血清FSH、IGF-Ⅰ及BMI对夫精人工授精助孕结局的影响

Effects of serum FSH,IGF⁃Ⅰand BMI on the outcome of artificial insemination of hus⁃band's sperm

目的探究血清促卵泡激素(FSH)、胰岛素样生长因子-Ⅰ(IGF-Ⅰ)及身体质量指数(BMI)对夫精人工授精助孕结局的影响。方法选取2018年2月至2019年11月本院收治的行AIH治疗的不孕患者104例。根据助孕结局分为妊娠组(34例)与非妊娠组(70例)。对比观察两组患者血清FSH、IGF-Ⅰ及BMI差异,并通过ROC曲线分析其预测助孕结局价值,根据随访12周流产情况将妊娠患者分为流产组(11例)与未流产组(23例),对比两组患者血清FSH、IGF-Ⅰ及BMI,并分析其与流产情况发生的相关性。结果妊娠组患者的BMI、血清FSH水平显著低于未妊娠组,血清IGF-1水平显著高于未妊娠组,差异均有统计学意义(P<0.05),多因素分析显示,BMI增加、血清FSH水平升高、血清GIF-1水平降低是未助孕成功的独立危险因素(P<0.05),ROC曲线分析显示,BMI、血清FSH水平及血清IGF-1水平对助孕结局的影响的AUC为0.759、0.738、0.976,敏感性、特异性为73.5%/97.1%/97.1%、60.6%/48.6%/94.3%。三项联合预测AUC为0.999,敏感性、特异性为97.1%、100%;流产组患者BMI≥25 kg/m2、血清FSH水平≥10 U/L高于未流产组,血清GIF-1水平低于未流产组,差异有统计学意义(P<0.05),Spearman相关性显示,BMI、血清FSH水平与流产发生呈显著正相关(r=0.807、0.408,P<0.05),血清IGF-1水平与流产发生呈显著负相关(r=-0.340,P<0.05)。结论夫精人工授精患者BMI≥25 kg/m2、血清FSH水平≥10 U/L,IGF-1水平低是助孕妊娠率与活产率的危险因素,临床可根据三者水平变化进行指导干预,改善助孕结局。

Objective To explore the serum FSH,IGF⁃Ⅰand BMI for pure artificial insemina⁃tion to help the influence of the pregnancy outcome.Methods From February 2018 to November 2019,104 infertile patients with AIH treatment were selected.They were divided into the pregnancy group(34 cases)and the non⁃pregnancy group(70 cases).To observe the difference of serum FSH、IGF⁃Ⅰand BMI between the two groups,and analyze its influence value by ROC curve,pregnancy patients were divided into abortion group(11 cases)and non⁃abortion group(23 cases)according to the 12⁃week follow⁃up of abortion.Serum FSH,IGF⁃I and BMI of the two groups were compared,and their correlation with the occurrence of abortion was analyzed.Result The level of BMI、serum FSH in the pregnant group was significantly lower than that in the non⁃pregnant group(P<0.05).Serum IGF⁃1 level was significantly higher than that in the non⁃pregnant group,difference was statistically significant(P<0.05).Multivariate analysis showed that increased BMI,in⁃creased serum FSH levels,and decreased serum GIF⁃1 levels were independent risk factors for successful preg⁃nancy failure(P<0.05).ROC curve analysis showed that the AUC of the effects of BMI,serum FSH level and serum IGF⁃1 level on the outcome of assisted pregnancy were 0.759,0.738,0.976,and the sensitivity and specificity were 73.5%/97.1%/97.1%,60.6%/48.6%/94.3%.The three⁃item combined prediction AUC is 0.999,the sensitivity and specificity are 97.1%,100%;the BMI≥25 kg/m2,serum FSH level≥10 U/L in the abortion group is higher than that in the non⁃abortion group,and the serum GIF⁃1 level is low In the non⁃abor⁃tion group,the difference was statistically significant(P<0.05).Spearman correlation showed that BMI and se⁃rum FSH levels were significantly positively correlated with abortion(r=0.807,0.408,P<0.05),and serum IGF⁃1 levels were significantly negatively correlated with abortion(r=-0.340,P<0.05).Conclusion The BMI≥25 kg/m2,serum FSH≥10 U/L,and low IGF⁃1 level are risk factors for assisted pregnancy rate and live birth rate in ivf patients.Clinical intervention can be conducted according to the changes of these three lev⁃els to improve the outcomes of assisted pregnancy.