早发性卵巢功能不全患者常见的自身免疫性疾病

Common Autoimmune Disease in Patients with Premature Ovarian Insufficiency

摘要: 早发性卵巢功能不全(POI)是指女性在40岁以前出现卵巢功能减退，主要表现为：月经异常、卵泡刺激素水平升高(>25 IU/L)、雌激素水平波动性下降。临床症状是由雌激素缺乏引起的，表现为月经频发或稀发、经量减少、闭经、潮热出汗、生殖道干涩灼热感、性欲减退、骨质疏松、情绪和认知功能改变、心血管症状，不孕、不育等。40岁前发生POI的风险为1%~5%。大多数POI的原因仍不明确。然而，据估计约4%~30%的病例是自身免疫起源。由于卵巢是自身免疫攻击的常见靶点，应始终考虑POI的自身免疫病因，特别是在存在抗卵母细胞抗体(AOAs)、自身免疫性疾病或活检中淋巴细胞性卵巢炎的情况下。POI可单独发生，但通常与其他自身免疫性疾病有关。合并甲状腺疾病如甲状腺功能减退、桥本甲状腺炎是最常见的。肾上腺自身免疫性疾病是与POI相关的第二大常见疾病。在患有糖尿病的女性中，POI的发病率约为2.5%。此外，自身免疫性相关的POI也可作为自身免疫性多腺综合征(APS)的一部分出现，这是一种自身免疫性活动导致特定内分泌器官损伤的情况。在其最常见的表现(3型)中，APS与Hashomoto型甲状腺抗体相关，其患病率为10%~40%。21 Addison氏病(AD)中的抗体可与APS-2相关。

Abstract: Premature ovarian insufficiency (POI) refers to the loss of ovarian dysfunction before the age of 40 among women, mainly manifested as abnormal menstruation, increased follicular hormone levels (>25 IU/L), and decreased fluctuation of estrogen levels. Clinical symptoms are caused by estrogen deficiency, manifested as frequent or sparse menstruation, reduced menstrual volume, amenorrhea, hot flashes, sweating, dryness and burning in the reproductive tract, decreased libido, osteoporosis, emotional and cognitive function changes, cardiovascular symptoms, infertility, infertility, etc. The risk of a POI before age 40 is 1%~5%. The reasons for most POI remain unclear. However, it is estimated that about 4%~30% of the cases are of autoimmune origin. As the ovary is a common target of autoimmune attack, the autoimmune etiology of POI should always be considered, especially in the presence of anti-oocyte antibodies (AOAs), autoimmune diseases, or lymphocytic ovariitis in biopsy. POI may occur alone, but is often associated with other autoimmune diseases. Combined thyroid diseases such as hypothyroidism and Hashimoto’s thyroiditis are the most common. Adrenal autoimmune disease is the second most common disease associated with POI. In women with diabetes, the incidence of POI is about 2.5%. In addition, autoimmune-related POI can also occur as part of the autoimmune polyglandular syndrome (APS), a condition in which autoimmune activity leads to damage to specific endocrine organs. In its most common presentation (type 3), APS is associated with type Hashomoto thyroid antibodies, with a prevalence of 10%~40%. 21 Antibodies in Addison’s disease (AD) can be associated with APS-2.