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卵巢衰老过程中血清性激素和卵巢大小的变化

王亚平,  陈蓉,  林守清,  白敬兰,  范燕燕,  林慧君,  张颖

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文章导航 > 协和医学杂志  > 2016 >  7(3): 161-167
王亚平, 陈蓉, 林守清, 白敬兰, 范燕燕, 林慧君, 张颖. 卵巢衰老过程中血清性激素和卵巢大小的变化[J]. 协和医学杂志, 2016, 7(3): 161-167. doi: 10.3969/j.issn.1674-9081.2016.03.001
引用本文: 王亚平, 陈蓉, 林守清, 白敬兰, 范燕燕, 林慧君, 张颖. 卵巢衰老过程中血清性激素和卵巢大小的变化[J]. 协和医学杂志, 2016, 7(3): 161-167. doi: 10.3969/j.issn.1674-9081.2016.03.001
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Ya-ping WANG, Rong CHEN, Shou-qing LIN, Jing-lan BAI, Yan-yan FAN, Hui-jun LIN, Ying ZHANG. Changes of Hormone Levels and Ovary Size in Ovarian Aging[J]. Medical Journal of Peking Union Medical College Hospital, 2016, 7(3): 161-167. doi: 10.3969/j.issn.1674-9081.2016.03.001
Citation: Ya-ping WANG, Rong CHEN, Shou-qing LIN, Jing-lan BAI, Yan-yan FAN, Hui-jun LIN, Ying ZHANG. Changes of Hormone Levels and Ovary Size in Ovarian Aging[J]. Medical Journal of Peking Union Medical College Hospital, 2016, 7(3): 161-167. doi: 10.3969/j.issn.1674-9081.2016.03.001
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卵巢衰老过程中血清性激素和卵巢大小的变化

doi: 10.3969/j.issn.1674-9081.2016.03.001
  • 1.

    中国医学科学院 北京协和医学院 北京协和医院妇产科, 北京 100730

  • 2.

    北京中医药大学东直门医院东区妇产科, 北京 101100

  • 3.

    滨州医学院护理学院, 山东滨州 256603

详细信息
    通讯作者:

    陈蓉  电话:010-69155012, E-mail:chenrongpumch@163.com

  • 中图分类号: R711.5

Changes of Hormone Levels and Ovary Size in Ovarian Aging

  • 1.

    Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

  • 2.

    Department of Obstetrics and Gynecology, East Part of Dongzhimen Hospital, Beijing University of Chinese Traditional Medicine, Beijing 101100, China

  • 3.

    School of Nursing, Binzhou Medical College, Binzhou, Shandong 256603, China

More Information

    摘要
  • 摘要:   目的  了解北京某社区女性在卵巢衰老过程中血清性激素水平和卵巢大小的变化。  方法  对北京市某社区418名年龄30~68岁、符合STRAW+10分期系统的健康女性, 前瞻性随访观察5年。记录月经日记, 检测雌二醇和促卵泡激素水平, 同时进行盆腔超声检查以测量卵巢大小。  结果  按照STRAW+10分期系统, 基线时雌二醇水平在绝经后期早期明显下降, 绝经后期晚期进一步下降; 促卵泡激素水平在绝经过渡期晚期开始显著增加, 绝经后稳定在高水平。卵巢长径、短径和面积在绝经后均明显缩小。经过5年随访, 即使分期没有改变, 性激素水平和卵巢大小仍有一定的变化规律; 分期进展的患者中, 绝经过渡期早期或绝经过渡期晚期向绝经后期早期转换时雌二醇、促卵泡激素、卵巢长径、卵巢短径和卵巢面积差异有统计学意义(P均 < 0.01)。不论基线还是5年后随访时, 卵巢功能性无回声(直径≥ 1.4 cm且 < 2.5 cm)均是在绝经过渡期晚期发生率最高, 分别为6.5%和12.1%。  结论  从绝经过渡期向绝经后期早期转换时雌二醇明显降低, 促卵泡激素明显升高; 卵巢萎缩明显。虽然增龄有一定影响, 但生殖衰老对性激素水平和卵巢大小的影响更显著。STRAW+10分期系统适用于北京女性。
    Abstract:   Objective  To investigate the changes of serum sex hormone levels and ovary size in ovarian aging in women living in a Beijing community.  Methods  A total of 418 healthy women aged 30 to 68 years who could be staged by STRAW+10 staging system were recruited from a Beijing community and prospectively followed-up for 5 years. Menstrual diary was recorded by every woman during the research. Serum estradiol(E2) and follicle stimulating hormone (FSH) levels were tested at baseline and 5 years later. Pelvic ultrasonography was performed for measurement of ovary size.  Results  According to STRAW+10 stage, E2 began to decrease in early postmenopausal stage, which further decreased in late postmenopausal stage. FSH increased significantly from the beginning of late menopausal transition stage, remaining at a high level after menopause. The length, width, and area of the ovary all reduced after menopause. Hormone levels and ovary size changed with some rules in the 5-year follow-up even when the STRAW+10 stage did not change. In women with staging progressed after 5 years of follow-up, E2 and FSH levels, and length, width, and area of the ovary were significantly different (all P < 0.01) when progressing from early or late menopausal transition stage to early postmenopausal stage. Ovarian no-echo cyst (diameter ≥ 1.4 cm and < 2.5 cm) was the most common in late menopausal transition stage both at baseline and after 5 years, with an incidence of 6.5% and 12.1%, respectively.  Conclusions  When the STRAW+10 stage changes from menopausal transition to early postmenopausal stage, E2 decreases and FSH increases significantly with obvious ovarian atrophy. Reproductive aging has more influence on hormone levels and ovary size than aging does. STRAW+10 staging system could be applied for women in Beijing.
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  • 表  1  北京市某社区女性基线时不同年龄段STRAW+10分期

