卵巢功能衰退过程中血清激素和卵巢大小的改变

摘要

Objective To explore the changes of hormone level and ovarian size during the process of ovary aging staged according to STRAW system. Methods Prospective community-based cohort study was conducted. Altogether 219 women aged 30 to 54 years old and meeting the request of STRAW system were recruited through convenience sampling, and they were required to keep menstrual diary. The average follow-up period was 2. 5 years. Serum FSH and estradial ( E2 ) were detected at any day for women at - 1 stage or + 1 stage and during the menstrual cycle day 4 to 8 for those at other stages. Transvaginal ultrasonography was performed to measure ovarian length and width, and therefore calculated ovarian area. Results The highest frequency of ovarian no echo structure ( diameter≧1. 4cm ) was at - 1 stage. For women with no echo structure < 1. 4cm at baseline, there were significantly differences in FSH at different reproductive aging stages (x2= 52.06, P <0.05 ). Significant differences in E2 , width, length and area were found between - 1 stage and - 2 stage or - 1 stage and -4/ -3 stage ( P = 0. 000 ). Longitudinal analysis showed that FSH increased significantly ( t/Z was - 4. 07 and - 4. 53 respectively, both P <0. 05 ) and ovarian width decreased significantly ( t value was 2. 46 and 3. 70, respectively, both P <0. 05 ) when reproductive aging stage changed from -2 to - 1 or from - 1 to +1. The significant decrease of E2( Z = - 2. 95 ), ovarian length ( t = 2. 64 ) and area ( t = 3. 13 ) was only found when stage changed from - 1 to +l(P<0.05). Conclusion The prevalence of abnormal development of ovarian follicle increases in menopausal transition period. When stage changes from early transition stage ( - 2 stage ) to early postmenopause ( + 1 stage ), FSH increases gradually, and E2 , ovarian width and area decrease gradually. The ovarian length shortens later. The process of reproductive aging accelerates when menopause approaches.%目的 按照STRAW分期法对卵巢功能衰退过程进行分期,认识该过程激素水平和卵巢大小的变化.方法 前瞻性社区队列研究.便利抽样选取30～54岁、符合STRAW分期要求的健康女性共219名.均记录月经日记.平均随访2.5年,-1和+1期在任意日,其它期在周期4～8天检测促卵泡激素和雌二醇,经阴道超声测量卵巢长径和宽(短)径,计算面积.结果 ①-1期卵巢功能性无回声(直径≥1.4cm)出现率最高;②无回声直径＜1.4cm者,基线时在各期别间促卵泡激素均有显著差异(χ2=52.06,P＜0.05),在-1与-2期、-1与-4/-3期间雌二醇(χ2=17.25,28.98)、卵巢短径、长径和面积差异显著(P=0.000);③纵向分析显示,在-2向-1期、-1向+1期转变中促卵泡激素升高显著(t/Z=-4.07,-4.53,P＜0.05),卵巢短径缩小显著(t=2.46,3.70,P＜0.05);④雌二醇(Z=-2.95)、卵巢长径(t=2.64)、面积(t=3.13)仅在-1向+1期转变中降低显著(P＜0.05).结论 绝经过渡期卵泡异常发育机率增大.从过渡早期(-2)到绝经期(+1)促卵泡激素逐步升高,雌二醇、卵巢短径和面积逐步降低或缩小,长径缩小稍晚.近绝经时生殖衰老加速.