妇科疾病中甲状腺功能紊乱的频率和结构

I.P. Netskar
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Prevalence of thyroid pathology women with infertility had at 3,8 time higher as compared to fertility women (48,0% and 12,5% respectively, p<0,05). In the structure of thyroid pathology at infertility prevailed the transmitter of antibodies to thyroperoxidase in combination with the signs of echo of autoimmune thyroiditis (24,0%); hypothyroidism as a result of autoimmune thyroiditis (9,4%), including manifest (0,8%) and subclinical (8,6%) women and euthyroid goitre (7,8%), while part of patients with infertility and thyrotoxicosis was low (0,6%). The estimation of the state of the reproductive system for women with infertility depending on found out pathology of thyroid rotined that a leading place in the structure of reasons of infertility for women external genital endometriosis occupied with autoimmuny thyroiditis - 34,4%, for women with found out a hypothyroidism is an endocrine factor of infertility (polycystic ovary syndrome) – 29,8%, for patients with the compensated hypothyroidism is external genital endometriosis (26,6%), for women with a euthyroid goitre and for patients without pathology of thyroid - pipe peritoneal factor (33,3% and 39,8%, respectively). Conclusion. The results of questionnaire, conducted for women with infertility, showed the low diagnostic value of clinical symptoms of hypothyroidism as compared to laboratory diagnostics in verification of this diagnosis. A sensitiveness of symptoms was low and hesitated from 16,1% to 27,8%, while specificity of symptoms was considerable and varied from 85,1% to 94,5%. A leading place in the structure of reasons of infertility for women with autoimmuny thyroiditis occupies external genital endometriosis (34,4%); for patients with a hypothyroidism is endocrine infertility (29,8%), for women with a euthyroid goitre and without pathology of thyroid - pipe peritoneal factor of infertility (33,3% and 39,8%). 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In the structure of thyroid pathology at infertility prevailed the transmitter of antibodies to thyroperoxidase in combination with the signs of echo of autoimmune thyroiditis (24,0%); hypothyroidism as a result of autoimmune thyroiditis (9,4%), including manifest (0,8%) and subclinical (8,6%) women and euthyroid goitre (7,8%), while part of patients with infertility and thyrotoxicosis was low (0,6%). The estimation of the state of the reproductive system for women with infertility depending on found out pathology of thyroid rotined that a leading place in the structure of reasons of infertility for women external genital endometriosis occupied with autoimmuny thyroiditis - 34,4%, for women with found out a hypothyroidism is an endocrine factor of infertility (polycystic ovary syndrome) – 29,8%, for patients with the compensated hypothyroidism is external genital endometriosis (26,6%), for women with a euthyroid goitre and for patients without pathology of thyroid - pipe peritoneal factor (33,3% and 39,8%, respectively). Conclusion. The results of questionnaire, conducted for women with infertility, showed the low diagnostic value of clinical symptoms of hypothyroidism as compared to laboratory diagnostics in verification of this diagnosis. 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引用次数: 0

