北京及周边地区早发性卵巢功能不全的病因学研究

doi:10.3969/j.issn.1006-7795.2018.04.003

首都医科大学学报 ›› 2018, Vol. 39 ›› Issue (4): 494-498.doi: 10.3969/j.issn.1006-7795.2018.04.003

北京及周边地区早发性卵巢功能不全的病因学研究

程姣姣¹, 阮祥燕^1,2, 李扬璐¹, 杜娟¹, 王虎生¹, Alfred O. Mueck^1,2

1. 首都医科大学附属北京妇产医院内分泌科, 北京 100026;
2. 德国图宾根大学妇产医院妇女健康部与妇女健康研究中心, 图宾根 D-72076, 德国

收稿日期:2018-05-31 出版日期:2018-07-21 发布日期:2018-07-21
通讯作者: 阮祥燕 E-mail:ruanxiangyan@163.com
基金资助:
国家外专局引智重点项目（20181100005），医疗健康技术创新与人才培养专项基金（2017041900004，2018042000001），北京市自然科学基金（Y181004），北京市医院管理局临床技术创新项目（XMLX201710），首都临床特色应用研究与成果推广项目（Z161100000516143），首都卫生发展科研专项（2016-2-2113），北京市卫生系统高层次卫生技术人才项目（2014-2-016），北京市医院管理局"登峰"计划专项经费资助（DFL20181401）。

Etiology of premature ovarian insufficiency in Beijing and surrounding areas

Cheng Jiaojiao¹, Ruan Xiangyan^1,2, Li Yanglu¹, Du Juan¹, Wang Husheng¹, Alfred O. Mueck^1,2

1. Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China;
2. Department for Women's Health, University Women's Hospital and Research Center for Women's Health, University of Tuebingen, Tuebingen D-72076, Germany

Received:2018-05-31 Online:2018-07-21 Published:2018-07-21
Supported by:
This study was by supported by SAFEA:Project for Key Foreign Experts (20181100005), Medical Health Technology Innovation and Talent Training Special Fund (2017041900004, 2018042000001), Natural Science Foundation of Beijing(Y181004), Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support (XMLX201710), Beijing Municipal Science and Technology Commission (Z161100000516143), Beijing Capital Foundation for Medical Science Development and Research (2016-2-2113), Beijing Municipality Health Technology High-level Talent (2014-2-016), Beijing Municipal Administration of Hospitals' Ascent Plan (DFL20181401).

摘要/Abstract

摘要： 目的早发性卵巢功能不全（premature ovarian insufficiency，POI）不仅影响女性的生育能力，而且早绝经相关慢性病和早死风险大大增高，研究其病因学/危险因素的规律，对于POI的防治极为重要。方法选取2016年12月至2018年5月，在首都医科大学附属北京妇产医院内分泌科就诊的149例早发性卵巢功能不全患者。收集信息包括年龄、确诊为POI时年龄、从初诊到确诊为POI时的时间、月经史，盆腔手术史、放化疗史，是否患腮腺炎等感染史，甲状腺功能异常疾病史、系统性红斑狼疮等免疫性疾病史等，测定身高、体质量、腰围、臀围、血清卵泡刺激素（follicle stimulation hormone，FSH）、雌二醇（estradiol，E₂）、抗苗勒管激素（anti-Müllerian hormone，AMH）、抑制素B（inhibin B，INHB）以及染色体核型等指标。将FSH值按25~40 IU/L和>40 IU/L将患者分为两组，进行一般情况、内分泌学指标、病因学的统计学分析。结果不同FSH组的年龄、体质量指数（body mass index，BMI）、腰臀比（waist hip ratio，WHR）、诊断为POI时的年龄、从初诊到确诊为POI的时间、INHB等之间差异无统计学意义（P>0.05）。FSH>40 IU/L组的E₂值（36.60±33.39）mg/L、AMH值（0.09±0.20）ng/mL低于FSH 25~40 IU/L的E₂值（66.80±56.70）mg/L、AMH值（0.41±0.77）ng/mL。149例POI患者病因中特发性占53.7%（80例），染色体异常占5.4%（8例），医源性因素占17.4%（26例），感染病史（如腮腺炎等）占21.5%（32例），免疫异常因素占2.0%（3例）；FSH 25~40 IU/L组、>40 IU/L组，其病因学/危险因素之间差异无统计学意义（P>0.05）。结论 POI的发生除特发性因素外，医源性是很重要的病因，提示对医源性POI的防治至关重要。

关键词: 早发性卵巢功能不全, 病因学, 危险因素, 医源性, 特发性, 染色体异常

Abstract: Objective Premature ovarian insufficiency (POI) not only affects women's fertility, but also significantly increases the risk of early menopause-related chronic diseases and early death. Studying the etiology/risk factors is very important for the prevention and treatment of POI. Methods From December 2016 to May 2018, 149 patients diagnosed with POI at the Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University were selected. We collected patients' informations including the age, the age of diagnosis with POI, time from hospital visit to confirming POI, menstruation, history of pelvic surgery, radiotherapy and chemotherapy history, history of mumps infection, history of thyroid dysfunction, history of immune diseases such as systemic lupus erythematosus (SLE). Body height, weight, waist circumference, hip circumference, follicle stimulating hormone (FSH), estradiol (E₂), anti-müllerian hormone (AMH), inhibin B (INHB), and karyotype analysis were measured. The 149 patients were divided into two groups according to FSH values 25-40 IU/L and FSH>40 IU/L for statistical analysis of general characteristics, endocrine parameters and etiology. Results For Age, BMI, WHI, age at diagnosis of POI, time from hospital visit to confirming POI, and INHB, there was no statistically significant difference (P>0.05). For E₂ and ANH, there was a significant difference between groups (P<0.05). The E₂ value (36.60±33.39) mg/L and AMH value (0.09±0.20) in the FSH>40 IU/L group were lower than the E₂ values (66.80±56.70) mg/L and the AMH value (0.41±0.77)ng/mL in the FSH 25-40 IU/L group. Among 149 patients with POI, 53.7% (80 cases) were idiopathic, 5.4% (8 cases) were chromosomal abnormalities, 17.4% (26 cases) were iatrogenic, and 21.5% (32 cases) had a history of infection (mumps et.), 2.0% (3 cases) were immune abnormalities;FSH 25~40 IU/L group,FSH>40 IU/L group, there was no significant difference in the etiology/risk factors between groups (P>0.05). Conclusion In addition to idiopathic factor, the more important cause of POI is iatrogenic cause, indicating that the prevention and treatment of iatrogenic POI is of utmost importance.

