【作者】 李莉；

【导师】 张宁；

【作者基本信息】 山东中医药大学 ， 中医妇科学（专业学位）， 2022， 硕士

【摘要】 目的:分析多囊卵巢综合征合并自身免疫性甲状腺疾病患者的相关影响因素、甲状腺功能、女性生殖内分泌、血清25（OH）D特征及中医证型的分布特征,研究分析两种疾病间的潜在关联,以期为合并自身免疫性甲状腺疾病PCOS患者的早期预防、西医治疗和中医辨证论治提供理论依据。方法:将2020年12月至2022年1月就诊于山东中医药大学附属医院（西院区）生殖与遗传中心的PCOS患者作为研究对象,根据TPO-Ab、TG-Ab水平分为合并有自身免疫性甲状腺疾病组（研究组）和不合并自身免疫性甲状腺疾病组（对照组）。通过调查问卷收集患者的基本临床信息,面对面进行中医辨证,并于早卵泡期或闭经期空腹抽取患者静脉血以测定25羟基维生素D（25（OH）D）,卵泡刺激素（FSH）、黄体生成素（LH）、雌二醇（E₂）、睾酮（T）、催乳素（PRL）等内分泌指标,促甲状腺激素（TSH）、游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）、抗甲状腺过氧化物酶抗体（TPO-Ab）、抗甲状腺球蛋白抗体（TG-Ab）等甲状腺功能指标,空腹血糖（FPG）、空腹胰岛素（FFINS）、甘油三酯（TG）、总胆固醇（TC）、低密度脂蛋白（LDL-C）、高密度脂蛋白（HDL-C）等糖脂代谢指标。结果:1.本研究共纳入研究对象132例,年龄范围为20-41岁,平均年龄为29.23±4.20岁。研究组62例（46.97%）,年龄20-38岁（29.47±4.14岁）,对照组70例（53.03%）,年龄21-41岁（29.03±4.28岁）。两组患者年龄无统计学差异（P>0.05）。2.单因素相关分析表明,受教育水平、饮食偏好、情志状态、工作压力、睡眠质量、日晒频率及PCOS病程均与PCOS患者合并AITD有关（P<0.05）。3.研究组与对照组在FSH、LH、LH/FSH、E₂、T、PRL、25（OH）D、FPG、FFINS、LDL-C、HDL-C、TG、TC、TSH水平方面无统计学差异（P>0.05）;病例组FT3、FT4水平高于对照组,差异具有统计学差异（P<0.01）。研究组中甲亢患者1例（1.61%）,甲减患者11例（17.74%）,甲状腺功能正常患者50例（80.65%）。此外,相较于对照组,研究组患者25（OH）D缺乏程度更重（P<0.01）。4.多因素Logistic回归分析表明,焦虑可能是PCOS合并AITD的危险因素（OR=7.77,P<0.01）,睡眠质量好可能是PCOS合并AITD的保护因素（OR=0.44,P<0.05）。5.研究组和对照组中医证型分布比较具有统计学差异（P<0.05）。研究组PCOS患者的中医证型以痰瘀互结型、痰湿型为主,其次为肾虚型、肾虚肝郁型等,对照组PCOS患者中医证型以肾虚肝郁型和肾虚型主,其次为肝经湿热型、肾虚痰湿型等。两组PCOS患者中医证型分别比较,研究组与对照组在痰瘀互结型及痰湿型的比较上具有统计学差异（P<0.05）,其余证型之间无统计学差异（P>0.05）。结论:1.较高的受教育水平、饮食偏好海产品、焦虑等负面情志状态、工作压力大、睡眠质量差、日晒频率低为PCOS合并AITD的影响因素,PCOS病程长的患者由于机体内分泌、代谢、免疫调节等严重紊乱,更易合并AITD。2.维生素D缺乏程度与PCOS患者易合并AITD密切相关,维生素D参与了机体的免疫调节过程,在PCOS合并AITD的发生发展中起着重要作用。3.中医证型分布提示,PCOS患者易合并AITD与痰湿、瘀血等病理产物有关,其可能的病机为痰瘀互结日久继而发展成癥瘕、瘿瘤等。更多还原

