van der Westhuizen S, van der Spuy Z M
Department of Obstetrics and Gynaecology, University of Cape Town Medical School, Groote Schuur Hospital, Observatory, South Africa.
Ultrasound Obstet Gynecol. 1996 May;7(5):335-41. doi: 10.1046/j.1469-0705.1996.07050335.x.
The objective of this investigation was to correlate the severity of ultrasound abnormality in the ovaries of women suspected of having the polycystic ovary syndrome (PCOS) with their endocrinopathy in an attempt to establish which anatomical abnormalities best predict endocrine dysfunction. There were 90 patients in the study group--all suspected clinically of having PCOS--and 12 control subjects. Of the study patients, 74 were classified ultrasonically as having polycystic ovaries, whereas 16 demonstrated no ovarian abnormality. On ultrasound examination of the ovaries, the follicular size, the number and type of distribution of follicles, ovarian volume and echogenicity of the stroma were assessed. Levels of the following serum hormones were measured: luteinizing hormone (LH), follicle stimulating hormone (FSH), estrone, estradiol, 17 alpha-OH-progesterone, androstenedione, dehydroepiandrosterone sulfate (DHEAS), sex hormone binding globulin and testosterone. Calculations were made using these results to obtain the LH:FSH ratio and the free androgen index. Endocrine assessment of these 90 patients demonstrated significantly lower LH levels, lower LH:FSH ratio and lower testosterone levels in the women without ovarian abnormality, compared to those with polycystic ovaries. The women with ultrasound evidence of polycystic ovaries had high. LH levels, a raised LH:FSH ratio and higher testosterone, DHEAS and androstenedione levels than the control subjects. Although a number of multivariate regressions of biochemistry on ovarian morphology were statistically significant, ovarian morphology predicted only a small proportion of the variability in the hormone levels. Multivariate regression models predicting androstenedione and the LH:FSH ratio had the best overall fit with ovarian volume and a rosary follicular pattern as factors, but even for these variables the adjusted R2 value was very low (0.23 for androstenedione and 0.20 for the LH:FSH ratio). It is therefore concluded that, although ovarian morphology may accurately diagnose polycystic ovaries, it does not predict the severity or presence of endocrine dysfunction. Management and prognosis must be determined on an individual basis against the background of a combination of the clinical, biochemical and ultrasound findings.
本研究的目的是将疑似患有多囊卵巢综合征（PCOS）的女性卵巢超声异常的严重程度与其内分泌病变相关联，以确定哪些解剖学异常最能预测内分泌功能障碍。研究组有90名患者——均临床疑似患有PCOS——以及12名对照受试者。在研究患者中，74名经超声检查被分类为患有多囊卵巢，而16名未显示卵巢异常。在对卵巢进行超声检查时，评估了卵泡大小、卵泡的数量和分布类型、卵巢体积以及基质的回声性。测量了以下血清激素水平：促黄体生成素（LH）、促卵泡生成素（FSH）、雌酮、雌二醇、17α-羟孕酮、雄烯二酮、硫酸脱氢表雄酮（DHEAS）、性激素结合球蛋白和睾酮。利用这些结果进行计算以获得LH:FSH比值和游离雄激素指数。对这90名患者的内分泌评估表明，与患有多囊卵巢的女性相比，无卵巢异常的女性LH水平显著较低、LH:FSH比值较低且睾酮水平较低。有超声证据显示多囊卵巢的女性LH水平较高、LH:FSH比值升高，且睾酮、DHEAS和雄烯二酮水平高于对照受试者。尽管多项卵巢形态学与生物化学的多因素回归在统计学上具有显著性，但卵巢形态仅能预测激素水平变异性的一小部分。预测雄烯二酮和LH:FSH比值的多因素回归模型总体上与卵巢体积和串珠状卵泡模式最为拟合，但即便对于这些变量，调整后的R2值也非常低（雄烯二酮为0.23，LH:FSH比值为0.20）。因此得出结论，尽管卵巢形态学可能准确诊断多囊卵巢，但它无法预测内分泌功能障碍的严重程度或存在情况。必须根据临床、生化和超声检查结果相结合的背景，对个体进行管理和预后判断。
