本文選題：多囊卵巢綜合征 + 甲狀腺激素　； 參考：《鄭州大學(xué)》2017年碩士論文

【摘要】：研究背景多囊卵巢綜合征(PCOS)占育齡婦女的約7%,占繼發(fā)性閉經(jīng)患者的20%左右,占女性多毛及高雄激素血癥的約80%,占無排卵性不孕癥患者的30%～60%,其臨床表現(xiàn)為月經(jīng)稀發(fā)或閉經(jīng)、肥胖、長期慢性無排卵、高血脂癥、胰島素抵抗及高胰島素血癥、多毛、痤瘡、不孕等,為女性常見的以雄激素高水平和持續(xù)無排卵或者排卵障礙、多囊卵巢等為特征,本質(zhì)上為育齡期婦女的內(nèi)分泌失調(diào)癥候群。多囊卵巢綜合征有著不同的表型,可以有高雄激素血癥、高胰島素血癥、多囊卵巢等高度異質(zhì)性的表現(xiàn)。其病因較復(fù)雜,說法不一,目前研究,可能為遺傳因素和環(huán)境因素相互作用所致。多囊卵巢綜合征患者常常伴有月經(jīng)紊亂、肥胖、胰島素抵抗、高雄激素血癥、多毛、痤瘡及黑棘皮病等臨床特征,其遠期如2型糖尿病、心血管疾病、子宮內(nèi)膜癌、阻塞性睡眠呼吸暫停綜合征(OSA)等并發(fā)癥的發(fā)生率高于正常人數(shù)倍到數(shù)十倍。隨著生活環(huán)境,包括:壓力過大、環(huán)境污染、飲食結(jié)構(gòu)等的改變,甲狀腺疾病(甲狀腺結(jié)節(jié)、甲亢、甲減、橋本甲狀腺炎等)的患病率在全球范圍內(nèi),呈上升趨勢,約3億人存在甲狀腺相關(guān)疾病的困擾。臨床中發(fā)現(xiàn),PCOS與甲狀腺疾病存在相同的臨床表現(xiàn),如月經(jīng)紊亂、糖脂異常、胰島素抵抗、不孕等,從發(fā)病機制上來看,PCOS由于卵巢卵泡膜細胞對LH的過度反應(yīng),加上內(nèi)在及外在調(diào)節(jié)因子(抑制素等)的異常共同作用,導(dǎo)致卵巢雄激素分泌增多,而下丘腦-垂體-甲狀腺軸系統(tǒng)中,FSH、LH可生理作用于卵巢,同時TSH可與卵巢細胞上TSH受體相結(jié)合,還有FT3、FT4可直接作用于卵巢顆粒細胞、上皮細胞等,兩者之間存在著相互的聯(lián)系和作用。有研究發(fā)現(xiàn)適量的甲狀腺激素水平有助于維持垂體-性腺軸的穩(wěn)定,國外有報道稱,在甲狀腺激素水平正常的前提下,PCOS組TSH平均水平高于對照組。結(jié)合其臨床癥狀及發(fā)病機制,正常范圍甲狀腺激素不同水平對PCOS各相關(guān)指標(biāo)是否存在影響?給予本文啟發(fā)。本文則探究甲狀腺激素不同水平與PCOS各相關(guān)指標(biāo)的相關(guān)性,為PCOS合并甲狀腺疾病提供更好、及時的防治�？赡転镻COS的發(fā)病機制的探究,提供新的思路。目的1.探究正常范圍甲狀腺激素不同水平和多囊卵巢綜合征胰島素、性激素、血脂等的相關(guān)性。2.為PCOS的防治提供新的參考;材料與方法回顧性分析2014.1-2016.12年至我科住院的132例多囊卵巢綜合征(PCOS)患者并甲狀腺功能正常作為病例組,146名同期體檢甲狀腺功能正常的健康者作為對照組;按照2003年鹿特丹診斷標(biāo)準(zhǔn)分為正常組及PCOS組。檢測促甲狀腺激素(TSH)、游離甲狀腺激素T4、游離三碘原氨酸T3,比較兩組一般指標(biāo)及激素水平差異性。然后對PCOS組給予甲狀腺激素水平三等分,比較各分組與PCOS患者性激素、血糖、血脂等的相關(guān)性。分析PCOS患者各甲狀腺激素水平階段對PCOS相關(guān)指標(biāo)的影響。結(jié)果1.健康正常組與PCOS組的比較,PCOS組性激素水平,FSH低于對照組;而E2、P、T、PRL則高于對照組,差異均具有統(tǒng)計學(xué)意義(P0.05);與對照組比較中,PCOS組甲狀腺激素水平,FT3顯著低于對照組,TSH顯著水平高于對照組,差異均具有統(tǒng)計學(xué)意義(P0.05);而FT4值略有升高,但無差異。2.以BMI標(biāo)準(zhǔn)進行分組,健康對照組與PCOS組比較,以BMI進行分組,可見年齡在低值組顯著低于高值組;FSH中值組顯著高于低值和高值組;TSH在中值組顯著低于低值組和高值組,差異具有統(tǒng)計學(xué)意義(P0.05);3.在PCOS組,以FT3水平三等分的三個亞組,以T3F水平三等分,隨著FT3水平的升高,FBG水平降低;FINS水平升高,但無統(tǒng)計學(xué)差異。4.在PCOS組,以FT4水平三等分的三個亞組,在年齡、FSH、LH/FSH比較中,FSH高值組明顯高于中值及低值組,LH/FSH則低值組明顯高于中值及高值組,差異具有統(tǒng)計學(xué)意義(P0.05),LDL隨著FT4升高而升高,但并未達到統(tǒng)計學(xué)差異;5.在PCOS組中,以TSH水平三等分的三個亞組比較中,E2低值組明顯高于中值和高值組;FINS水平及HOMA-IR高值組明顯高于低中值組;差異具有統(tǒng)計學(xué)意義(P0.05)。6 .FT3 與 BMI (r=0.237x P=0.042)及 FINS (r=0.284xP=0.033)隨著 FT3 的升高而升高,呈正相關(guān);隨年齡、FSH、E2隨著FT4升高而升高,而LDL則相反,與年齡(r=0.471xx P=0.000)、FSH(r=0.274xx P=0.009)、E2(r=0.262xP=0.013)呈正相關(guān),FT4與LDL (r=-0.208xP=0.049)呈負相關(guān);T年齡隨TSH水平升高而減小,FINS、HOMA-IR則隨著其升高而升高,與年齡(r=-0.240x P=0.023)、E2(r=-0.300xx P=0.004)呈負相關(guān),TSH 與 FINS (r=0.249xP=0.018)、HOMA-IR(r=0.266xP=0.011)呈正相關(guān);結(jié)論1.正常范圍FT4水平升高,有利于改善PCOS卵巢功能;2.對于PCOS,隨著正常范圍TSH水平的升高,胰島素抵抗越顯著;3.正常范圍FT4升高及TSH降低的趨勢,對于PCOS具有保護作用,同時,正常范圍的甲狀腺激素水平對于PCOS防治,可能過于寬泛;4.對于PCOS患者,在正常范圍甲狀腺激素對于卵巢及胰島素的影響,對于PCOS發(fā)病機制的研究,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.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R711.75

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