代谢综合征合并不育患者的甲状腺超声以及功能状况与性激素分析

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（metabolicsyndrome，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6．76Yoo（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。

Changes of ultrasound structure and function of thyroid and sexual hormone levels in infertile patients with metabolic syndrome

Objective： To assess with metabolic syndrome. changes ultrasound structure and function of thyroid in infertility patients Methods： A total of 322 infertile patients with metabolic syndrome were recruited from March 2002 to December 2010 in this study. The metabolic syndrome was diagnosed according to the diagnosis consensus of Chinese Diabetes Society Conference in 2004. The sugar tolerance,insulin releasing and blood lipids were tested in these patients. All of the patients underwent thyroid ultrasound and function examination, and serum sexual hormone levels assay. The patients were divided in to three groups（normal thyroid ultrasound group,nodule thyroid goiter group, Hashimoto＇s thyroiditis group）according to the results of thyroidultrasound and function examination and thyroglobulin antibody levels. Results. In 322 patients, the percentage of abnormal thyroid structure was 45.96% （148/322）. The percentage of nodule thyroid goiter was 66.89 % （99/148）, Hashimoto＇ s thyroiditis 14.86 % （ 22/148）, follicular goiter 6.76 % （ 10/148）, thyroid carcinoma 0.68% （ 1/148）, thyroid adenoma 2.03 % （3/148）, and others 8.11% （12/148）, Hashimoto＇s thyroiditis group had the highest ratio of fatty liver（95.45%, P〈 0.05）and the lowest ratio of hyperandrogenism（40.91% ,P〈0. 05）. No statistical difference was found in sexual hormone levels among the three groups. Hashimoto＇s thyroiditis group also had the highest TSH level （6.40!8.70）mU/LJ（P〈0.05）. Conclusions： The infertile patients with metabolic syndrome have a high risk of abnormal thyroid ultrasound structure and function. Thyroid ultrasound and function tests should be carried out in these patients for early diagnosis and treatments.