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Особенности овариального резерва женщин репродуктивного возраста, страдающих аутоиммунными заболеваниями
Особенности овариального резерва женщин репродуктивного возраста, страдающих аутоиммунными заболеваниями
Андреева Е.Н., Григорян О.Р., Абсатарова Ю.С. и др. Особенности овариального резерва женщин репродуктивного возраста, страдающих аутоиммунными заболеваниями. Гинекология. 2020; 22 (5): 27–30. DOI:10.26442/20795696.2020.5.200416
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Аннотация
Репродуктивный потенциал женщины зависит от показателей овариального резерва, таких как антимюллеров гормон (АМГ) и количество антральных фолликулов (КАФ). Аутоиммунные заболевания оказывают значимое влияние на фертильность и способствуют развитию преждевременной недостаточности яичников.
Цель. Оценить показатели овариального резерва у пациенток с сахарным диабетом 1-го типа, носительниц антител к щитовидной железе в состоянии эутиреоза и сравнить их с аналогичными параметрами у здоровых женщин.
Материалы и методы. В I блоке исследования провели изучение уровня АМГ, фолликулостимулирующего гормона, лютеинизирующего гормона, КАФ среди
224 женщин с сахарным диабетом и 230 здоровых женщин группы контроля. Во II блоке исследован уровень вышеуказанных гормональных показателей у 35 носительниц антитиреоидных антител в состоянии эутиреоза и 35 здоровых женщин.
Результаты. У больных сахарным диабетом 1-го типа уровень АМГ, КАФ оказался статистически значимо меньше при сравнении с группой контроля. Среди носительниц антитиреоидных антител и здоровых женщин разницы в показателях АМГ и КАФ не обнаружили.
Заключение. На показатели овариального резерва в большей мере влияют аутоиммунные процессы, сопровождающие сахарный диабет, чем аутоиммуноагрессия к тканям щитовидной железы.
Ключевые слова: сахарный диабет 1-го типа, антитела к щитовидной железе, преждевременная недостаточность яичников, антимюллеров гормон, антральные фолликулы, овариальный резерв, аутоиммунные заболевания, аутоиммунный тиреоидит.
Aim. To evaluate the parameters of the ovarian reserve in patients with type 1 diabetes mellitus, carriers of antibodies to the thyroid gland in a state of euthyroidism and compare them with similar parameters in healthy women.
Materials and methods. In the first block of the study, the level of AMH, follicle-stimulating hormone, luteinizing hormone, NAF was studied among 224 women with diabetes and 230 healthy women in the control group. In block II, the level of the above hormonal indices was studied in 35 carriers of antithyroid antibodies in the state of euthyroidism and 35 healthy women.
Results. In patients with type 1 diabetes, the level of AMH, NAF was statistically significantly lower when compared with the control group. Among carriers of antithyroid antibodies and healthy women, no difference in AMH and NAF was found.
Conclusion. The autoimmune processes accompanying diabetes are more influenced by the ovarian reserve indices than autoimmune aggression to the tissues of the thyroid gland.
Key words: type 1 diabetes mellitus; thyroid antibodies, premature ovarian failure, anti-mullerian hormone, antral follicles, ovarian reserve, autoimmune diseases, autoimmune thyroiditis.
Цель. Оценить показатели овариального резерва у пациенток с сахарным диабетом 1-го типа, носительниц антител к щитовидной железе в состоянии эутиреоза и сравнить их с аналогичными параметрами у здоровых женщин.
Материалы и методы. В I блоке исследования провели изучение уровня АМГ, фолликулостимулирующего гормона, лютеинизирующего гормона, КАФ среди
224 женщин с сахарным диабетом и 230 здоровых женщин группы контроля. Во II блоке исследован уровень вышеуказанных гормональных показателей у 35 носительниц антитиреоидных антител в состоянии эутиреоза и 35 здоровых женщин.
Результаты. У больных сахарным диабетом 1-го типа уровень АМГ, КАФ оказался статистически значимо меньше при сравнении с группой контроля. Среди носительниц антитиреоидных антител и здоровых женщин разницы в показателях АМГ и КАФ не обнаружили.
Заключение. На показатели овариального резерва в большей мере влияют аутоиммунные процессы, сопровождающие сахарный диабет, чем аутоиммуноагрессия к тканям щитовидной железы.
Ключевые слова: сахарный диабет 1-го типа, антитела к щитовидной железе, преждевременная недостаточность яичников, антимюллеров гормон, антральные фолликулы, овариальный резерв, аутоиммунные заболевания, аутоиммунный тиреоидит.