Key words: premature ovarian insufficiency, etiology, risk factors, iatrogenic, idiopathic, chromosomal abnormalities

中图分类号:

R711.75

程姣姣, 阮祥燕, 李扬璐, 杜娟, 王虎生, Alfred O. Mueck. 北京及周边地区早发性卵巢功能不全的病因学研究[J]. 首都医科大学学报, 2018, 39(4): 494-498.

Cheng Jiaojiao, Ruan Xiangyan, Li Yanglu, Du Juan, Wang Husheng, Alfred O. Mueck. Etiology of premature ovarian insufficiency in Beijing and surrounding areas[J]. Journal of Capital Medical University, 2018, 39(4): 494-498.

参考文献

[1] European Society for Human Reproduction and Embryology(ESHRE) Guideline Group on POI, Webber L, Davies M, et al. ESHRE Guideline:management of women with premature ovarian insufficiency[J]. Hum Reprod, 2016,31(5):926-937.
[2] Falorni A, Minarelli V, Eads C M, et al. A clinical research integration special program (CRISP) for young women with primary ovarian insufficiency[J]. Panminerva Med, 2014,56(4):245-261.
[3] Sadeghi M R. New hopes for the treatment of primary ovarian insufficiency/premature ovarian failure[J]. J Reprod Infertil, 2013,14(1):1-2.
[4] Coulam C B, Adamson S C, Annegers J F. Incidence of premature ovarian failure[J]. Obstet Gynecol, 1986,67(4):604-606.
[5] 李雪, 阮祥燕, 王虎生, 等. 原发性卵巢功能不全对病人糖脂代谢及生物化学指标的影响[J]. 首都医科大学学报, 2017,38(4):504-508.
[6] Fenton A, Panay N. Does routine gynecological surgery contribute to an early menopause?[J]. Climacteric, 2012,15(1):1-2.
[7] Hoek A, Schoemaker J, Drexhage H A. Premature ovarian failure and ovarian autoimmunity[J]. Endocr Rev, 1997,18(1):107-134.
[8] De Vos M, Devroey P, Fauser B C. Primary ovarian insufficiency[J]. Lancet (London, England), 2010,376(9744):911-921
[9] 陈子江, 田秦杰, 乔杰. 早发性卵巢功能不全的临床诊疗中国专家共识[J]. 中华妇产科杂志, 2017,52(9):577-581.
[10] Pastore L M, Christianson M S, Stelling J, et al. Reproductive ovarian testing and the alphabet soup of diagnoses:DOR, POI, POF, POR, and FOR[J]. J Assist Reprod Genet, 2018,35(1):17-23.
[11] Hewlett M, Mahalingaiah S. Update on primary ovarian insufficiency[J]. Curr Opin Endocrinol Diabetes Obes, 2015,22(6):483-489.
[12] Luisi S, Orlandini C, Regini C, et al. Premature ovarian insufficiency:from pathogenesis to clinical management[J]. J Endocrinol Invest, 2015,38(6):597-603.
[13] Nelson L M. Clinical practice. Primary ovarian insufficiency[J]. N Engl J Med, 2009,360(6):606-614.
[14] 阮祥燕, 田秦杰, 代荫梅,等. 卵巢组织冻存与移植中国专家共识[J]. 中国临床医生杂志, 2018,46(4):496-500.
[15] Chen W, Zheng R, Baade P D, et al. Cancer statistics in China, 2015[J]. CA:Cancer J Clin, 2016,66(2):115-132.
[16] Fenton A J. Premature ovarian insufficiency:Pathogenesis and management[J]. J Mid Life Health, 2015,6(4):147-153.
[17] Meirow D, Ra'anani H, Biderman H. Ovarian tissue cryopreservation and transplantation:a realistic, effective technology for fertility preservation[J]. Methods Mol Biol, 2014,1154:455-473.
[18] 阮祥燕, 杜娟, 卢丹. 中国首例冻存卵巢组织移植报告[J]. 首都医科大学学报, 2016,37(6):840-842.
[19] Morrison J C, Givens J R, Wiser W L, et al. Mumps oophoritis:a cause of premature menopause[J]. Fertil Steril, 1975,26(7):655-659.
[20] Ebrahimi M, Akbari Asbagh F. The role of autoimmunity in premature ovarian failure[J]. Iran J Reprod Med, 2015,13(8):461-472.
[21] Kinney A, Kline J, Kelly A, et al. Smoking, alcohol and caffeine in relation to ovarian age during the reproductive years[J]. Hum Reprod, 2007,22(4):1175-1185.
[22] Practice Committee of the American Society for Reproductive Medicine. Testing and interpreting measures of ovarian reserve:a committee opinion[J]. Fertil Steril, 2015,103(3):e9-e17.

北京及周边地区早发性卵巢功能不全的病因学研究

Etiology of premature ovarian insufficiency in Beijing and surrounding areas

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