背景:现有证据提示心血管功能障碍与卵巢储备功能下降有关。虽然已知先前存在的心血管功能障碍也与怀孕期间先兆子痫(PE)的发展有关,我们假设,在有妊娠期高血压疾病(HDP)病史的女性中,卵巢储备功能减退的征象可能更常见.因此,我们研究的目的是分析是否有HDP病史的女性表现出卵巢储备减少的迹象,以较低的抗Mullarian激素(AMH)水平为代表,与对照组相比。对于这项回顾性观察性病例对照研究,患者包括有HDP病史的女性,而对照组由具有无并发症妊娠史的女性组成。该研究是在三级转诊中心进行的,所有女性都接受了一次性心血管和代谢评估。评估卵巢储备和心血管功能标志物,使用线性回归分析调整年龄和体重指数(BMI)。
结果:在3年的时间跨度内纳入了163例患者和81例对照。与对照组相比,在患者组中没有观察到卵巢储备减少的迹象,即较低的AMH水平。亚组分析甚至显示,与对照组相比,晚发性HDP的AMH水平更高(2.8vs.2.0µg/L,p=0.025)。不出所料,与对照组相比,患者组的心血管功能指标明显较差;收缩压(BP)水平较高(5%),舒张压血压(4%),甘油三酯(29%),葡萄糖(4%)和胰岛素水平(81%)(所有p<0.05),而高密度脂质(HDL)胆固醇低12%(NS)。
结论:尽管心血管风险状况不利,本研究未证实以下假设:与健康的对照组相比,患有HDP的女性表现出加速的卵巢老化.虽然HDP患者应该被警告他们的心血管健康,他们不应该担心不利的卵巢储备状态。
BACKGROUND: Existing evidence suggests a relation between cardiovascular dysfunction and diminished ovarian reserve. While it is known that pre-existent cardiovascular dysfunction is also associated with the development of preeclampsia (PE) during pregnancy, we hypothesize that signs of diminished ovarian reserve may occur more frequently among women with a history of hypertensive disorders of pregnancy (HDP). The aim of our study was therefore to analyse if women with a history of HDP show signs of diminished ovarian reserve, represented by lower anti-Mullarian hormone (AMH) levels, compared to controls. For this retrospective observational
case control study, patients included women with a history of HDP, whereas controls constituted of women with a history of an uncomplicated pregnancy. The study was conducted in a tertiary referral centre in which all women underwent a one-time cardiovascular and metabolic assessment. Ovarian reserve and markers of cardiovascular function were evaluated, adjusted for age and body mass index (BMI) using linear regression analyses.
RESULTS: 163 patients and 81 controls were included over a time span of 3 years. No signs of diminished ovarian reserve i.e. lower AMH level were observed in the patient group versus controls. A subgroup analysis even showed higher AMH levels in late onset HDP as compared to controls (2.8 vs. 2.0 µg/L, p = 0.025). As expected, cardiovascular function markers were significantly less favourable in the patient group compared to controls; higher levels of systolic blood pressure (BP) (5%), diastolic BP (4%), triglycerides (29%), glucose (4%) and insulin levels (81%) (all p < 0.05), whereas high density lipid (HDL) cholesterol was 12% lower (NS).
CONCLUSIONS: Despite unfavourable cardiovascular risk profile, the present study does not substantiate the hypothesis that women with HDP show accelerated ovarian ageing as compared to healthy parous controls. Although HDP patients should be warned about their cardiovascular health, they shouldn\'t be concerned about unfavourable ovarian reserve status.