________________________________________________
Aim. To evaluate the parameters of the ovarian reserve in patients with type 1 diabetes mellitus, carriers of antibodies to the thyroid gland in a state of euthyroidism and compare them with similar parameters in healthy women.
Materials and methods. In the first block of the study, the level of AMH, follicle-stimulating hormone, luteinizing hormone, NAF was studied among 224 women with diabetes and 230 healthy women in the control group. In block II, the level of the above hormonal indices was studied in 35 carriers of antithyroid antibodies in the state of euthyroidism and 35 healthy women.
Results. In patients with type 1 diabetes, the level of AMH, NAF was statistically significantly lower when compared with the control group. Among carriers of antithyroid antibodies and healthy women, no difference in AMH and NAF was found.
Conclusion. The autoimmune processes accompanying diabetes are more influenced by the ovarian reserve indices than autoimmune aggression to the tissues of the thyroid gland.
Key words: type 1 diabetes mellitus; thyroid antibodies, premature ovarian failure, anti-mullerian hormone, antral follicles, ovarian reserve, autoimmune diseases, autoimmune thyroiditis.
Полный текст
Список литературы
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2. Desai MK, Brinton RD. Autoimmune Disease in Women: Endocrine Transition and Risk Across the Lifespan. Front Endocrinol (Lausanne) 2019; 10: 265. DOI: 10.3389/fendo.2019.00265
3. Sjoberg L, Pitkaniemi J, Harjutsalo V et al. Menopause in women with type 1 diabetes. Menopause 2011; 18: 158–63. DOI: 10.1097/gme.0b013e3181ef3af0
4. Li L, Jing Y, Dong MZ et al. Type 1 diabetes affects zona pellucida and genome methylation in oocytes and granulosa cells. Mol Cell Endocrinol 2020; 500: 110627. DOI: 10.1016/j.mce.2019.110627
5. Krassas GE, Poppe K, Glinoer D. Thyroid function and human reproductive health. Endocr Rev 2010; 31 (5): 702–55. DOI: 10.1210/er.2009-0041
6. Kuroda K, Uchida T, Nagai S. Elevated serum thyroid-stimulating hormone is associated with decreased anti-Müllerian hormone in infertile women of reproductive age. J Assist Reprod Genet 2015; 32 (2): 243–7. DOI: 10.1007/s10815-014-0397-7
7. Practice Committee of the American Society for Reproductive Medicine. Subclinical hypothyroidism in the infertile female population: a guideline. Fertil Steril 2015; 104 (3): 545–53. DOI: 10.1016/j.fertnstert.2015.05.028
8. Kim C, Miller RS, Braffett BH et al. Ovarian markers and irregular menses among women with type 1 diabetes in the Epidemiology of Diabetes Interventions and Complications study. Clin Endocrinol (Oxf) 2018; 88 (3): 453–9. DOI: 10.1111/cen.13546
9. Nayki U, Onk D, Balci G et al. The Effects of Diabetes Mellitus on Ovarian Injury and Reserve: An Experimental Study. Gynecol Obstet Invest 2016; 81 (5): 424–9. DOI: 10.1159/000442287
10. Kadiroğulları P, Demir E, Bahat PY et al. Evaluation of relationship between HbA1c levels and ovarian reserve in patients with type 1 diabetes mellitus. Gynecol Endocrinol 2020; 36 (5): 426–30. DOI: 10.1080/09513590.2019.1708893
11. Kim C, Karvonen-Gutierrez C, Kong S et al. Antimüllerian hormone among women with and without type 1 diabetes: the Epidemiology of Diabetes Interventions and Complications Study and the Michigan Bone Health and Metabolism Study. Fertil Steril 2016; 106 (6): 1446–52. DOI: 10.1016/j.fertnstert.2016.07.009
12. Betterle C, Rossi A, Dalla Pria S et al. Premature ovarian failure: autoimmunity and natural history. Clin Endocrinol (Oxf) 1993; 39 (1): 35–43. DOI: 10.1111/j.1365-2265.1993.tb01748.x
13. Chen CW, Huang YL, Tzeng CR et al. Idiopathic Low Ovarian Reserve Is Associated with More Frequent Positive Thyroid Peroxidase Antibodies. Thyroid 2017; 27 (9): 1194–200. DOI: 10.1089/thy.2017.0139
