【摘要】：目的通過研究肥胖、超重、正常體重不孕癥患者血清胰島素水平、瘦素水平、性激素水平與對(duì)照組比較及生殖抗體定性檢測,探討肥胖因素與不孕癥相關(guān)指標(biāo)的變化,并通過組織切片觀察不孕癥患者子宮內(nèi)膜的組織學(xué)特征性改變,為進(jìn)一步探索肥胖與不孕癥之間的關(guān)系提供參考。研究對(duì)象及方法1研究對(duì)象:收集2012年3月-2016年11月期間,來菏澤市立醫(yī)院、菏澤醫(yī)學(xué)�？茖W(xué)校附屬醫(yī)院、牡丹人民醫(yī)院就診的不孕患者269例,根據(jù)目前通用的國際標(biāo)準(zhǔn),以體重指數(shù)(BMI)=體重(Kg)/[身高(m)]2作為評(píng)估肥胖的指標(biāo),BMI=18.5~24.0Kg/(m)2為正常體重,BMI=25~29 Kg/(m)2為超重,BMI=30~34.9 Kg/(m)2則為肥胖,對(duì)病人身高、體重及腰、腹圍等指標(biāo)進(jìn)行測量記錄,根據(jù)測量數(shù)據(jù)進(jìn)行計(jì)算,將269例不孕患者分為三組:正常體重組94例,超重組77例,肥胖組98例,另外選取100名正常生育史及正常體重的育齡期女性作為對(duì)照組。2方法:采用GE(logiq E9S8)B型超聲儀,測量脂肪厚度記錄患者體內(nèi)脂肪分布情況及脂肪厚度;利用酶聯(lián)免疫技術(shù)檢測血清中與生殖功能相關(guān)的激素水平,采用全自動(dòng)電化學(xué)發(fā)光測定儀技術(shù)檢測血清中的生殖抗體;尊重患者意愿采取子宮內(nèi)膜組織,制作組織切片,觀察子宮內(nèi)膜的組織學(xué)變化。結(jié)果1、肥胖組與超重組肝前皮下脂肪、肝前脂肪、內(nèi)臟脂肪、腹部皮下脂肪分別與正常體重組、對(duì)照組比較脂肪厚度明顯增加。2、肥胖組與超重組胰島素水平、瘦素水平分別于與正常體重組、對(duì)照組比較表現(xiàn)為高胰島素水平,高瘦素水平,兩者呈正相關(guān)。3、肥胖組、超重組、正常體重組性激素(FSH、LH、E2、T)測得值與對(duì)照組比較有顯著性差異。4、不孕癥患者與對(duì)照組生殖抗體檢測陽性率各組間比較無顯著性差異。5、88例患者在子宮內(nèi)膜分泌期做組織切片,增生類反應(yīng)34例,分泌類反應(yīng)54例。結(jié)論通過對(duì)肥胖、超重不孕癥患者體內(nèi)血清胰島素水平、瘦素水平檢測與正常體重組、對(duì)照組比較發(fā)現(xiàn),肥胖女性不孕癥患者體重越重胰島素含量、瘦素含量越多,高胰島素水平與高瘦素水平相伴行,兩者呈正相關(guān);肥胖組、超重組、正常體重組測得性激素與對(duì)照組比較存在差異;生殖抗體陽性率肥胖組、超重組、正常體重組測得性激素與對(duì)照組比較表達(dá)差異不明顯提示不孕癥患者進(jìn)行多項(xiàng)抗生殖免疫自身抗體檢測是十分必要的。子宮內(nèi)膜組織切片顯示分泌期子宮內(nèi)膜過度增生,腺體擴(kuò)張或分泌期內(nèi)膜間質(zhì)反應(yīng)差,缺乏蛻膜樣反應(yīng)。通過本實(shí)驗(yàn)表明肥胖與不孕癥之間存在一定的相關(guān)性,肥胖體征性不孕是相對(duì)概念,是體重過高和脂肪分布不均勻引起的暫時(shí)性不孕,不孕癥常有多種因素同時(shí)存在,肥胖因素可作為不孕的原因與其他病因并存。
[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.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R711.6

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