    年龄段 -4/-3期 -2期 -1期 +1期 +2期 合计
    30~34岁 4 1 0 0 0 5
    35~39岁 24 7 1 0 0 32
    40~44岁 30 31 2 0 0 63
    45~49岁 37 46 13 9 0 105
    50~54岁 3 11 29 71 6 120
    55~59岁 0 1 1 26 22 50
    ≥60岁 0 0 0 3 40 43
    合计 98 97 46 109 68 418
    STRAW:生殖衰老分期系统
    下载: 导出CSV

    表  2  各STRAW+10分期女性直径≥1.4 cm卵巢无回声在基线和随访时的分布情况(n/N, %)

    STRAW+10分期 基线无回声 随访无回声
    -4/-3期 6/98, 6.1% 3/16, 18.8%
    -2期 11/97, 11.3% 9/63, 14.3%
    -1期 8/46, 17.4% 11/57, 19.2%
    +1期 3/109, 2.8% 5/167, 3.0%
    总计 28/350, 8.0% 28/303, 9.2%
    STRAW:同表 1；%为直径≥1.4 cm卵巢无回声人数(n)占各期别总人数(N)的百分比
    下载: 导出CSV

    表  3  北京市某社区女性基线时各期血清性激素和卵巢大小(x±s)

    分组 分期 例数 年龄(岁) E2(pg/ml) FSH(U/L) 卵巢长径(cm) 卵巢短径(cm) 卵巢面积(cm2)
    总体 -4/-3 98 41.89±6.09 65.37±53.53 10.55±8.57 2.61±0.42 1.70±0.28 3.53±1.10
    -2 97 45.31±3.97 69.92±54.99 14.61±12.34 2.49±0.36 1.66±0.28 3.40±1.07
    -1 46 50.09±3.04 80.54±87.92 36.61±26.21 2.30±0.43 1.50±0.31 3.01±1.46
    +1 109 52.94±2.96 36.53±53.60 60.89±29.29 1.93±0.48 1.19±0.25 1.93±0.83
    +2 68 60.41±4.57 14.97±7.00 69.14±26.92 1.82±0.50 1.14±0.29 1.73±0.81
    P ＜0.001 ＜0.001 ＜0.001 ＜0.001 ＜0.001
    A组 -4/-3 6 41.83±4.58 143.89±153.98 7.45±2.47 3.06±0.64 2.13±0.23 5.17±1.09
    -2 11 45.36±4.22 159.02±149.74 19.08±10.92 2.80±0.35 1.91±0.33 4.74±1.38
    -1 8 50.43±2.37 113.95±95.74 19.50±13.46 2.78±0.31 1.83±0.28 4.80±2.09
    +1 3 50.94±2.82 116.69±114.90 54.65±43.68 2.50±0.30 1.45±0.25 2.59±0.83
    P 0.132 0.001 0.173 0.052 0.047
    B组 -4/-3 92 42.45±4.61 60.07±36.19 10.76±8.79 2.57±0.39 1.67±0.26 3.41±1.02
    -2 86 45.31±3.96 71.30±55.14 14.05±12.05 2.46±0.35 1.64±0.25 3.36±1.07
    -1 38 50.03±3.16 74.55±91.55 39.67±26.86 2.19±0.39 1.43±0.29 2.61±0.90
    +1 106 53.04±2.92 33.29±47.76 61.13±29.48 1.92±0.48 1.19±0.25 1.89±0.82
    +2 68 60.41±4.57 14.97± 7.00 69.14±26.92 1.82±0.50 1.14±0.29 1.73±0.81
    P ＜0.001 ＜0.001 ＜0.001 ＜0.001 ＜0.001
    A组：卵巢无回声直径≥1.4 cm者；B组：除A组外的其余研究对象；E2：雌二醇；FSH：促卵泡激素
    下载: 导出CSV

    表  4  北京市某社区女性基线和5年后随访时STRAW+10分期情况

    基线时STRAW+10分期 5年后随访STRAW+10分期
    -4/-3 -2 -1 +1 +2 合计
    -4/-3 16 42 25 15 0 98
    -2 0 21 32 44 0 97
    -1 0 0 0 46 0 46
    +1 0 0 0 62 47 109
    +2 0 0 0 0 68 68
    合计 16 63 57 167 115 418
    STRAW：同表 1
    下载: 导出CSV