14. Polyzos NP, Sakkas E, Vaiarelli A et al. Thyroid autoimmunity, hypothyroidism and ovarian reserve: a cross-sectional study of 5000 women based on age-specific AMH values. Hum Reprod 2015; 30 (7): 1690–6. DOI: 10.1093/humrep/dev089
15. Andrisani A, Sabbadin C, Marin L et al. The influence of thyroid autoimmunity on embryo quality in women undergoing assisted reproductive technology. Gynecol Endocrinol 2018; 34 (9): 752–5. DOI: 10.1080/09513590.2018.1442427
16. Monteleone P, Parrini D, Faviana P et al. Female infertility related to thyroid autoimmunity: the ovarian follicle hypothesis. Am J Reprod Immunol 2011; 66 (2): 108–14. DOI i: 10.1111/j.1600-0897.2010.00961.x
2. Desai MK, Brinton RD. Autoimmune Disease in Women: Endocrine Transition and Risk Across the Lifespan. Front Endocrinol (Lausanne) 2019; 10: 265. DOI: 10.3389/fendo.2019.00265
3. Sjoberg L, Pitkaniemi J, Harjutsalo V et al. Menopause in women with type 1 diabetes. Menopause 2011; 18: 158–63. DOI: 10.1097/gme.0b013e3181ef3af0
4. Li L, Jing Y, Dong MZ et al. Type 1 diabetes affects zona pellucida and genome methylation in oocytes and granulosa cells. Mol Cell Endocrinol 2020; 500: 110627. DOI: 10.1016/j.mce.2019.110627
5. Krassas GE, Poppe K, Glinoer D. Thyroid function and human reproductive health. Endocr Rev 2010; 31 (5): 702–55. DOI: 10.1210/er.2009-0041
6. Kuroda K, Uchida T, Nagai S. Elevated serum thyroid-stimulating hormone is associated with decreased anti-Müllerian hormone in infertile women of reproductive age. J Assist Reprod Genet 2015; 32 (2): 243–7. DOI: 10.1007/s10815-014-0397-7
7. Practice Committee of the American Society for Reproductive Medicine. Subclinical hypothyroidism in the infertile female population: a guideline. Fertil Steril 2015; 104 (3): 545–53. DOI: 10.1016/j.fertnstert.2015.05.028
8. Kim C, Miller RS, Braffett BH et al. Ovarian markers and irregular menses among women with type 1 diabetes in the Epidemiology of Diabetes Interventions and Complications study. Clin Endocrinol (Oxf) 2018; 88 (3): 453–9. DOI: 10.1111/cen.13546
9. Nayki U, Onk D, Balci G et al. The Effects of Diabetes Mellitus on Ovarian Injury and Reserve: An Experimental Study. Gynecol Obstet Invest 2016; 81 (5): 424–9. DOI: 10.1159/000442287
10. Kadiroğulları P, Demir E, Bahat PY et al. Evaluation of relationship between HbA1c levels and ovarian reserve in patients with type 1 diabetes mellitus. Gynecol Endocrinol 2020; 36 (5): 426–30. DOI: 10.1080/09513590.2019.1708893
11. Kim C, Karvonen-Gutierrez C, Kong S et al. Antimüllerian hormone among women with and without type 1 diabetes: the Epidemiology of Diabetes Interventions and Complications Study and the Michigan Bone Health and Metabolism Study. Fertil Steril 2016; 106 (6): 1446–52. DOI: 10.1016/j.fertnstert.2016.07.009
12. Betterle C, Rossi A, Dalla Pria S et al. Premature ovarian failure: autoimmunity and natural history. Clin Endocrinol (Oxf) 1993; 39 (1): 35–43. DOI: 10.1111/j.1365-2265.1993.tb01748.x
13. Chen CW, Huang YL, Tzeng CR et al. Idiopathic Low Ovarian Reserve Is Associated with More Frequent Positive Thyroid Peroxidase Antibodies. Thyroid 2017; 27 (9): 1194–200. DOI: 10.1089/thy.2017.0139
14. Polyzos NP, Sakkas E, Vaiarelli A et al. Thyroid autoimmunity, hypothyroidism and ovarian reserve: a cross-sectional study of 5000 women based on age-specific AMH values. Hum Reprod 2015; 30 (7): 1690–6. DOI: 10.1093/humrep/dev089
15. Andrisani A, Sabbadin C, Marin L et al. The influence of thyroid autoimmunity on embryo quality in women undergoing assisted reproductive technology. Gynecol Endocrinol 2018; 34 (9): 752–5. DOI: 10.1080/09513590.2018.1442427
