多囊卵巢的临床特征及其与不孕症关系的研究

目的：研究多囊卵巢的临床特征、子宫内膜病理及雌、孕激素受体变化。方法：对４７０例Ｂ超提示多囊卵巢的病人进行临床症状统计、妇科内分泌激素测定，并对部分病人的子宫内膜进行病理检查和雌激素受体（ＥＲ）、孕激素受体（ＰＲ）测定。结果：多囊性卵巢综合征（ＰＣＯＳ）和多囊卵巢趋势（ＰＣＯ Ｔ）的临床表现相似，ＰＣＯＳ组的黄体生成素（ＬＨ）、雌激素（Ｅ２）和雄激素（Ｔ）较ＰＣＯ Ｔ和正常妇女升高（Ｐ＜００１），ＰＣＯ Ｔ组ＬＨ，Ｔ值较正常人升高（Ｐ＜００５）。ＰＣＯＳ病人子宫内膜有８７２％呈无排卵型、３５９％腺体发育不同步、４６２％间质反应不良，ＰＣＯ Ｔ组各种情况发生率低。多囊卵巢病人增生期宫内膜ＥＲ、ＰＲ增多，合并增殖症者间质ＰＲ减少，且分布不匀，局部ＥＲ、ＰＲ明显减少或缺乏。结论：ＰＣＯＳ的主要临床表现为月经异常、不孕、卵巢多囊性变、ＬＨ／ＦＳＨ比值升高和雄激素增多。对其诊断应结合临床表现、Ｂ超和内分泌检查，进行综合分析判断。ＰＣＯ Ｔ可能是ＰＣＯＳ的早期阶段，病情较轻，及早诊治效果较好。ＰＣＯＳ病人子宫内膜的病理改变及ＥＲ、ＰＲ的局部减少或缺乏可能是不孕的重要原因之一。

The clinical features of patients with polycystic overy and therelationship between them and infertility

Objective: To investigate the clinical features and the changes of endometrial pathology and estrogen receptor (ER) and progestrone receptor (PR) in patients with polycystic ovary (PCO). Methods: The 470 patients with PCO were studied by collecting their clinical symptoms,testing endocrine hormones and doing ultrasonic examination.The endometrium form 39 patients with polycystic ovary syndrome (PCOS),31 patients with polycystic ovarytendency (PCOT) and 20 normal women were studied by HE staining and immunohistochemical method using antiestrogen receptor and antiprogesterone receptor monoclonal antibodies. Results: The clinical symptoms of patients with PCOS were similar to the patients with PCOT.The level of luteotrophic hormone (LH),estradiol (E2) and testosterone (T) for patients with PCOS were higher than those of PCOT and normal women (P<001).The levels of LH and T in patients with PCOT were higher than those in normal women (P<005).87.2% (34/39) of the endometrium showed anovulatory prolife ;51.3% (20/39) had sign of hyperplasia;359%(14/39) showed asynchronization of endometrial glands and 46.2% (18/39) poor response of stroma to sex hormone.The levels of ER and PR in endometrium during proliferative phase were significantly higher than those of normal control,and the PR in the stroma of hyperplasia endometrium had an uneven distribution and was significantly less than that in the control group (P<005). Conclusion: The main clinical pictures of PCOS were menstruation disorder,infertility,polycystic ovaries,high ratio of LH/FSH and high antrogens.Diagnosing PCOS should combine clinical pictures with ultrasonic features and the level of endocrine hormones.PCOT might be the early stage of PCOS.The endometrial histopathological changes and local decrese or absense of ER and PR in PCOS might be one of the causal factors of infertility.