.05)。相关性分析显示,PCOS患者的超声参数TA与T呈正相关关系(r=0.719,P<0.05),V与LH/FSH、HOMA-IR均呈正相关关系(r=0.611、0.558,均P<0.05),SA与T呈正相关关系(r=0.701,P<0.05),卵泡数与LH、LH/FSH、T均呈正相关关系(r=0.663、0.574及0.761,均P<0.05)。其他超声参数(卵巢间质RI、卵巢间质PI)与各内分泌指标均无相关性(P>0.05)。结论 PCOS患者多存在内分泌功能紊乱,且卵巢超声征象与内分泌功能指标存在相关性,卵巢超声征象能在一定程度上反映机体的内分泌功能。

Objective To explore the application value of ovarian ultrasound in the evaluation of endocrine function in patients with polycystic ovary syndrome(PCOS).Methods Retrospective analysis was used to study PCOS patients(PCOS group,208 cases)and healthy women(control group,100 cases)who underwent physical examinations at Hangzhou Linping District Hospital of Integrated Traditional Chinese and Western Medicinefrom June 2021 to June 2023.All study subjects underwent transvaginal ovarian ultrasound examination,with examination indicators including follicle count,ovarian interstitial area(SA),total ovarian area(TA),ovarian volume(V),and ovarian blood flow parameters.They were simultaneously collected fasting venous blood and test serum endocrine indicators.The differences in ultrasound parameters[resistance index(RI)and pulsatility index(PI)],serum endocrine indicators[luteinizing hormone(LH),follicle stimulating hormone(FSH),testosterone(T),estradiol(E_(2))],and insulin resistance index(HOMA-IR)were compared between two groups,and the correlation were analyzed between ultrasound indicators and endocrine indicators in PCOS patients.Results Compared with the control group,the PCOS group had higher levels of TA[(4.50±0.63)cm^(2) vs.(3.78±0.47)cm^(2)],V[(9.59±2.13)ml vs.(5.40±0.61)ml],and SA[(1.40±0.35)cm^(2) vs.(0.57±0.14)cm^(2)],and more follicles[(13.05±3.09)vs.(9.42±1.74)],with statistically significant differences(t=10.148,19.280,22.837,and 10.938,all P<0.05).Compared with the control group,the ovarian interstitial PI[(0.74±0.17)vs.(0.97±0.23)]and RI[(0.49±0.14)vs.(0.57±0.12)]values in the PCOS group were lower,and the differences were statistically significant(t=9.871,4.911,all P<0.05);The levels of uterine artery PI[(1.13±0.42)vs.(1.10±0.31)]and RI[(2.60±0.74)vs.(2.46±0.20)]were similar,and the differences were not statistically significant(t=0.636,1.858,all P>0.05).Compared with the control group,the serum LH[(16.04±3.82)U/L vs.(6.53±1.23)U/L],LH/FSH[(2.91±0.87)vs.(1.10±0.18)],T[(126.23±18.65)pmol/L vs.(34.47±7.29)pmol/L],E_(2)[(0.39±0.07)nmol/L vs.(0.24±0.06)nmol/L],and HOMA-IR[(3.91±0.76)vs.(1.46±0.22)]levels in the PCOS group were higher,and the level of FSH[(5.89±0.65)U/L vs.(6.24±0.37)U/L]levels were lowerr,and the differences were statistically significant(t=24.280,20.577,47.456,18.410,31.583,and 5.006,all P<0.05).Correlation analysis showed that the ultrasound parameters TA and T in PCOS patients were positively correlated(r=0.719,P<0.05),V was positively correlated with LH/FSH and HOMA-IR(r=0.611,0.558,all P<0.05),SA was positively correlated with T(r=0.701,P<0.05),and follicle count was positively correlated with LH,LH/FSH,and T(r=0.663,0.574,and 0.761,all P<0.05).There was no correlation between other ultrasound parameters(ovarian interstitial RI,ovarian interstitial PI)and various endocrine indicators(P>0.05).Conclusion PCOS patients often have endocrine dysfunction,and there is a correlation between ovarian ultrasound signs and endocrine function indicators.Ovarian ultrasound signs can reflect the endocrine function of the body to a certain extent.