正常范围甲状腺激素不同水平与PCOS患者性激素、胰岛素水平及血脂的相关性分析

发布时间：2018-06-03 00:42

本文选题：多囊卵巢综合征 + 甲状腺激素　；参考：《郑州大学》2017年硕士论文

【摘要】：研究背景多囊卵巢综合征(PCOS)占育龄妇女的约7%,占继发性闭经患者的20%左右,占女性多毛及高雄激素血症的约80%,占无排卵性不孕症患者的30%～60%,其临床表现为月经稀发或闭经、肥胖、长期慢性无排卵、高血脂症、胰岛素抵抗及高胰岛素血症、多毛、痤疮、不孕等,为女性常见的以雄激素高水平和持续无排卵或者排卵障碍、多囊卵巢等为特征,本质上为育龄期妇女的内分泌失调症候群。多囊卵巢综合征有着不同的表型,可以有高雄激素血症、高胰岛素血症、多囊卵巢等高度异质性的表现。其病因较复杂,说法不一,目前研究,可能为遗传因素和环境因素相互作用所致。多囊卵巢综合征患者常常伴有月经紊乱、肥胖、胰岛素抵抗、高雄激素血症、多毛、痤疮及黑棘皮病等临床特征,其远期如2型糖尿病、心血管疾病、子宫内膜癌、阻塞性睡眠呼吸暂停综合征(OSA)等并发症的发生率高于正常人数倍到数十倍。随着生活环境,包括:压力过大、环境污染、饮食结构等的改变,甲状腺疾病(甲状腺结节、甲亢、甲减、桥本甲状腺炎等)的患病率在全球范围内,呈上升趋势,约3亿人存在甲状腺相关疾病的困扰。临床中发现,PCOS与甲状腺疾病存在相同的临床表现,如月经紊乱、糖脂异常、胰岛素抵抗、不孕等,从发病机制上来看,PCOS由于卵巢卵泡膜细胞对LH的过度反应,加上内在及外在调节因子(抑制素等)的异常共同作用,导致卵巢雄激素分泌增多,而下丘脑-垂体-甲状腺轴系统中,FSH、LH可生理作用于卵巢,同时TSH可与卵巢细胞上TSH受体相结合,还有FT3、FT4可直接作用于卵巢颗粒细胞、上皮细胞等,两者之间存在着相互的联系和作用。有研究发现适量的甲状腺激素水平有助于维持垂体-性腺轴的稳定,国外有报道称,在甲状腺激素水平正常的前提下,PCOS组TSH平均水平高于对照组。结合其临床症状及发病机制,正常范围甲状腺激素不同水平对PCOS各相关指标是否存在影响?给予本文启发。本文则探究甲状腺激素不同水平与PCOS各相关指标的相关性,为PCOS合并甲状腺疾病提供更好、及时的防治。可能为PCOS的发病机制的探究,提供新的思路。目的1.探究正常范围甲状腺激素不同水平和多囊卵巢综合征胰岛素、性激素、血脂等的相关性。2.为PCOS的防治提供新的参考;材料与方法回顾性分析2014.1-2016.12年至我科住院的132例多囊卵巢综合征(PCOS)患者并甲状腺功能正常作为病例组,146名同期体检甲状腺功能正常的健康者作为对照组;按照2003年鹿特丹诊断标准分为正常组及PCOS组。检测促甲状腺激素(TSH)、游离甲状腺激素T4、游离三碘原氨酸T3,比较两组一般指标及激素水平差异性。然后对PCOS组给予甲状腺激素水平三等分,比较各分组与PCOS患者性激素、血糖、血脂等的相关性。分析PCOS患者各甲状腺激素水平阶段对PCOS相关指标的影响。结果1.健康正常组与PCOS组的比较,PCOS组性激素水平,FSH低于对照组;而E2、P、T、PRL则高于对照组,差异均具有统计学意义(P0.05);与对照组比较中,PCOS组甲状腺激素水平,FT3显著低于对照组,TSH显著水平高于对照组,差异均具有统计学意义(P0.05);而FT4值略有升高,但无差异。2.以BMI标准进行分组,健康对照组与PCOS组比较,以BMI进行分组,可见年龄在低值组显著低于高值组;FSH中值组显著高于低值和高值组;TSH在中值组显著低于低值组和高值组,差异具有统计学意义(P0.05);3.在PCOS组,以FT3水平三等分的三个亚组,以T3F水平三等分,随着FT3水平的升高,FBG水平降低;FINS水平升高,但无统计学差异。4.在PCOS组,以FT4水平三等分的三个亚组,在年龄、FSH、LH/FSH比较中,FSH高值组明显高于中值及低值组,LH/FSH则低值组明显高于中值及高值组,差异具有统计学意义(P0.05),LDL随着FT4升高而升高,但并未达到统计学差异;5.在PCOS组中,以TSH水平三等分的三个亚组比较中,E2低值组明显高于中值和高值组;FINS水平及HOMA-IR高值组明显高于低中值组;差异具有统计学意义(P0.05)。6 .FT3 与 BMI (r=0.237x P=0.042)及 FINS (r=0.284xP=0.033)随着 FT3 的升高而升高,呈正相关;随年龄、FSH、E2随着FT4升高而升高,而LDL则相反,与年龄(r=0.471xx P=0.000)、FSH(r=0.274xx P=0.009)、E2(r=0.262xP=0.013)呈正相关,FT4与LDL (r=-0.208xP=0.049)呈负相关;T年龄随TSH水平升高而减小,FINS、HOMA-IR则随着其升高而升高,与年龄(r=-0.240x P=0.023)、E2(r=-0.300xx P=0.004)呈负相关,TSH 与 FINS (r=0.249xP=0.018)、HOMA-IR(r=0.266xP=0.011)呈正相关;结论1.正常范围FT4水平升高,有利于改善PCOS卵巢功能;2.对于PCOS,随着正常范围TSH水平的升高,胰岛素抵抗越显著;3.正常范围FT4升高及TSH降低的趋势,对于PCOS具有保护作用,同时,正常范围的甲状腺激素水平对于PCOS防治,可能过于宽泛;4.对于PCOS患者,在正常范围甲状腺激素对于卵巢及胰岛素的影响,对于PCOS发病机制的研究,可能提供了新的思路。
[Abstract]:Research background polycystic ovary syndrome (PCOS) accounts for about 7% of women of childbearing age, accounting for about 20% of secondary amenorrhea, accounting for about 80% of women's hairy and Kaohsiung steroids, accounting for 30% to 60% of anovulatory infertility. The clinical manifestations are menstrual dilute or amenorrhea, obesity, chronic anovulatory, hyperlipidemia, insulin resistance and high islets. Hyperandrogenism, hairy, acne, and infertility, characterized by high androgen levels and persistent anovulatory or ovulatory disorders and polycystic ovary, which are essentially an endocrine disorder syndrome in women of childbearing age. Polycystic ovary syndrome has