目的 分析围绝经期女性糖脂代谢水平与卵巢储备功能减退（DOR）的相关性，并探讨绝经激素治疗的应用价值。方法 回顾性选取2024年2月至2026年2月就诊于本院的194例围绝经期女性为研究对象，根据其卵巢储备功能将其分为DOR组（n=103）与卵巢储备功能正常组（NOR，n=91）。比较2组临床资料，采用Logistic回归分析围绝经期女性DOR的危险因素，绘制ROC曲线分析其预测效能，并利用Spearman相关系数分析指标相关性。同时予以所有患者绝经激素治疗（MHT），比较治疗前后的性激素指标、糖代谢指标、超声指标及安全性指标。结果 Logistic多因素结果显示：年龄、FSH、HbA1c、TG是围绝经期女性DOR的重要影响因素（P＜0.05）。ROC结果显示：联合预测的AUC=0.982，95%CI为0.964~1.000，灵敏度为0.990，特异度为0.923，校准曲线拟合性好。卵巢储备功能与年龄、FSH、HbA1c、TG均呈显著正相关（P均<0.05）。与治疗前相比，FSH、LH、HbA1c、TG、LDL-C水平有明显下降（P＜0.05），子宫内膜厚度略有增加（P＜0.05）；AMH、卵巢体积无显著变化（P＞0.05）。MHT治疗后不良反应发生率为4.64%。结论 糖脂代谢异常与围绝经期女性DOR密切相关，是其重要危险因素。规范MHT干预可有效改善内分泌代谢紊乱，且安全性可靠。

Objective To analyze the correlation between glycolipid metabolism levels and diminished ovarian reserve (DOR) in perimenopausal women, and to explore the application value of menopausal hormone therapy.Methods A total of 194 perimenopausal women admitted to our hospital from February 2024 to February 2026 were retrospectively enrolled. They were divided into the DOR group (n=103) and the normal ovarian reserve (NOR) group (n=91) according to ovarian reserve function. Clinical data were compared between the two groups. Logistic regression analysis was used to identify risk factors for DOR. Receiver operating characteristic (ROC) curves were plotted to evaluate predictive efficacy, and Spearman correlation analysis was performed to assess indicator correlations. All patients received menopausal hormone therapy (MHT). Sex hormone indicators, glycolipid metabolic indicators, ultrasonographic indicators and safety indicators were compared before and after treatment.Results Multivariate Logistic regression showed that age, folliclestimulating hormone (FSH), glycated hemoglobin A1c (HbA1c) and triglyceride (TG) were independent risk factors for DOR in perimenopausal women (P＜0.05). ROC analysis revealed that the combined prediction yielded an AUC of 0.982 (95%CI: 0.964–1.000), with a sensitivity of 0.990 and a specificity of 0.923, and good calibration curve fitting. Ovarian reserve was significantly positively correlated with age, FSH, HbA1c and TG (all P＜0.05). After treatment, levels of FSH, luteinizing hormone (LH), HbA1c, TG and lowdensity lipoproteincholesterol (LDLC) decreased significantly (P＜0.05), and endometrial thickness increased slightly (P＜0.05). No significant changes were observed in antiMüllerian hormone (AMH) and ovarian volume (P＞0.05). The incidence of adverse reactions after MHT was 4.64%.Conclusion Abnormal glycolipid metabolism is closely associated with DOR and serves as a critical risk factor in perimenopausal women. Standardized MHT can effectively improve endocrinemetabolic disorders with satisfactory safety.

目的 探讨腹腔镜下输卵管积水既往手术史对血清AMH和卵巢储备功能的影响。方法 选择2016年1月—2016年12月期间在中山市博爱医院生殖内分泌科就诊拟行体外受精—胚胎移植术患者,按照既往的输卵管积水的不同处理方式将患者分为腹腔镜下双侧输卵管切除术组(A组,n=52)、腹腔镜下双侧输卵管开窗术组(B组,n=71)、双侧输卵管阻塞或通而不畅而无积水组(C组,n=96),比较各组在促排卵首日AMH、以及AFC、FSH、LH、E2、孕酮的差异,比较各组Gn治疗时间和用量,以及注射HCG日的成熟卵泡数的差异。结果 A组的AMH、LH低于B组和C组(P<0.05),而B组和C组间AMH、LH差异无统计学意义(P>0.05)。A组AFC水平低于C组(P<0.05),而E2水平高于C组(P<0.05)。A组的FSH高于B组和C组(P<0.05),B组和C组间FSH差异无统计学意义(P>0.05)。三组间孕酮差异无统计学意义(P>0.05)。A组的注射HCG日的成熟卵泡数低于B组和C组(P<0.05),而B组和C组间成熟卵泡数差异无统计学意义(P>0.05)。A组Gn用量高于B组和C组(P<0.05),而B组和C组间Gn用量差异无统计学意义(P>0.05)。三组间Gn治疗时间差异无统计学意义(P>0.05)。结论 通过AMH等指标检测,腹腔镜输卵管切除术会降低患者的卵巢储备功能,而开窗术则影响相对较小,对有生育要求的妇女应考虑行输卵管开窗术等方式以保护卵巢功能。