16. Monteleone P, Parrini D, Faviana P et al. Female infertility related to thyroid autoimmunity: the ovarian follicle hypothesis. Am J Reprod Immunol 2011; 66 (2): 108–14. DOI i: 10.1111/j.1600-0897.2010.00961.x
2. Desai MK, Brinton RD. Autoimmune Disease in Women: Endocrine Transition and Risk Across the Lifespan. Front Endocrinol (Lausanne) 2019; 10: 265. DOI: 10.3389/fendo.2019.00265
3. Sjoberg L, Pitkaniemi J, Harjutsalo V et al. Menopause in women with type 1 diabetes. Menopause 2011; 18: 158–63. DOI: 10.1097/gme.0b013e3181ef3af0
4. Li L, Jing Y, Dong MZ et al. Type 1 diabetes affects zona pellucida and genome methylation in oocytes and granulosa cells. Mol Cell Endocrinol 2020; 500: 110627. DOI: 10.1016/j.mce.2019.110627
5. Krassas GE, Poppe K, Glinoer D. Thyroid function and human reproductive health. Endocr Rev 2010; 31 (5): 702–55. DOI: 10.1210/er.2009-0041
6. Kuroda K, Uchida T, Nagai S. Elevated serum thyroid-stimulating hormone is associated with decreased anti-Müllerian hormone in infertile women of reproductive age. J Assist Reprod Genet 2015; 32 (2): 243–7. DOI: 10.1007/s10815-014-0397-7
7. Practice Committee of the American Society for Reproductive Medicine. Subclinical hypothyroidism in the infertile female population: a guideline. Fertil Steril 2015; 104 (3): 545–53. DOI: 10.1016/j.fertnstert.2015.05.028
8. Kim C, Miller RS, Braffett BH et al. Ovarian markers and irregular menses among women with type 1 diabetes in the Epidemiology of Diabetes Interventions and Complications study. Clin Endocrinol (Oxf) 2018; 88 (3): 453–9. DOI: 10.1111/cen.13546
9. Nayki U, Onk D, Balci G et al. The Effects of Diabetes Mellitus on Ovarian Injury and Reserve: An Experimental Study. Gynecol Obstet Invest 2016; 81 (5): 424–9. DOI: 10.1159/000442287
10. Kadiroğulları P, Demir E, Bahat PY et al. Evaluation of relationship between HbA1c levels and ovarian reserve in patients with type 1 diabetes mellitus. Gynecol Endocrinol 2020; 36 (5): 426–30. DOI: 10.1080/09513590.2019.1708893
11. Kim C, Karvonen-Gutierrez C, Kong S et al. Antimüllerian hormone among women with and without type 1 diabetes: the Epidemiology of Diabetes Interventions and Complications Study and the Michigan Bone Health and Metabolism Study. Fertil Steril 2016; 106 (6): 1446–52. DOI: 10.1016/j.fertnstert.2016.07.009
12. Betterle C, Rossi A, Dalla Pria S et al. Premature ovarian failure: autoimmunity and natural history. Clin Endocrinol (Oxf) 1993; 39 (1): 35–43. DOI: 10.1111/j.1365-2265.1993.tb01748.x
13. Chen CW, Huang YL, Tzeng CR et al. Idiopathic Low Ovarian Reserve Is Associated with More Frequent Positive Thyroid Peroxidase Antibodies. Thyroid 2017; 27 (9): 1194–200. DOI: 10.1089/thy.2017.0139
14. Polyzos NP, Sakkas E, Vaiarelli A et al. Thyroid autoimmunity, hypothyroidism and ovarian reserve: a cross-sectional study of 5000 women based on age-specific AMH values. Hum Reprod 2015; 30 (7): 1690–6. DOI: 10.1093/humrep/dev089
15. Andrisani A, Sabbadin C, Marin L et al. The influence of thyroid autoimmunity on embryo quality in women undergoing assisted reproductive technology. Gynecol Endocrinol 2018; 34 (9): 752–5. DOI: 10.1080/09513590.2018.1442427
16. Monteleone P, Parrini D, Faviana P et al. Female infertility related to thyroid autoimmunity: the ovarian follicle hypothesis. Am J Reprod Immunol 2011; 66 (2): 108–14. DOI i: 10.1111/j.1600-0897.2010.00961.x
________________________________________________
2. Desai MK, Brinton RD. Autoimmune Disease in Women: Endocrine Transition and Risk Across the Lifespan. Front Endocrinol (Lausanne) 2019; 10: 265. DOI: 10.3389/fendo.2019.00265
3. Sjoberg L, Pitkaniemi J, Harjutsalo V et al. Menopause in women with type 1 diabetes. Menopause 2011; 18: 158–63. DOI: 10.1097/gme.0b013e3181ef3af0