【Abstract】 Object:To analyze the related influencing factors,thyroid function,female reproductive endocrine,serum 25（OH）D characteristics and distribution characteristics of TCM syndromes in patients with polycystic ovary syndrome complicated with autoimmune thyroid disease,and to analyze the potential relationship between the two diseases,which aims to provide a theoretical basis for the early prevention,western medicine treatment and TCM syndrome differentiation and treatment of PCOS patients with autoimmune thyroid disease.Methods:PCOS patients who were treated at the Reproductive and Genetics Center of Shandong University of Traditional Chinese Medicine Hospital（West Campus）from December 2020 to January 2022 were selected as the research subjects.According to the levels of TPO-Ab and TG-Ab,they were divided into patients with autoimmune thyroid Disease group（study group）and group without autoimmune thyroid disease（control group）.The basic clinical information of the patients was collected through questionnaires,and TCM dialectics were conducted face-to-face,and venous blood was drawn from the patients on an empty stomach during the early follicular phase or amenorrhea to determine 25-hydroxyvitamin D（25（OH）D）,follicle-stimulating hormone（FSH）,Luteinizing hormone（LH）,Estradiol（E₂）,Testosterone（T）,Prolactin（PRL）and other endocrine indexes,Thyroid Stimulating Hormone（TSH）,Free Triiodothyronine（FT3）,Free Thyroxine（FT4）,anti-thyroid peroxidase antibody（TPO-Ab）,anti-thyroglobulin antibody（TG-Ab）and other thyroid function indicators,fasting plasma glucose（FPG）,fasting insulin（FINS）,triglyceride（TG）,total Cholesterol（TC）,low-density lipoprotein（LDL-C）,high-density lipoprotein（HDL-C）and other glucose and lipid metabolism indicators.Results:1.A total of 132 subjects were included in this study,ranging in age from20 to 41 years old,with an average age of 29.23±4.20 years.There were62 patients（46.97%）in the study group,aged 20-38 years（29.47±4.14years）,and 70 patients（53.03%）in the control group,aged 21-41 years（29.03±4.28 years）.There was no significant difference in age between the two groups（P>0.05）.2.Univariate correlation analysis showed that education level,dietary preference,emotional state,work stress,sleep quality,frequency of sun exposure and course of PCOS were associated with AITD in PCOS patients（P<0.05）.3.There was no statistical difference between the study group and the control group in the levels of FSH,LH,LH/FSH,E₂,T,PRL,25（OH）D,FPG,FINS,LDL-C,HDL-C,TG,TC,and TSH（P>0.05）.The levels of FT3 and FT4 in the case group were higher than those in the control group,and the difference was statistically significant（P<0.01）.In the study group,there were 1 patient（1.61%）with hyperthyroidism,11 patients with hypothyroidism（17.74%）,and 50 patients with normal thyroid function（80.65%）.In addition,compared with the control group,the degree of25（OH）D deficiency in the study group was more severe（P<0.01）.4.Multivariate Logistic regression analysis showed that anxiety may be a risk factor for PCOS combined with AITD（OR=7.77,P<0.01）,and good sleep quality may be a protective factor for PCOS combined with AITD（OR=0.44,P<0.05）.5.There was a statistically significant difference in the distribution of TCM syndrome types between the study group and the control group（P<0.05）.The TCM syndrome types of patients with PCOS in the study group were mainly phlegm and blood stasis type and phlegm-dampness type,followed by kidney deficiency type,kidney deficiency and liver depression type and so on.In the control group,the main TCM syndrome types of PCOS patients were kidney deficiency and liver depression type and kidney deficiency type,followed by liver meridian damp-heat type,kidney deficiency phlegm dampness type and so on.There was significant difference between the study group and the control group in the type of phlegm and blood stasis and the type of phlegm-dampness in the comparison of TCM syndrome types of PCOS patients between the two groups（P<0.05）,and there was no statistical difference among other syndrome types（P>0.05）.Conclusion:1.Higher education level,dietary preference for seafood,other negative emotional states like anxiety,high work pressure,poor sleep quality,and low frequency of sun exposure are the influencing factors of PCOS combined with AITD.Patients with long course of PCOS are more likely to be combined with AITD due to serious disorders of the body’s endocrine,metabolism,and immune regulation.2.The degree of vitamin D deficiency is closely related to the susceptibility to AITD in PCOS patients.Vitamin D participates in the immune regulation process of the body and plays an important role in the occurrence and development of PCOS combined with AITD.3.The distribution of TCM syndrome types suggests that patients with PCOS complicated with autoimmune thyroid disease is likely to be associated with pathological products such as phlegm-dampness and blood stasis.Its possible pathogenesis is that the phlegm and blood stasis will form together for a long time and then develop into lump,a thyroid tumor and so on.更多还原