探讨北京市月坛社区女性卵巢储备功能变化的规律。

采用前瞻性研究，通过分层随机抽样方法，选择2014年3月至8月，于北京市月坛社区卫生服务中心进行乳腺癌、宫颈癌筛查，并且符合本研究纳入与排除标准的207例25～49岁女性为研究对象。根据受试者年龄，将其分为≥25～30岁组(n＝32)，≥30～40岁组(n＝62)，≥40～50岁组(n＝113)。对3组受试者进行为期1年随访，采用自行设计的《月经模式问卷调查表》，分析受试者随访开始时与随访1年后的月经模式变化情况，采用血清性激素水平检测，了解受试者血清卵泡刺激素(FSH)、雌二醇水平，以及通过超声检查，测定受试者卵巢内窦卵泡数(AFC)与卵巢体积变化情况，并进行统计学比较。本研究遵循的程序符合首都医科大学附属复兴医院伦理委员会所制定的伦理学标准，得到该委员会批准，并与所有受试者均签署临床研究知情同意书。3组受试者的体重、人体质量指数等一般临床资料比较，差异均无统计学意义(P>0.05)。

①随着受试者年龄增加，3组受试者在1年随访期内连续2次月经周期提前或延后时间持续≥7 d，以及月经周期间隔>60 d或2个月经周期的发生率，均呈升高趋势，差异均有统计学意义(χ²＝5.099、5.602，P＝0.024、0.018)。②对≥40～50岁组受试者随访1年后，血清FSH中位水平为36.1 mIU/mL，显著高于随访开始时的24.7 mIU/mL，二者比较，差异有统计学意义(Z＝2.880，P＝0.004)。3组受试者血清雌二醇水平随访开始时与随访1年后分别比较，差异均无统计学意义(P>0.05)。③本研究中，≥30～40岁组受试者随访开始时与随访1年后AFC中位数分别为7.5个和6.5个，≥40～50岁组受试者AFC中位数分别为4.7个与3.2个，2组受试者随访开始时与随访1年后AFC中位数分别比较，差异均有统计学意义(Z＝2.120、2.345，P＝0.034、0.019)。≥40～50岁组受试者随访开始时与随访1年后的卵巢体积中位数分别为4.4 cm³和3.3 cm³，二者比较，差异有统计学意义(Z＝2.229，P＝0.026)。

北京市月坛社区女性中，随着年龄增加，卵巢储备功能呈下降趋势。月经模式及卵巢AFC，可作为早期预测女性卵巢储备功能下降的有效指标。

To explore the ovarian reserve function changes of women in Yuetan community of Beijing.

From March to August 2014, a total of 207 women, aged 25-49 and met the inclusion and exclusion criteria of this study in Yuetan Community Health Service Center of Beijing for breast cancer and cervical cancer screening, were selected as research subjects by stratified random sampling method and perspective longitudinal study. According to different ages, they were divided into ≥25-30 years group (n=32), ≥30-40 years group (n=62) and ≥40-50 years group (n=113). One-year follow-up was conducted on each subject. Self-designed Menstrual Model Questionnaire was used to analyze the changes of menstrual patterns at the beginning of follow-up and after 1-year follow-up. Serum sex hormone levels were measured to detect the levels of serum follicle stimulating hormone (FSH) and estradiol. Ultrasound examinations were performed to determine the changes of ovarian antral follicle count (AFC) and ovarian volume. And the above indexes were compared by statistical methods among 3 groups. This study followed the ethical standards set by the Ethics Committee of Fuxing Hospital, Capital Medical University, and signed the informed consents of clinical study with all subjects. There were no statistical differences among 3 groups in the weight, body mass index and other basic clinical data (P>0.05).

①With the increase of age, the incidences of two consecutive menstrual cycles with an early or delayed duration ≥7 d, and a menstrual cycle interval > 60 d or 2 menstrual cycles during 1-year follow-up period increased gradually in all 3 groups, and the differences were statistically significant (χ²=5.099, 5.602; P=0.024, 0.018). ②In ≥40-50 years group, the median serum FSH level after 1-year follow-up was 36.1 mIU/mL which was significantly higher than that of 24.7 mIU/mL at the beginning of follow-up, and the difference was statistically significant (Z=2.880, P=0.004). There were no statistical differences in the levels of serum estradiol at the beginning and after 1-year follow-up among the 3 groups (P>0.05). ③ In ≥30-40 years group, at the beginning and after 1-year follow-up, the median AFC were 7.5 and 6.5, respectively, and in ≥40-50 years group, the median AFC were 4.7 and 3.2, respectively, and both the differences were statistically significant (Z=2.120, 2.345; P=0.034, 0.019). In ≥40-50 years group, at the beginning and after 1-year follow-up, the median ovary volume were 4.4 cm³ and 3.3 cm^3, respectively, and the difference was statistically significant (Z=2.229, P=0.026).

Along with the age increasing, the ovarian reserve function of women is reduced in Yuetan community of Beijing. Menstrual pattern and ovarian AFC can be used as effective indexes to predict the declining of ovarian reserve function.