多囊卵巢综合征与亚临床甲状腺功能减退的相关研究

发布时间：2018-01-15 22:07

  本文关键词：多囊卵巢综合征与亚临床甲状腺功能减退的相关研究　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

  更多相关文章： 多囊卵巢综合征 亚临床甲状腺功能减退 甲状腺过氧化物酶抗体 妊娠结局

【摘要】：背景多囊卵巢综合征(Polycystic Ovary syndrome,PCOS)是一种病因复杂、临床症状多样性的女性内分泌紊乱性疾病,以长期无排卵、高雄激素血症及胰岛素抵抗为基本特征,在临床上可同时伴发月经不调、不孕、多毛、肥胖等多系统表现。此病长期易并发冠心病、糖尿病、胰岛素抵抗代谢综合征、高血压等疾病,约占育龄期妇女的10%。甲状腺功能减退症是由各种原因导致的甲状腺激素合成或分泌减少而引起的全身性低代谢综合症,其临床表现为低代谢状态、性情冷漠、黏液性水肿等。临床甲状腺功能减退的患病率是1.0%,发病率为2.9/1000。甲减常见病因包括:(1)自身免疫损伤;(2)甲状腺破坏;(3)碘过量;(4)抗甲状腺药物。临床上较常见甲状腺功能减退类型为亚临床甲状腺功能减退,其中以自身免疫性损伤最为常见。大量流行病学资料显示在多囊卵巢综合症中亚临床甲状腺功能减退的发病率明显高于普通人中亚临床甲状腺功能减退的发病率。目的探讨多囊卵巢综合症与亚临床甲状腺功能减退之间的关系为进一步探索多囊卵巢综合征的发病机制提供了新的切入点,也为干预或治疗多囊卵巢综合征提供新的靶点。方法选取2015年5月-2016年12月就诊于吉林大学第二医院内分泌科及生殖医学科门诊18-30岁患有单纯多囊卵巢综合症患者共57例作为PCOS组,选取同期门诊18-30岁患有多囊卵巢综合症伴亚临床甲状腺功能减退患者共57例为PCOS伴甲减组。同时根据TPOAb是否阳性将PCOS伴甲减组分为TPO-Ab阳性组及TPO-Ab阴性组,对所有受试者行病史采集、体格检查及生化检测。同时对多囊卵巢伴亚临床甲状腺功能减退患者进行后期随访,观察妊娠结局。使用SPSS21.0统计软件进行分析统计,以P0.05判定为有统计学差异。结果1、在一般资料与生化指标方面,PCOS伴甲减组患者空腹血糖(FPG)、甘油三酯(TG)、空腹胰岛激素(FCP)、胰岛素抵抗指数(HOMA-IR)、瘦素(LP)明显高于PCOS组(P值0.05);两组在年龄、身高、体重、体重指数(BMI)、餐后2h血糖(2h PPG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL)、低密度脂蛋白胆固醇(LDL)、餐后2h胰岛激素(2h CP)方面无明显统计学差异。2、在性激素六项和甲功三项方面,PCOS伴甲减组患者黄体生成素(LH)、卵泡刺激素(FSH)、睾丸酮(T)明显低于PCOS组(P值0.05);PCOS伴甲减组患者垂体泌乳素(PRL)、促甲状腺激素(TSH)高于PCOS组(P值0.05);两组在孕酮(P)、雌激素(E)、LH/FSH、游离T3(FT3)、游离T4(FT4)方面无统计学意义。3、PCOS伴甲减组,在一般资料与生化指标方面,TPO-Ab阳性组患者身高、体重明显低于TPO-Ab阴性组;两组在年龄、体重指数(BMI)、空腹血糖(FPG)、餐后2h血糖(2h PPG)、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL)、低密度脂蛋白胆固醇(LDL)、空腹胰岛激素(FCP)、餐后2h胰岛激素(2h CP)、胰岛素抵抗指数(HOM A-IR)、瘦素(LP)方面无明显统计学差异。4、PCOS伴甲减组,在性激素六项和甲功三项方面,TPO-Ab阳性组患者促甲状腺激素(TSH)明显高于TPO-Ab阴性组(P值0.05);两组在黄体生成素(LH)、卵泡刺激素(FSH)、LH/FSH、孕酮(P)、雌激素(E)、睾丸酮(T)、垂体泌乳素(PRL)、游离T3(FT3)、游离T4(FT4)方面无统计学意义。5、在后期随访中,TPO-Ab阳性组患者既往流产的发生率明显高于TPO-Ab阴性组(P值0.05);两组患者在自然流产、先兆早产、羊水量异常、妊高症、妊娠期糖尿病的不良妊娠结局方面无明显统计学差异。6、将TSH与PCOS伴甲减组整组参数进行回归分析,TSH与孕激素存在相关性,与其他参数无显著相关。结论1、多囊卵巢综合征伴发亚临床甲状腺功能减退时,对性激素水平、血脂、胰岛素抵抗、肥胖方面的影响更为突出。2、甲状腺过氧化物酶抗体(TPOAb)对不良妊娠结局有一定影响,故在筛查多囊卵巢综合征伴亚临床甲状腺功能减退的患者时,应注意对甲状腺素抗体的检查。
[Abstract]:The background of polycystic ovary syndrome (Polycystic Ovary, syndrome, PCOS) is a kind of complex etiology, clinical symptoms of the diversity of female endocrine disorders, by chronic anovulation, Kaohsiung hormone level and insulin resistance is the basic characteristic, hairy in clinic can simultaneously associated with menstruation, infertility, obesity, and other system performance it is easy to long. Coronary heart disease, diabetes, insulin resistance, metabolic syndrome, hypertension and other diseases, accounting for about 10%. of thyroid function in women of