Nelson L M, Anasti J N, Kimzey L M, Defensor R A, Lipetz K J, White B J, Shawker T H, Merino M J
Section on Gynecologic Research, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892.
J Clin Endocrinol Metab. 1994 Nov;79(5):1470-5. doi: 10.1210/jcem.79.5.7962345.
Despite having amenorrhea and markedly elevated serum gonadotropin levels, some women with karyotypically normal spontaneous premature ovarian failure, nevertheless, have ovarian follicles that function intermittently. Graafian follicles capable of responding to these high FSH levels are faced with high serum LH levels as well, which might induce inappropriate luteinization and prevent normal follicle function. We examined this possibility using weekly blood sampling and sonography in 65 patients. Nearly 50% of our patients demonstrated ovarian follicle function [serum estradiol, > 183 pmol/L (50 pg/mL)] during a median of 4 months of observation (range, 2-6 months). However, during this observation, only 16% achieved an ovulatory serum progesterone level [> 9.5 nmol/L (3.0 ng/mL)]. We imaged an antral follicle by sonography in over 40% of patients (27 of 65), and serum estradiol was significantly greater when an antral follicle was present. The follicles in these patients were not functioning normally, however. In contrast to normal women, patients with ovarian failure had poor correlation between follicle diameter and serum estradiol. We biopsied these antral follicles in 6 patients and found luteinized Graafian follicles in all cases. Therefore, luteinized Graafian follicles account for at least 60% of the antral structures imaged (95% confidence limit). Thus, inappropriate luteinization of Graafian follicles appears to be a major pathophysiological mechanism in patients with karyotypically normal spontaneous premature ovarian failure.
尽管存在闭经且血清促性腺激素水平显著升高，但一些核型正常的特发性卵巢早衰女性仍有间歇性发挥功能的卵巢卵泡。能够对这些高水平促卵泡生成素作出反应的格拉夫卵泡也面临着高水平的血清促黄体生成素，这可能会导致不适当的黄素化并妨碍正常卵泡功能。我们通过对65例患者每周进行采血和超声检查来探究这种可能性。在中位4个月（范围2 - 6个月）的观察期内，近50%的患者表现出卵巢卵泡功能[血清雌二醇>183 pmol/L（50 pg/mL）]。然而，在该观察期内，只有16%的患者血清孕酮水平达到排卵水平[>9.5 nmol/L（3.0 ng/mL）]。我们通过超声检查在超过40%的患者（65例中的27例）中发现了窦卵泡，并且存在窦卵泡时血清雌二醇水平显著更高。然而，这些患者的卵泡功能并不正常。与正常女性不同，卵巢早衰患者的卵泡直径与血清雌二醇之间的相关性较差。我们对6例患者的这些窦卵泡进行了活检，在所有病例中均发现了黄素化的格拉夫卵泡。因此，黄素化的格拉夫卵泡至少占所成像窦状结构的60%（95%置信区间）。如此看来，格拉夫卵泡不适当的黄素化似乎是核型正常的特发性卵巢早衰患者的主要病理生理机制。
