高雄激素血症和代谢综合征对多囊卵巢综合征患者早期妊娠结局的影响

Effects of hyperandrogenism and metabolic syndrome on early pregnancy outcome of patients with polycystic ovary syndrome

目的探讨血清雄激素水平和代谢综合征相关指标对多囊卵巢综合征(PCOS)患者早期妊娠结局的影响。方法选取2013年1月-2015年2月该院收治的PCOS患者118例,根据早期妊娠是否发生胚胎丢失分为PCOS胚胎丢失组(A组,n=62)和PCOS胚胎正常发育组(B组,n=56),比较两组妇女血清雄激素水平和代谢综合征相关指标,并对影响PCOS患者早期胚胎发育的高危因素行Logistic回归分析。结果 A组腰围(WC)、舒张压(DBP)、空腹胰岛素(FINS)、空腹血糖(FBG)及甘油三酯(TG)均高于B组(均P<0.05);性激素结合球蛋白(SHBG)和高密度脂蛋白(HDL)均低于B组(均P<0.05);收缩压(SBP)、睾酮(T)、胆固醇(TC)及低密度脂蛋白(LDL)两组间比较,差异无统计学意义(均P>0.05)。A组体重指数(BMI)、游离睾酮指数(FAI)、稳态胰岛素评价指数(HOMR-IR)及动脉硬化指数(AI)均高于B组(均P<0.05)。两组血清SHBG水平与WC、DBP、FINS、FBG呈显著负相关(均P<0.05);与HDL呈显著正相关(P<0.05)。Logistic回归分析结果显示,SHBG和FINS是PCOS患者发生胚胎丢失的影响因素(均P<0.05)。当FINS以14.9 u IU/ml为临界值时,FINS对PCOS患者发生胚胎丢失预测的敏感度为80.6%,特异度为76.8%。结论高雄激素血症和异常的糖脂代谢状态与胚胎丢失的发生密切相关,FINS水平可作为预测PCOS患者早期妊娠结局的一个可选指标。

Objective To explore the effects of serum androgen levels and metabolic syndrome-related indexes on early pregnancy outcome of patients with polycystic ovary syndrome （PCOS）.Methods A total of 118 patients with PCOS treated in the hospital from January 2013 to February 2015 were selected and divided into embryonic loss group （A group,62 patients） and normal embryo development group （B group,56 patients）.The levels of androgen and metabolic syndrome-related indexes in the two groups were compared.The high-risk factors of early embryo development in PCOS patients were analyzed by logistic regression analysis.Results Waist circumference （WC）,diastolic blood pressure （DBP）,fasting insulin （FINS）,fasting blood glucose （FBG）,and triglyceride （TG） levels in A group were statistically significantly higher than those in B group （all P〈0.05）.The levels of sex hormone binding globulin （SHBG） and high-density lipoprotein （HDL） in A group were statistically significantly lower than those in B group （all P〈0.05）.There was no statistically significant difference in systolic blood pressure （SBP）,testosterone （T）,total cholesterol （TC）,and low-density lipoprotein （LDL） between the two groups （all P〉0.05）.Body mass index （BMI）,free testosterone index （FAI）,insulin steady state evaluation index （HOMR-IR）,and atherosclerosis index （AI） in A group were statistically significantly higher than those in B group （all P〈0.05）.In the two groups,serum SHBG levels were significantly negatively correlated with WC,DBP,FINS,FBG （all P〈0.05）,while serum SHBG levels were significantly positively correlated with HDL （P〈0.05）.Logistic regression analysis showed that SHBG and FINS were influencing factors of embryonic loss in PCOS patients （all P〈O.05）.Taking 14.9 uIU/ml as the critical value of FINS,the sensitivity and specificity of FINS for predicting embryonic loss in PCOS patients were 80.6% and 76.8%,respectively.Conclusion Hyperandrogenism and abnormal glucose and lipid metabolism are closely correlated with embryonic loss in PCOS patients,FINS can be used as an index for predicting early pregnancy outcome of PCOS patients.