4. Li L, Jing Y, Dong MZ et al. Type 1 diabetes affects zona pellucida and genome methylation in oocytes and granulosa cells. Mol Cell Endocrinol 2020; 500: 110627. DOI: 10.1016/j.mce.2019.110627
5. Krassas GE, Poppe K, Glinoer D. Thyroid function and human reproductive health. Endocr Rev 2010; 31 (5): 702–55. DOI: 10.1210/er.2009-0041
6. Kuroda K, Uchida T, Nagai S. Elevated serum thyroid-stimulating hormone is associated with decreased anti-Müllerian hormone in infertile women of reproductive age. J Assist Reprod Genet 2015; 32 (2): 243–7. DOI: 10.1007/s10815-014-0397-7
7. Practice Committee of the American Society for Reproductive Medicine. Subclinical hypothyroidism in the infertile female population: a guideline. Fertil Steril 2015; 104 (3): 545–53. DOI: 10.1016/j.fertnstert.2015.05.028
8. Kim C, Miller RS, Braffett BH et al. Ovarian markers and irregular menses among women with type 1 diabetes in the Epidemiology of Diabetes Interventions and Complications study. Clin Endocrinol (Oxf) 2018; 88 (3): 453–9. DOI: 10.1111/cen.13546
9. Nayki U, Onk D, Balci G et al. The Effects of Diabetes Mellitus on Ovarian Injury and Reserve: An Experimental Study. Gynecol Obstet Invest 2016; 81 (5): 424–9. DOI: 10.1159/000442287
10. Kadiroğulları P, Demir E, Bahat PY et al. Evaluation of relationship between HbA1c levels and ovarian reserve in patients with type 1 diabetes mellitus. Gynecol Endocrinol 2020; 36 (5): 426–30. DOI: 10.1080/09513590.2019.1708893
11. Kim C, Karvonen-Gutierrez C, Kong S et al. Antimüllerian hormone among women with and without type 1 diabetes: the Epidemiology of Diabetes Interventions and Complications Study and the Michigan Bone Health and Metabolism Study. Fertil Steril 2016; 106 (6): 1446–52. DOI: 10.1016/j.fertnstert.2016.07.009
12. Betterle C, Rossi A, Dalla Pria S et al. Premature ovarian failure: autoimmunity and natural history. Clin Endocrinol (Oxf) 1993; 39 (1): 35–43. DOI: 10.1111/j.1365-2265.1993.tb01748.x
13. Chen CW, Huang YL, Tzeng CR et al. Idiopathic Low Ovarian Reserve Is Associated with More Frequent Positive Thyroid Peroxidase Antibodies. Thyroid 2017; 27 (9): 1194–200. DOI: 10.1089/thy.2017.0139
14. Polyzos NP, Sakkas E, Vaiarelli A et al. Thyroid autoimmunity, hypothyroidism and ovarian reserve: a cross-sectional study of 5000 women based on age-specific AMH values. Hum Reprod 2015; 30 (7): 1690–6. DOI: 10.1093/humrep/dev089
15. Andrisani A, Sabbadin C, Marin L et al. The influence of thyroid autoimmunity on embryo quality in women undergoing assisted reproductive technology. Gynecol Endocrinol 2018; 34 (9): 752–5. DOI: 10.1080/09513590.2018.1442427
16. Monteleone P, Parrini D, Faviana P et al. Female infertility related to thyroid autoimmunity: the ovarian follicle hypothesis. Am J Reprod Immunol 2011; 66 (2): 108–14. DOI i: 10.1111/j.1600-0897.2010.00961.x
Авторы
Е.Н. Андреева*1,2, О.Р. Григорян1, Ю.С. Абсатарова1, И.С. Яровая1, Р.К. Михеев1,2
1 ФГБУ «Национальный медицинский исследовательский центр эндокринологии» Минздрава России, Москва, Россия;
2 ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» Минздрава России, Москва, Россия
*endogin@mail.ru
1 Endocrinology Research Centre, Moscow, Russia;
2 Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
*endogin@mail.ru
1 ФГБУ «Национальный медицинский исследовательский центр эндокринологии» Минздрава России, Москва, Россия;
2 ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» Минздрава России, Москва, Россия
*endogin@mail.ru
________________________________________________
1 Endocrinology Research Centre, Moscow, Russia;
2 Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
*endogin@mail.ru
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