肥胖因素与女性不孕相关性的研究

发布时间：2018-09-01 06:09

【摘要】：目的通过研究肥胖、超重、正常体重不孕症患者血清胰岛素水平、瘦素水平、性激素水平与对照组比较及生殖抗体定性检测,探讨肥胖因素与不孕症相关指标的变化,并通过组织切片观察不孕症患者子宫内膜的组织学特征性改变,为进一步探索肥胖与不孕症之间的关系提供参考。研究对象及方法1研究对象:收集2012年3月-2016年11月期间,来菏泽市立医院、菏泽医学专科学校附属医院、牡丹人民医院就诊的不孕患者269例,根据目前通用的国际标准,以体重指数(BMI)=体重(Kg)/[身高(m)]2作为评估肥胖的指标,BMI=18.5~24.0Kg/(m)2为正常体重,BMI=25~29 Kg/(m)2为超重,BMI=30~34.9 Kg/(m)2则为肥胖,对病人身高、体重及腰、腹围等指标进行测量记录,根据测量数据进行计算,将269例不孕患者分为三组:正常体重组94例,超重组77例,肥胖组98例,另外选取100名正常生育史及正常体重的育龄期女性作为对照组。2方法:采用GE(logiq E9S8)B型超声仪,测量脂肪厚度记录患者体内脂肪分布情况及脂肪厚度;利用酶联免疫技术检测血清中与生殖功能相关的激素水平,采用全自动电化学发光测定仪技术检测血清中的生殖抗体;尊重患者意愿采取子宫内膜组织,制作组织切片,观察子宫内膜的组织学变化。结果1、肥胖组与超重组肝前皮下脂肪、肝前脂肪、内脏脂肪、腹部皮下脂肪分别与正常体重组、对照组比较脂肪厚度明显增加。2、肥胖组与超重组胰岛素水平、瘦素水平分别于与正常体重组、对照组比较表现为高胰岛素水平,高瘦素水平,两者呈正相关。3、肥胖组、超重组、正常体重组性激素(FSH、LH、E2、T)测得值与对照组比较有显著性差异。4、不孕症患者与对照组生殖抗体检测阳性率各组间比较无显著性差异。5、88例患者在子宫内膜分泌期做组织切片,增生类反应34例,分泌类反应54例。结论通过对肥胖、超重不孕症患者体内血清胰岛素水平、瘦素水平检测与正常体重组、对照组比较发现,肥胖女性不孕症患者体重越重胰岛素含量、瘦素含量越多,高胰岛素水平与高瘦素水平相伴行,两者呈正相关;肥胖组、超重组、正常体重组测得性激素与对照组比较存在差异;生殖抗体阳性率肥胖组、超重组、正常体重组测得性激素与对照组比较表达差异不明显提示不孕症患者进行多项抗生殖免疫自身抗体检测是十分必要的。子宫内膜组织切片显示分泌期子宫内膜过度增生,腺体扩张或分泌期内膜间质反应差,缺乏蜕膜样反应。通过本实验表明肥胖与不孕症之间存在一定的相关性,肥胖体征性不孕是相对概念,是体重过高和脂肪分布不均匀引起的暂时性不孕,不孕症常有多种因素同时存在,肥胖因素可作为不孕的原因与其他病因并存。
[Abstract]:Objective to study the changes of serum insulin, leptin, sex hormone levels and reproductive antibodies in obese, overweight and normal body weight infertility patients. The histological characteristics of endometrium in infertile women were observed by histological section, which provided a reference for further exploring the relationship between obesity and infertility. Study objects and methods: from March 2012 to November 2016, 269 infertile patients who visited Heze Municipal Hospital, Heze Medical College affiliated Hospital and Peony people's Hospital were collected according to the current international standards. The body mass index (BMI) = weight (Kg) / [height (m)] 2 was taken as the index of obesity. The normal body weight of BMI-2529 Kg/ (m) 2 was overweight and the weight of the patient was 3034.9 Kg/ (m) 2. The height, weight, waist and abdominal circumference of the patients were measured and calculated according to the measured data. 269 infertile patients were divided into three groups: normal weight group (n = 94), hyperrecombination group (n = 77), obesity group (n = 98). The distribution of fat and the thickness of fat were measured by measuring the fat thickness, the serum hormone levels related to reproductive function were detected by enzyme-linked immunosorbent assay (Elisa), and the reproductive antibodies in serum were detected by automatic electrochemiluminescence assay (ECL). Tissue sections were made to observe the histological changes of endometrium. Results 1. The fat thickness of obesity group and superrecombinant prehepatic subcutaneous fat, prehepatic fat, visceral fat and abdominal subcutaneous fat were significantly higher than that of normal weight group. Leptin levels in the normal weight group and control group showed high insulin level, high leptin level, positive correlation between the two groups, obesity group, superrecombinant, There was significant difference in sex hormone (FSH,LH,E2,T) between normal body weight group and control group. There was no significant difference in positive rate of reproductive antibody detection between infertile patients and control group. Proliferative reaction 34 cases, secretory reaction 54 cases. Conclusion the levels of serum insulin and leptin in obese and overweight infertility patients were compared with those in normal weight group. The results of control group showed that the heavier the insulin content, the more leptin content in obese women with infertility. There was a positive correlation between high insulin level and high leptin level, there was significant difference in sex hormones between obese group, hyperrecombination group, normal body weight group and control group, the positive rate of reproductive antibody in obesity group, hyperrecombination group, The difference of sex hormone expression between normal body weight group and control group was not obvious. It suggested that it was necessary to detect multiple anti reproductive immune autoantibodies in infertile patients. Endometrial tissue sections showed endometrial hypertrophy in secretory phase, poor glandular dilatation or secretory endometrial stromal response, and lack of decidua-like response. This experiment shows that there is a certain correlation between obesity and infertility. Physical infertility of obesity is a relative concept. It is a temporary infertility caused by high weight and uneven distribution of fat. Infertility often has many factors at the same time. Obesity factors can be used as the cause of infertility and other causes co-exist.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R711.6

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