摘要

目的。研究甲状腺疾病与妇科疾病的频率和结构。材料和方法。在298名不孕症妇女(基础组)和50名选择避孕方法的妇女(对照组)中进行了甲状腺病理学筛查。在处理不孕症患者的生殖功能维持和发展分离的过程中,患者的选择是通过开放式队列法进行的。对 205 名不孕症妇女进行了问卷调查。对不孕症患者的检查按照公认的诊断算法进行,包括内窥镜检查方法,治疗方法则根据查明的不孕症原因而定。检查结果甲状腺病变在不孕症妇女中的发病率是生育妇女的3.8倍(分别为48.0%和12.5%,P<0.05)。在不孕症患者的甲状腺病理结构中,甲状腺过氧化物酶抗体发射器与自身免疫性甲状腺炎回声体征(24.0%)、自身免疫性甲状腺炎导致的甲状腺功能减退(9.4%),包括显性(0.8%)和亚临床(8.6%)妇女以及甲状腺功能亢进性甲状腺炎(7.8%)占主导地位,而不孕症和甲状腺毒症患者的比例较低(0.6%)。根据已发现的甲状腺病变对不孕妇女生殖系统状况的评估结果显示,外生殖器子宫内膜异位症和自身免疫性甲状腺炎在妇女不孕原因结构中占主要地位(34.4%)、甲状腺功能减退症是导致不孕的内分泌因素(多囊卵巢综合征),占29.8%;代偿性甲状腺功能减退症是外生殖器子宫内膜异位症,占26.6%;甲状腺功能亢进症和无甲状腺病变的患者是腹膜因素(分别占33.3%和39.8%)。结论对不孕症妇女进行的问卷调查结果表明,与实验室诊断相比,甲状腺功能减退症的临床症状在确诊时的诊断价值较低。症状的敏感性较低,从16.1%到27.8%不等,而症状的特异性很高,从85.1%到94.5%不等。患有自身免疫性甲状腺炎的妇女不孕的主要原因是外生殖器子宫内膜异位症(34.4%);甲状腺功能减退症患者不孕的主要原因是内分泌性不孕(29.8%);甲状腺功能亢进且无甲状腺病变的妇女不孕的主要原因是管道性腹膜因素(33.3%和39.8%)。在制定诊断、治疗和预防措施时,必须考虑到上述结果。
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Frequency and structure of thyroid disfunction is at gynaecological diseases
The objective. Women have a study of frequency and structure of thyroid violations with gynaecological diseases. Materials and methods. The screening estimation of pathology of thyroid is conducted was mine-out in 298 women with infertility (basic group) and in 50 fertility of women which appealed to the clinic for the selection of method of contraception (control group). The selection of patients was carried out by the opened cohort method as far as handling of patients infertility in the separation of maintainance and proceeding in a reproductive function. A questionnaire is conducted in 205 women with infertility. The inspection of patients with infertility was conducted in accordance with the generally accepted diagnostic algorithm, including endoscopic methods, and treatment – depending on found out reasons of infertility. Results. Prevalence of thyroid pathology women with infertility had at 3,8 time higher as compared to fertility women (48,0% and 12,5% respectively, p<0,05). In the structure of thyroid pathology at infertility prevailed the transmitter of antibodies to thyroperoxidase in combination with the signs of echo of autoimmune thyroiditis (24,0%); hypothyroidism as a result of autoimmune thyroiditis (9,4%), including manifest (0,8%) and subclinical (8,6%) women and euthyroid goitre (7,8%), while part of patients with infertility and thyrotoxicosis was low (0,6%). The estimation of the state of the reproductive system for women with infertility depending on found out pathology of thyroid rotined that a leading place in the structure of reasons of infertility for women external genital endometriosis occupied with autoimmuny thyroiditis - 34,4%, for women with found out a hypothyroidism is an endocrine factor of infertility (polycystic ovary syndrome) – 29,8%, for patients with the compensated hypothyroidism is external genital endometriosis (26,6%), for women with a euthyroid goitre and for patients without pathology of thyroid - pipe peritoneal factor (33,3% and 39,8%, respectively). Conclusion. The results of questionnaire, conducted for women with infertility, showed the low diagnostic value of clinical symptoms of hypothyroidism as compared to laboratory diagnostics in verification of this diagnosis. A sensitiveness of symptoms was low and hesitated from 16,1% to 27,8%, while specificity of symptoms was considerable and varied from 85,1% to 94,5%. A leading place in the structure of reasons of infertility for women with autoimmuny thyroiditis occupies external genital endometriosis (34,4%); for patients with a hypothyroidism is endocrine infertility (29,8%), for women with a euthyroid goitre and without pathology of thyroid - pipe peritoneal factor of infertility (33,3% and 39,8%). The got results must be taken into account at development of algorithm of diagnostic and treatment-and-prophylactic measures.
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