different phenotypes, which can have high levels of Kaohsiung hormone, hyperinsulinemia, polycystic ovary, etc. The manifestations of degree heterogeneity. The cause of the disease is complex and different. The current study may be caused by the interaction of genetic and environmental factors. Patients with polycystic ovary syndrome are often accompanied by menstrual disorders, obesity, insulin resistance, Kaohsiung steroid, hairy, acne and eanthoderma, such as type 2 diabetes, cardiovascular disease in the long term. The incidence of complications such as disease, endometrial cancer, obstructive sleep apnea syndrome (OSA) is more than the number of times as many times as normal. The prevalence of thyroid diseases (thyroid nodules, hyperthyroidism, hypothyroidism, Hashimoto's thyroiditis, etc.) in the living environment, including excessive pressure, environmental pollution, dietary structure, etc. Upward trend, about 300 million people have thyroid related diseases. In clinical, PCOS and thyroid diseases have the same clinical manifestations, such as menstrual disorders, glycolipid abnormalities, insulin resistance, infertility, and so on. From the pathogenesis, PCOS is due to the overreaction of ovarian follicle membrane cells to LH, combined with internal and external regulatory factors (inhibition). The abnormal joint action of hormone and so on leads to the increase of androgen secretion in ovary, and in the hypothalamus pituitary thyroid axis system, FSH, LH can function in the ovary, while TSH can combine with TSH receptor on ovarian cells, and FT3, FT4 can directly act on ovarian granulosa cells, epithelial cells and so on. There is a mutual relationship and effect between the two. Some studies have found that moderate thyroid hormone levels help to maintain the stability of the pituitary - gonadal axis. It is reported that the average level of TSH in group PCOS is higher than that of the control group under the condition of normal thyroid hormone levels. This article explores the correlation between different levels of thyroid hormones and PCOS related indicators to provide better and more timely prevention and treatment for PCOS combined with thyroid diseases. It may provide new ideas for the pathogenesis of PCOS. 1. The correlation.2. of sex hormone, blood lipid, and so on provides a new reference for the prevention and control of PCOS; materials and Methods Retrospective analysis of 132 cases of polycystic ovary syndrome (PCOS) and normal thyroid function as case group from 2014.1-2016.12 to our department, and 146 healthy persons with normal thyroid function as control group in the same period; according to 2003 The Rotterdam diagnostic standard was divided into the normal group and the PCOS group. The thyroid hormone (TSH), the free thyroid hormone T4, the free three iodonine T3 were measured, and the differences in the general indexes and hormone levels in the two groups were compared. Then the thyroid hormone levels were given to the PCOS group by three equal scores, and the correlation