下丘脑综合征女性的激素代谢紊乱在个体发生方面

I. V. Zhukovets, O. Leshchenko
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引用次数: 0

摘要

介绍。儿童和青少年肥胖率的上升已成为一个主要的公共卫生问题。与肥胖相关的女性生殖功能问题包括月经不规律、妊娠和分娩并发症以及不孕症。对原发性不孕症和青春期下丘脑综合征女性的碳水化合物、脂质代谢、神经内分泌调节进行前瞻性分析。材料和方法。前瞻性、纵向研究:下丘脑功能障碍少女170例,年龄14.2±1.6岁,平均年龄14.41±0.26岁。研究的第二阶段包括评估86名妇女的激素状态和代谢变化,其中46名妇女有生育能力,26名妇女有原发性不孕症,14名妇女有继发性不孕症,平均年龄21.89±1.15岁。采用临床和实验室方法研究脂质和碳水化合物代谢指标、垂体-卵巢和肾上腺激素调节系统、仪器和功能研究方法以及统计分析方法。下丘脑功能障碍的青春期少女继发性闭经占比高达31% (p=0.042),代谢综合征占比高达86%,同时卵泡刺激素、睾酮、皮质醇显著升高,孕酮、抑制素B浓度显著降低,胆固醇、低密度脂蛋白、甘油三酯、HOMA指数、胰岛素升高,高密度脂蛋白胆固醇降低。我们发现,在青春期有下丘脑肥胖史的女性中,多囊卵巢综合征(19.8%)、多经(18.6%)、少经(19.8%)、原发性不孕症(30.2%)的比例很高(p=0.001)。我们确定了一组主要的不孕预测因素:青春期出现甘油三酯血症和高脂血症(OR 9.5;95%CI[1.7-51.9])和生殖期激素依赖性疾病(OR 5.6;95%置信区间[2.5 - -18.2]).Conclusion。我们认为,及时预防和纠正青少年脂质代谢紊乱,以及早期发现生殖期激素依赖性疾病,是预防生殖障碍的重要途径。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Hormono-metabolic disorders in women with hypothalamic syndrome in the ontogenetic aspect
Introduction. The rising incidence of obesity among children and adolescents has become a major public health problem. Problems of female reproductive function associated with obesity include menstrual irregularities, complications of pregnancy and childbirth, and infertility.Aim. To conduct a prospective analysis of carbohydrate, lipid metabolism, neuroendocrine regulation in women with primary infertility and hypothalamic syndrome of puberty.Materials and methods. Prospective, longitudinal study of adolescent girls (n=170) with hypothalamic dysfunction for 14.2±1.6 years, mean age was 14.41±0.26 years. The second stage of the study included an assessment of the hormonal status and metabolic changes in 86 women, of which 46 were fertile, 26 had primary infertility and 14 had secondary infertility, mean age was 21.89±1.15 years. Clinical and laboratory methods were used to study the indicators of lipid and carbohydrate metabolism, pituitary-ovarian and adrenal hormonal regulation systems, instrumental and functional research methods, as well as statistical analysis methods were carried out.Results. Among adolescent girls with hypothalamic dysfunction a high proportion of secondary amenorrhea − 31% (p=0.042) and metabolic syndrome − 86% was revealed, as well as a significant increase in follicle-stimulating hormone, testosterone, cortisol and a decrease in the concentration of progesterone, inhibin B, an increase in cholesterol, low density lipoproteins, triglycerides, the HOMA index, insulin and a decrease in high density lipoprotein cholesterol. We found a high proportion of polycystic ovary syndrome − 19.8%, polymenorrhea − 18.6%, oligomenorrhea − 19.8%, primary infertility − 30.2%, (p=0.001) in women with a history of hypothalamic obesity in the pubertal period. We determined a set of primary infertility predictors: the presence of triglyceridemia and hyperlipidemia in the puberty period (OR 9.5; 95%CI [1.7–51.9]) and hormone-dependent diseases in the reproductive period (OR 5.6; 95%CI [2.5–18.2]).Conclusion. In our opinion, timely prevention and correction of lipid metabolism disorders in adolescents, as well as early detection of hormone-dependent diseases in the reproductive period are promising for the prevention of reproductive disorders.
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