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目的探讨代谢综合征合并不孕症患者甲状腺结构和功能异常的特点,并寻求合理的治疗方案,以提高助孕成功率以及新生儿出生质量。方法 2002年3月至2010年12月在本院就诊的代谢综合征合并不孕患者共322例,这部分患者来自全国各地,以山东省内各地为主。根据病史、体征对可能存在胰岛素抵抗的患者进行糖耐量及胰岛素释放试验、血脂等检查确定代谢综合征(metabolic syndrome,MS),对这类患者进行相关的体格检查、生化测定指标及辅助检查。根据甲状腺超声及甲状腺功能和抗体测定将患者分为超声正常组、结节性甲状腺肿组(结甲组)及桥本氏甲状腺炎组(桥本组)。对三组的一般情况、基础生殖内分泌水平及甲状腺功能各项指标进行比较和分析。结果代谢综合征患者按甲状腺超声结果分为正常组54.04%(174/322)和异常组45.96%(148/322),各种异常占甲状腺超声异常总数(148)百分比分别为:结节性甲状腺肿66.89%(99/148);桥本氏甲状腺炎14.86%(22/148);甲状腺滤泡囊肿6.76%(10/148);甲状腺癌0.68%(1/148);甲状腺腺瘤2.03%(3/148);其他异常8.11%(12/148)。将超声正常组(174),结甲组(99)及桥本组(22)各项指标进行比较后发现桥本组的脂肪肝患者比例(95.45%)较高,高雄激素血症患者比例(40.91%)较低(P<0.05);基础生殖内分泌测定各组间并无统计学差异;桥本组TSH升高,与正常超声组及结甲组相比有统计学差异(P<0.05),结论代谢综合征合并不孕不育患者是甲状腺结构异常的高发人群,应该做甲状腺结构以及功能的筛查,以做到早期诊断及治疗。
Objective To investigate the characteristics of thyroid structure and dysfunction in patients with metabolic syndrome complicated with infertility and seek a reasonable treatment plan to improve the success rate of pregnancy and the birth quality of newborns. Methods A total of 322 cases of metabolic syndrome with infertility were selected from March 2002 to December 2010 in our hospital. These patients were from all over the country and were mainly found in Shandong Province. According to medical history and signs, glucose tolerance and insulin release test were conducted in patients with possible insulin resistance. Blood lipid and other tests were performed to identify metabolic syndrome (MS). Physical examination, biochemical indicators and laboratory tests were performed on these patients. Patients were divided into normal group, nodular goiter group (nodule group) and Hashimoto’s thyroiditis group (Hashimoto’s group) according to thyroid ultrasound and thyroid function and antibody. The three groups of general situation, basic reproductive and endocrine levels and thyroid function indicators were compared and analyzed. Results According to the results of thyroid ultrasound, 54.04% (174/322) of the normal group and 45.96% (148/322) of the abnormal group according to the results of thyroid ultrasound. The percentage of the total number of abnormalities in the thyroid (148) were all nodular thyroid Hashimoto’s thyroiditis 14.86% (22/148); thyroid follicular cyst 6.76% (10/148); thyroid cancer 0.68% (1/148); thyroid adenoma 2.03% (99/148) 3/148); other abnormalities 8.11% (12/148). Comparing the indexes of ultrasound normal group (174), knot nail group (99) and Hashimoto group (22), we found that the proportion of patients with Hashimoto’s fatty liver was higher (95.45%), the proportion of patients with hyperandrogenism 40.91%) was lower (P <0.05). There was no significant difference in basic reproductive endocrine assay among all groups. The TSH in Hashimoto’s group was significantly higher than that in normal ultrasound group and tuberculosis group (P <0.05) , Conclusion Metabolic syndrome patients with infertility is a high incidence of thyroid structural abnormalities, thyroid structure and function should be screened to achieve early diagnosis and treatment.