between the groups and the sex hormones, blood glucose and blood lipids of the PCOS patients was compared. The effect of thyroid hormone level on PCOS related indexes of PCOS patients was analyzed. Results 1. compared with group PCOS, the level of sex hormone in group PCOS and FSH were lower than that of control group, while E2, P, T, PRL were higher than those of control group, and the difference was statistically significant (P0.05), and the level of thyroid hormone in PCOS group was significantly lower than that of the control group. FT3 was significantly lower than the control group. Group TSH significantly higher than the control group, the difference was statistically significant (P0.05), but the FT4 value slightly increased, but no difference.2. was grouped by BMI standard, the healthy control group compared with the PCOS group, BMI was compared, and the age group was significantly lower than the high value group; FSH median group was significantly higher than the low value and high value group; TSH was significantly lower in the middle value group. In the low value group and the high value group, the difference was statistically significant (P0.05); 3. in the group PCOS, the three subgroups of the FT3 level three, the FBG level decreased with the level of FT3, and the FINS level increased, but there was no statistical difference between the PCOS group and the three subgroups of FT4 level three, in age, FSH, LH/FSH comparison. The value group was significantly higher than the median and low value group, LH/FSH was significantly higher than the median and high value group, the difference was statistically significant (P0.05), LDL increased with the increase of FT4, but did not reach statistical difference. 5. in the PCOS group, the E2 low value group was obviously higher than the median and high value group in the three subgroups of TSH level three equal, FINS level and HO. The MA-IR high value group was significantly higher than the low middle value group; the difference was statistically significant (P0.05).6.FT3 and BMI (r=0.237x P=0.042) and FINS (r=0.284xP=0.033) increased with the increase of FT3, and increased with age, FSH, E2. .013) was positively correlated, and FT4 was negatively correlated with LDL (r=-0.208xP=0.049); T age decreased with the increase of TSH level, while FINS, HOMA-IR increased with its rise, and was negatively correlated with age (r=-0.240x P=0.023), E2 (r=-0.300xx); conclusion the 1. normal range rose horizontally. High, improve PCOS ovarian function; 2. for PCOS, with the normal range of TSH level increased, the more significant insulin resistance; 3. normal range FT4 and TSH decrease trend, the protection of PCOS, and the normal range of thyroid hormone for PCOS prevention and treatment, may be too broad; 4. for PCOS patients in the normal range. The effect of thyroid hormone on ovary and insulin may provide new ideas for the study of the pathogenesis of PCOS.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R711.75

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