性激素结合球蛋白水平与多囊卵巢综合征合并不孕症患者黄体期短效促性腺激素释放激素激动剂长方案助孕结局相关性分析

Correlation between SHBG level and the outcome of long-term assisted pregnancy plan of luteal phase short-acting GnRH-a in patients with PCOS and infertility

目的:探究性激素结合球蛋白(SHBG)水平与多囊卵巢综合征(PCOS)合并不孕症患者黄体期短效促性腺激素释放激素激动剂(GnRH-a)长方案助孕结局的相关性。方法:选择接受体外受精-胚胎移植(IVF-ET)助孕治疗且采用黄体期短效GnRH-a长方案的PCOS不孕症患者164例作为研究对象,并依据患者血清SHBG水平将患者分为正常水平组(SHBG水平≥18 nmol/L,93例)和低水平组(SHBG水平<18 nmol/L,71例),对比两组患者促排卵治疗前基础内分泌水平、促排卵情况和妊娠结局。结果:与正常水平组比,低水平组患者基础内分泌激素黄体生成素(LH)、睾酮(T)、黄体生成素/卵泡刺激素(LH/FSH)比值、脱氢表雄酮(DHEAS)和游离雄激素指数(FAI)水平均明显升高(均P<0.05),促排卵时促性腺激素(Gn)启动量、Gn天数、Gn总量明显增加,人绒毛膜促性腺激素(hCG)日雌二醇(E 2)表达水平明显下降(均P<0.01),LH水平明显升高(P<0.05);获卵数、成熟卵母细胞数(MⅡ)、受精卵数、卵裂数、优胚数、可移植胚胎数明显减少(均P<0.01),患者胚胎着床率和临床妊娠率明显下降,流产率明显升高(P<0.05)。结论:SHBG水平与PCOS不孕症患者机体内分泌激素异常密切相关,PCOS不孕症患者体内SHBG水平越低,黄体期短效GnRH-a长方案促排卵Gn用量越多,用时越长,且优胚率越低,患者IVF-ET助孕效果越差。

Objective:To explore the correlation between the level of sex hormone binding globulin(SHBG)and the outcome of a long-term plan of short-acting gonadotropin releasing hormone agonist(GnRH-a)in patients with polycystic ovary syndrome(PCOS)and infertility.Methods:164 patients with PCOS and infertility who received in vitro fertilization-embryo transfer(IVF-ET)and long-term assisted pregnancy plan of luteal phase short-acting GnRH-a were selected as the research objects.According to the patients’serum SHBG level,patients were divided into normal level group(SHBG≥18 nmol/L,93 cases)and low level group(SHBG<18 nmol/L,71 cases).The basic serum endocrine hormone levels,ovulation induction and pregnancy outcome were compared between the two groups.Results:Compared with normal level group,the levels of luteinizing hormone(LH),testosterone(T),medium luteinizing hormone/follicle stimulating hormone(LH/FSH)ratio,dehydroepiandrosterone(DHEAS)and free androgen index(FAI)in low level group were significantly increased(all P<0.05);the initial dose and total dose of Gn in the ovulation induction program were significantly higher,and the days of Gn was significantly prolonged,and the expression level of serum E_(2)on hCG day was significantly lower,and the expression level of LH was significantly higher(all P<0.05);the number of eggs obtained,the number of MⅡeggs,the number of fertilized eggs,the number of cleavage,the number of high-quality embryos,and the number of transferable embryos were decreased significantly,and the patients’embryo implantation rate and clinical pregnancy rate decreased significantly,and the abortion rate increased significantly(all P<0.05).Conclusion:The level of SHBG is closely related to the abnormal expression of endocrine hormones in patients with PCOS and infertility.The lower the SHBG level in patients with PCOS and infertility,the higher the dosage and days of Gn in luteal phase short-acting long-term plan,and the lower the rate of high-quality embryos,the worse the effect of IVF-ET.