    表  5  随访5年后分期未发生改变女性血清性激素水平和卵巢大小的变化情况(n=167, x±s)

    分期 例数 E2(pg/ml) FSH(U/L) 卵巢长径(cm) 卵巢短径(cm) 卵巢面积(cm2)
    -4/-3 16 基线 51.26±20.26 7.96±1.59 2.94±0.55 1.89±0.30 4.27±1.55
    随访 72.14±61.76** 11.94±8.81** 2.71±0.40 2.09±0.36 4.64±1.41
    差值 18.20±40.98 3.00±7.99 -0.23±0.18 0.11±0.30 0.41±1.27
    -2 21 基线 55.57±30.56 8.62±5.43 2.62±0.28 1.71±0.16 3.54±0.61
    随访 83.84±43.62** 12.46±13.10** 2.53±0.32 1.91±0.25 3.91±0.97
    差值 27.92±13.12 3.84±7.52 -0.10±7.52 0.20±0.09 0.38±0.41
    +1 62 基线 44.78±59.70 56.94±34.10 2.10±0.49 1.25±0.26 2.16±0.87
    随访 8.49±7.87** 65.19±22.59 1.66±0.19** 1.16±0.16* 1.61±0.30**
    差值 -36.29±57.72 7.52±24.24 -0.48±5.55 -0.16±0.31 -0.70±0.90
    +2 68 基线 14.75±7.19 69.32±26.76 1.82±0.49 1.14±0.29 1.73±0.81
    随访 6.02±7.23** 68.43±23.17 1.69±0.43 1.22±0.32 1.63±0.67
    差值 -8.79±7.34 -0.84±13.38 -0.14±0.13 -0.03±0.13 -0.07±0.46
    与基线数据比较，* P＜0.05，* * P＜0.01；各项指标差值为随访检查结果减去基线检查结果的数值；E2、FSH：同表 3
    下载: 导出CSV

    表  6  随访5年后分期发生改变女性血清性激素水平和卵巢大小的变化情况(n=251, x±s)

    分期转变 例数 E2(pg/ml) FSH(U/L) 卵巢长径(cm) 卵巢短径(cm) 卵巢面积(cm2)
    -4/-3到-2 42 基线 65.76±44.90 8.57±4.44 2.57±0.36 1.68±0.19 3.51±0.83
    随访 94.39±96.13** 17.16±21.02** 2.55±0.27 1.93±0.23 3.92±1.01
    差值 28.63±113.63 8.57±15.89 -0.07±0.35 0.24±0.26 0.36±1.22
    -4/-3到-1 25 基线 75.15±80.84 9.37±6.99 2.57±0.33 1.68±0.32 3.44±0.91
    随访 63.20±70.35 24.61±19.79** 2.49±0.38 1.86±0.31 3.73±1.68*
    差值 -11.95±109.59 15.24±19.05 -0.11±0.47 0.22±0.39 0.52±1.51
    -4/-3到+1 15 基线 72.89±70.18 27.60±19.82 2.23±0.52 1.49±0.41 2.70±1.39
    随访 38.09±32.18** 66.56±20.87** 1.85±0.20* 1.30±0.18 2.27±1.44
    差值 -34.79±106.93 38.96±30.30 -0.24±0.39 -0.18±0.35 -0.46±1.70
    -2到-1 32 基线 82.33±66.35 11.05±8.20 2.50±0.39 1.72±0.29 3.44±1.10
    随访 58.70±108.59** 30.74±27.13** 2.48±0.43 1.90±0.45 3.73±1.68
    差值 -23.63±129.83 19.69±23.71 -0.08±0.48 0.15±0.45 0.20±1.55
    -2到+1 44 基线 68.68±54.34 19.18±14.10 2.40±0.37 1.58±0.31 3.30±1.24
    随访 16.08±32.26** 75.02±30.25** 1.92±0.27** 1.35±0.22** 2.23±1.15**
    差值 -52.52±64.94 54.42±32.18 -0.49±0.31 -0.25±0.32 -1.04±1.31
    -1到+1 46 基线 80.54±87.91 36.61±26.21 2.30±0.43 1.50±0.31 3.01±1.45
    随访 12.47±18.21** 63.27±21.30** 1.79±0.11** 1.27±0.13** 1.85±0.30**
    差值 -68.08±84.89 26.67±29.75 -0.57±0.35 -0.26±0.21 -1.18±1.34
    +1到+2 47 基线 21.01±23.39 66.83±25.40 1.70±0.37 1.10±0.23 1.58±0.67
    随访 7.60±6.33** 62.66±21.12 1.79±0.17 1.25±0.09 1.64±0.32
    差值 -13.15±25.21 -4.12±18.22 0.32±0.18 0.38±0.04 0.10±0.66
    与基线数据比较，*P＜0.05，* *P＜0.01；各项指标差值为随访检查结果减去基线检查结果的数值；E2、FSH：同表 3
    下载: 导出CSV
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