【摘要】：目的：通過(guò)檢測(cè)不孕癥組與對(duì)照組甲狀腺激素水平及性激素水平,探討甲狀腺激素功能減退與女性不孕癥的關(guān)系及臨床意義�，F(xiàn)今女性不孕癥有日漸升高的趨勢(shì),甲狀腺功能減退因素導(dǎo)致不孕受到廣泛的關(guān)注,甲狀腺功能減退癥作為一種最常見(jiàn)的自身免疫性疾病,多見(jiàn)于性成熟女性,女性患者常伴有月經(jīng)失調(diào)、閉經(jīng)、溢乳,甚至導(dǎo)致不孕癥的發(fā)生。另一方面,甲狀腺功能紊亂會(huì)影響性激素分泌水平及性腺功能,進(jìn)而造成女性患者出現(xiàn)月經(jīng)紊亂卵巢功能減退,排卵異常不孕。探討甲狀腺功能減退對(duì)不孕癥的影響,進(jìn)一步觀察甲狀腺功能減退患者性激素水平的變化,研究其下丘腦-垂體-性腺軸的變化規(guī)律,對(duì)女性不孕預(yù)防及治療具有重要的臨床意義。方法：研究實(shí)驗(yàn)對(duì)象選擇自2012年10月至2013年10月期間在石家莊市第四醫(yī)院就診進(jìn)行不孕癥檢查的婦女(非輸卵管因素及男方因素者)500例,年齡21歲～40歲,中位數(shù)年齡32歲。入選標(biāo)準(zhǔn)：婚后同居1年以上,未采取避孕措施而未孕者,或曾有孕育而后1年以上未再孕育女性,而且排除因輸卵管因素和男方因素導(dǎo)致不孕的患者。正常對(duì)照組選取門診健康體檢女性1 00例,年齡22歲～40歲。入選標(biāo)準(zhǔn)：a.排除甲狀腺過(guò)氧化物酶抗體(TPOAb)、甲狀腺球蛋白抗體(TgAb)j陽(yáng)性者；b.排除甲狀腺疾病個(gè)人史、家族史或其他自身免疫性疾病史；c.排除可見(jiàn)或者可以觸及的甲狀腺腫；d.排除服用藥物者(雌激素類除外)。采用固相化學(xué)發(fā)光酶免疫分析法,空腹測(cè)定被檢者血清中游離三碘甲腺原氨酸(FT3)、游離甲狀腺素(FT4)、促甲狀腺激素(TSH),及性激素六項(xiàng)：促卵泡成熟激素(FSH)、促黃體生成激素(LH)、催乳激素(PRL)、雌二醇(E2)、睪酮(T)和孕酮(P)。數(shù)據(jù)得出后分別比較對(duì)照組與不孕組FT3,FT4,TSH和性激素六項(xiàng),不孕組內(nèi)甲狀腺激素TSH變化模式所占比例,不孕TSH超范圍組與不孕對(duì)照組性激素六項(xiàng)對(duì)照。檢測(cè)數(shù)據(jù)以x±s表示,應(yīng)用SPSS13.0軟件進(jìn)行處理,組間分析比較采用t檢驗(yàn),以P0.05為差異具有統(tǒng)計(jì)學(xué)意義。結(jié)果：不孕組TSH含量明顯高于對(duì)照組,兩組比較差異有顯著性(尸0.01),不孕組FT3,FT4差異無(wú)顯著性(P0.05)；不孕組中,TSH升高伴月經(jīng)異常無(wú)明顯甲減癥狀所占比例為10.3%；不孕組的E2明顯低于對(duì)照組,兩組比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)；不孕組的LH、FSH、PRL明顯高于正常對(duì)照組,兩組比較差異有統(tǒng)計(jì)學(xué)意義(P0.05),不孕組的T和P與對(duì)照組相比差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)；不孕組中TSH異常升高的92例患者LH、FSH、PRL明顯高于不孕組中TSH正常的其他患者,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論：1甲狀腺功能減退是導(dǎo)致女性不孕癥的原因之一。2 TSH單獨(dú)升高,表明臨床亞臨床甲狀腺功能減退比例高,可導(dǎo)致不孕癥發(fā)生,不存在年齡差異。3甲狀腺功能減退導(dǎo)致不孕癥高發(fā)年齡為36-40歲育齡女性。4甲狀腺功能低下可導(dǎo)致雌激素水平降低,LH、FSH、PRL升高,影響卵巢功能,使卵泡發(fā)育不良,內(nèi)膜變薄,導(dǎo)致不孕。
[Abstract]:Objective: To investigate the relationship between hypothyroidism and female infertility and its clinical significance by detecting thyroid hormone level and sex hormone level in infertility group and control group. Because of the increasing trend of female infertility, the factors of hypothyroidism lead to the widespread concern of infertility, hypothyroidism as one of the most common autoimmune diseases, often seen in female and female patients with menstrual disorders, amenorrhea, galactorrhoea, even causing infertility. On the other hand, thyroid function disorder can affect sex hormone secretion level and gonadal function, which causes female patient to suffer menstrual disorder ovarian function decline, ovulation abnormal infertility. To study the effect of hypothyroidism on infertility, and to further observe the change of sex hormone level in patients with hypothyroidism, and to study the change law of hypothalamus-pituitary-gonadal axis, which has important clinical significance for the prevention and treatment of female infertility. Methods: 500 women, aged 21 to 40 years, with median age of 32 years, were selected from October 2012 to October 2013. Inclusion criteria: after 1 year of cohabitation after marriage, no pregnant women were taken, or pregnant women were not pregnant for more than 1 year, and patients with infertility caused by tubal factor and teratogenic factors were excluded. In the normal control group, there were 100 women in the outpatient health examination, aged 22 to 40 years old. Inclusion criteria: a. elimination of thyroid peroxidase antibody (TPOAb), thyroglobulin antibody (TgAb) j-positive; b. exclusion of individual history of thyroid disease, family history or other autoimmune disease history; c. elimination of visible or palpable goiter; d. Excludes drug users (other than estrogen). The serum free triiodothyronine (FT3), free thyroxine (FT4), thyroid stimulating hormone (TSH) and sex hormone 6: follicle stimulating hormone (FSH) and luteinizing hormone (LH) were determined by solid phase chemiluminescence enzyme immunoassay. prolactin (PRL), estradiol (E2), testosterone (T) and progesterone (P). Six controls were compared between control group and infertile group, FT3, FT4, TSH, sex hormone, thyroid hormone TSH in infertility group and infertility control group. The test data was expressed by x/ s, and the SPSS 13.0 software was used for the treatment. The t-test was used for the intergroup analysis, and the difference was statistically significant with P0.05. Results: The content of TSH in infertile group was significantly higher than that in control group (P <0.01), there was no significant difference between FT3 and FT4 in infertile group (P0.05). The difference of LH, FSH and PRL in infertile group was significantly higher than that in normal control group (P0.05). LH, FSH and PRL of 92 patients with abnormal TSH in infertility group were significantly higher than those of other patients with normal TSH in infertility group (P <0.05). Conclusion: 1 hypothyroidism is one of the causes of female infertility. TSH alone increases, indicating that the ratio of clinical subclinical hypothyroidism is high, which can lead to infertility. There is no age difference. 3 hypothyroidism results in a high incidence of infertility of 36-40 years old female. The low thyroid function can lead to lower estrogen level, LH, FSH, PRL increase, affect ovarian function, cause follicular dysplasia, thinning of endometrium, and lead to infertility.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R581.2;R711.6

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相關(guān)期刊論文 前1條

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