甲状腺过氧化物酶抗体水平对促甲状腺激素正常的多囊卵巢综合征不孕患者促排卵效果及妊娠成功率的预测价值

Predicting value of TPOAb level in ovulation induction and pregnancy success rate in patients with PCOS infertility with normal TSH

目的探讨甲状腺过氧化物酶抗体(thyroid peroxidase antibody,TPOAb)水平对促甲状腺激素(thyroid stimulating hormone,TSH)正常的多囊卵巢综合征(polycystic ovary syndrome,PCOS)不孕患者促排卵效果及妊娠成功率的预测价值。方法回顾性分析2016年6月至2017年6月东莞东华医院生殖医学中心收治的65例TSH正常的PCOS不孕患者的临床资料,将其纳入研究组,另选取同期医院体检中心收治的40例健康女性纳入对照组,对比研究组和对照组TPOAb水平;研究组常规促排卵治疗,根据阴道超声检查是否出现排卵征象将其分别纳入排卵组和未排卵组,对比两组TPOAb水平;根据是否临床妊娠,将其分别纳入成功组和失败组,对比两组TPOAb水平;通过绘制受试者工作曲线(subject working curve,ROC),分析TPOAb水平对促排卵及妊娠成功的影响。结果研究组TPOAb水平[(110.25±20.37)IU/mL]明显高于对照组[(42.51±8.17)IU/mL],差异有统计学意义(P<0.05);65例TSH正常的PCOS不孕患者排卵率为78.46%(51/65),未排卵组TPOAb水平[(177.75±21.83)IU/mL]明显高于排卵组[(91.72±10.64)IU/mL],差异有统计学意义(P<0.05);51例排卵患者中临床妊娠成功率为29.41%(15/51),失败组TPOAb水平[(103.87±12.95)IU/mL]明显高于成功组[(62.56±7.70)IU/mL],差异有统计学意义(P<0.05);TPOAb预测TSH正常的PCOS不孕患者促排卵及妊娠成功的最佳截断点分别为92.70 IU/mL、65.26 IU/mL,TPOAb预测TSH正常的PCOS不孕患者排卵的灵敏度、准确度及曲线下面积高于预测妊娠成功组,特异度低于预测妊娠成功组。结论 TPOAb水平对TSH正常的PCOS不孕患者促排卵及妊娠成功具有一定预测价值,且对促排卵预测价值较高。

Objective To investigate the predictive value of thyroid peroxidase antibody(TPOAb) level in ovulation induction and pregnancy success rate in infertility patients with polycystic ovary syndrome(PCOS) infertility with normal thyroid stimulating hormone(TSH).Methods Retrospective analysis of 65 patients with PCOS infertility with normal TSH who were admitted to the Dongguan Donghua Hospital from June 2016 to June 2017 was included in the study group. 40 healthy women who were admitted to the hospital physical examination center were included in the control group. The TPOAb levels of the study group and the control group were compared. The study group routinely promoted ovulation treatment, according to vaginal ultrasound examination whether ovulation signs were included in the ovulation group and the non-ovulation group, respectively, the two groups of TPOAb levels were compared. Follow-up statistics were included in the clinical pregnancy, and they were included in the successful group and the failed group, respectively, and the levels of TPOAb in the two groups were compared. The predictive value of TPOAb levels for ovulation induction and pregnancy success was analyzed by plotting subject working curve(ROC). Results The level of TPOAb in the study group was significantly higher than that in the control group(P<0.05). The ovulation rate of 65 patients with PCOS infertility with mormal TSH was 78.46 %(51/65), and the level of TPOAb in the non-ovulation group was significantly higher than that in the ovulation group(P<0.05). The clinical pregnancy success rate was 29.41 %(15/51) in 51 patients with ovulation, and the TPOAb level in the failure group was significantly higher than that in the successful group(P<0.05). The best cut-off points for TPOAb predicting ovulation and pregnancy success in patients with PCOS infertility with normal TSH are 92.70 IU/mL and 65.26 IU/mL, respectively. TPOAb predicts the sensitivity, accuracy and AUC of ovulation in patients with PCOS infertility with nomal TSH, which is higher than the predicted pregnancy success, and the specificity is lower than the predicted pregnancy success. Conclusion The level of TPOAb has a certain predictive value for ovulation induction and pregnancy success in patients with PCOS infertility with normal TSH, and it has a higher predictive value for ovulation induction.