营养干预对肥胖型多囊卵巢综合征病人AMH水平及受孕率的影响

EFFECT OF NUTRITIONAL INTERVENTION ON AMH LEVEL AND CONCEPTION RATE IN PATIENTS WITH OBESE POLYCYSTIC OVARY SYNDROME

目的探讨营养干预对肥胖型多囊卵巢综合征病人抗苗勒管激素(AMH)水平及受孕率影响。方法以2015年8月—2017年8月在我院妇科门诊就诊并接受治疗的110例肥胖型多囊卵巢综合征所致不孕病人为研究对象,按随机数字表法将病人分为3组,对照组30例,二甲双胍组和营养干预组各40例。对照组病人单纯给予达英-35治疗,二甲双胍组病人给予达英-35联合二甲双胍治疗,营养干预组病人给予达英-35联合营养干预治疗。检测并比较各组病人治疗前后血清AMH、促卵泡生成素(FSH)、促黄体生成素(LH)、雌二醇(E_2)、睾酮(T)水平以及空腹胰岛素(FINS)、空腹血糖(FBG)、胰岛素抵抗指数(HOMR-IR)、体质量指数(BMI)等指标变化。所有病人均给予促排卵治疗,统计各组病人的排卵率和受孕率。结果治疗后,3组病人血清AMH、LH、T、FINS和HOMR-IR均较治疗前下降,差异具有统计学意义(t=3.021～21.519,P<0.05);3组病人治疗前后血清AMH、LH、T、FBG、FINS、BMI和HOMR-IR差值比较差异均具有统计学意义(F=4.692～10.605,P<0.05)。营养干预组排卵成功率(90.00%)和受孕成功率(57.50%)最高,与对照组病人的63.33%和26.67%比较差异有显著意义(χ~2=7.240、6.605,P<0.05)。结论营养干预能够调节肥胖型多囊卵巢综合征病人激素分泌和糖代谢水平,减轻病人体质量,降低胰岛素抵抗,改善卵巢功能,提高病人排卵和受孕成功率,值得妇科临床推广使用。

Objective To investigate the effect of nutritional intervention on anti-mullerian HOMRone （AMH） level and conception rate in patients with obese polycystic ovary syndrome. Methods A total of 110 obese polycystic ovary syndrome-induced infertile patients, who visited the clinic of the Gynecology Department in our hospital from August 2015 to August 2017, were enrolled in the research. These patients were divided into three groups （30 cases in the control group, and 40 cases each in the metformin group and nutritional intervention group） according to the random number table. Patients in the control group, metformin group, and nutritional intervention group were treated with Diane-35, Diane-35 combined with metformin, and Diane-35 combined with nutritional intervention, respectively. Serum levels of AMH, follicle-stimulating HOMRone （FSH）, luteinizing HOMRone （LH）, estradiol （E 2）, testosterone （T）, fasting insulin （FINS）, and fasting blood glucose （FBG）, as well as insulin resistance index （HOMR-IR） and body mass index （BMI） were measured for each group to evaluate and compare changes in the above indices after treatment. All the patients were given ovarian stimulation treatment, and the ovulation rate and conception rate in each group were summarized. Results After treatment, patients in the three groups had significantly reduced serum levels of AMH, LH, T, and FINS, as well as HOMR-IR, the difference is significant （ t =3.021-21.519, P 〈0.05）. There were significant differences between the three groups with respect to the changes in serum levels of AMH, LH, T, FBG, and FINS, as well as BMI and HOMR-IR （ F = 4.692- 10.605, P 〈0.05）. The success rates of ovulation and conception were highest in the nutritional intervention group, and were significantly higher than those in the control group （90.00% vs 63.33%, χ^2=7.240, P 〈0.05; 57.50% vs 26.67%, χ^2= 6.605 , P 〈0.05）. Conclusion Nutritional intervention can regulate the levels of HOMRone secretion and glucose metabolism, reduce BMI, alleviate insulin resistance, improve the ovarian function, and increase the success rates of ovulation and conception in patients with obese polycystic ovary syndrome. Therefore, it is highly recommended for use in clinical gynecology.