本文關(guān)鍵詞：多囊卵巢綜合征與亞臨床甲狀腺功能減退的相關(guān)研究　出處：《吉林大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 多囊卵巢綜合征 亞臨床甲狀腺功能減退 甲狀腺過氧化物酶抗體 妊娠結(jié)局

【摘要】：背景多囊卵巢綜合征(Polycystic Ovary syndrome,PCOS)是一種病因復(fù)雜、臨床癥狀多樣性的女性內(nèi)分泌紊亂性疾病,以長期無排卵、高雄激素血癥及胰島素抵抗為基本特征,在臨床上可同時伴發(fā)月經(jīng)不調(diào)、不孕、多毛、肥胖等多系統(tǒng)表現(xiàn)。此病長期易并發(fā)冠心病、糖尿病、胰島素抵抗代謝綜合征、高血壓等疾病,約占育齡期婦女的10%。甲狀腺功能減退癥是由各種原因?qū)е碌募谞钕偌に睾铣苫蚍置跍p少而引起的全身性低代謝綜合癥,其臨床表現(xiàn)為低代謝狀態(tài)、性情冷漠、黏液性水腫等。臨床甲狀腺功能減退的患病率是1.0%,發(fā)病率為2.9/1000。甲減常見病因包括:(1)自身免疫損傷;(2)甲狀腺破壞;(3)碘過量;(4)抗甲狀腺藥物。臨床上較常見甲狀腺功能減退類型為亞臨床甲狀腺功能減退,其中以自身免疫性損傷最為常見。大量流行病學(xué)資料顯示在多囊卵巢綜合癥中亞臨床甲狀腺功能減退的發(fā)病率明顯高于普通人中亞臨床甲狀腺功能減退的發(fā)病率。目的探討多囊卵巢綜合癥與亞臨床甲狀腺功能減退之間的關(guān)系為進一步探索多囊卵巢綜合征的發(fā)病機制提供了新的切入點,也為干預(yù)或治療多囊卵巢綜合征提供新的靶點。方法選取2015年5月-2016年12月就診于吉林大學(xué)第二醫(yī)院內(nèi)分泌科及生殖醫(yī)學(xué)科門診18-30歲患有單純多囊卵巢綜合癥患者共57例作為PCOS組,選取同期門診18-30歲患有多囊卵巢綜合癥伴亞臨床甲狀腺功能減退患者共57例為PCOS伴甲減組。同時根據(jù)TPOAb是否陽性將PCOS伴甲減組分為TPO-Ab陽性組及TPO-Ab陰性組,對所有受試者行病史采集、體格檢查及生化檢測。同時對多囊卵巢伴亞臨床甲狀腺功能減退患者進行后期隨訪,觀察妊娠結(jié)局。使用SPSS21.0統(tǒng)計軟件進行分析統(tǒng)計,以P0.05判定為有統(tǒng)計學(xué)差異。結(jié)果1、在一般資料與生化指標(biāo)方面,PCOS伴甲減組患者空腹血糖(FPG)、甘油三酯(TG)、空腹胰島激素(FCP)、胰島素抵抗指數(shù)(HOMA-IR)、瘦素(LP)明顯高于PCOS組(P值0.05);兩組在年齡、身高、體重、體重指數(shù)(BMI)、餐后2h血糖(2h PPG)、總膽固醇(TC)、高密度脂蛋白膽固醇(HDL)、低密度脂蛋白膽固醇(LDL)、餐后2h胰島激素(2h CP)方面無明顯統(tǒng)計學(xué)差異。2、在性激素六項和甲功三項方面,PCOS伴甲減組患者黃體生成素(LH)、卵泡刺激素(FSH)、睪丸酮(T)明顯低于PCOS組(P值0.05);PCOS伴甲減組患者垂體泌乳素(PRL)、促甲狀腺激素(TSH)高于PCOS組(P值0.05);兩組在孕酮(P)、雌激素(E)、LH/FSH、游離T3(FT3)、游離T4(FT4)方面無統(tǒng)計學(xué)意義。3、PCOS伴甲減組,在一般資料與生化指標(biāo)方面,TPO-Ab陽性組患者身高、體重明顯低于TPO-Ab陰性組;兩組在年齡、體重指數(shù)(BMI)、空腹血糖(FPG)、餐后2h血糖(2h PPG)、甘油三酯(TG)、總膽固醇(TC)、高密度脂蛋白膽固醇(HDL)、低密度脂蛋白膽固醇(LDL)、空腹胰島激素(FCP)、餐后2h胰島激素(2h CP)、胰島素抵抗指數(shù)(HOM A-IR)、瘦素(LP)方面無明顯統(tǒng)計學(xué)差異。4、PCOS伴甲減組,在性激素六項和甲功三項方面,TPO-Ab陽性組患者促甲狀腺激素(TSH)明顯高于TPO-Ab陰性組(P值0.05);兩組在黃體生成素(LH)、卵泡刺激素(FSH)、LH/FSH、孕酮(P)、雌激素(E)、睪丸酮(T)、垂體泌乳素(PRL)、游離T3(FT3)、游離T4(FT4)方面無統(tǒng)計學(xué)意義。5、在后期隨訪中,TPO-Ab陽性組患者既往流產(chǎn)的發(fā)生率明顯高于TPO-Ab陰性組(P值0.05);兩組患者在自然流產(chǎn)、先兆早產(chǎn)、羊水量異常、妊高癥、妊娠期糖尿病的不良妊娠結(jié)局方面無明顯統(tǒng)計學(xué)差異。6、將TSH與PCOS伴甲減組整組參數(shù)進行回歸分析,TSH與孕激素存在相關(guān)性,與其他參數(shù)無顯著相關(guān)。結(jié)論1、多囊卵巢綜合征伴發(fā)亞臨床甲狀腺功能減退時,對性激素水平、血脂、胰島素抵抗、肥胖方面的影響更為突出。2、甲狀腺過氧化物酶抗體(TPOAb)對不良妊娠結(jié)局有一定影響,故在篩查多囊卵巢綜合征伴亞臨床甲狀腺功能減退的患者時,應(yīng)注意對甲狀腺素抗體的檢查。
[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),槨愬悗2h鑳板矝嬋，

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