childbearing age hypothyroidism is a systemic metabolic syndrome caused by various causes of low thyroid hormone synthesis or secretion decreased, the clinical manifestations of low metabolic state, aloof, mucinous edema. The clinical hypothyroidism prevalence rate is 1%, the incidence rate of hypothyroidism 2.9/1000. common causes include: (1) autoimmune injury; (2) thyroid damage; iodine excess; (3) (4) Anti thyroid drugs. The more common clinical hypothyroidism type decline in subclinical thyroid function, which is the most common autoimmune injury. A large number of epidemiological data showed that the incidence of subclinical thyroid function impairment in polycystic ovary syndrome was significantly higher than the incidence of subclinical hypothyroidism was ordinary. Polycystic ovarian syndrome and the relationship between subclinical thyroid function drops provide new perspectives for further exploring the pathogenesis of polycystic ovary syndrome, but also for the intervention or treatment of polycystic ovary syndrome provide new targets. Methods from May 2015 -2016 year in December in the Second Affiliated Hospital of Jilin University, Department of Endocrinology and Department of reproductive medicine clinic 18-30 years old suffering from polycystic ovary a total of 57 cases of SARS patients were selected as PCOS group, 18-30 years old with polycystic ovary in clinic The syndrome with subclinical hypothyroidism in patients with a total of 57 cases of PCOS patients with hypothyroidism group. At the same time, according to whether the TPOAb positive PCOS with hypothyroidism were divided into TPO-Ab positive group and TPO-Ab negative group, all the subjects underwent history collection, physical examination and biochemical tests. At the same time on polycystic ovary patients with subclinical hypothyroidism late follow-up, the pregnancy outcome was observed. Statistical analysis using SPSS21.0 statistical software, using P0.05 to determine statistically significant. Results in 1, and the biochemical indicators of general information, PCOS with hypothyroidism patients fasting blood glucose (FPG), glycerin three ester (TG), fasting insulin hormone, insulin resistance index (FCP) (HOMA-IR), leptin (LP) was significantly higher than that of group PCOS (P = 0.05); the two groups in age, height, weight, body mass index (BMI), 2h postprandial blood glucose (2H PPG), total cholesterol (TC), high density lipoprotein cholesterol (HDL), low density lipoprotein cholesterol (L DL),椁愬悗2h鑳板矝婵，

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