血清Hcy、IGFBP-1联合预测多囊卵巢综合征患者孕早期自然流产的价值

Value of Combined Detection of Serum Hcy and IGFBP-1 in Prediction of Early Spontaneous Abortion in Patients with Polycystic Ovary Syndrome

目的探讨血清同型半胱氨酸(Hcy)、胰岛素样生长因子结合蛋白-1(IGFBP-1)联合检测对多囊卵巢综合征患者孕早期自然流产的预测价值。方法选取2018年3月—2020年5月行促排卵治疗并成功临床妊娠的多囊卵巢综合征165例,检测血清Hcy、IGFBP-1水平。根据孕早期自然流产发生情况分为孕早期自然流产组与未自然流产组,比较两组妊娠前一次促排卵后血清Hcy、IGFBP-1水平;多囊卵巢综合征患者孕早期自然流产的危险因素采用多因素Logistic回归分析,并采用受试者工作特征(ROC)曲线分析血清Hcy、IGFBP-1水平单项及联合检测对多囊卵巢综合征患者孕早期自然流产的预测价值。结果患者妊娠前一次促排卵后血清Hcy水平低于入院时,血清IGFBP-1水平高于入院时(P<0.01);自然流产组妊娠前一次促排卵后血清Hcy水平高于未自然流产组,血清IGFBP-1水平低于未自然流产组(P<0.01)。孕早期自然流产的发生率为28.48%。年龄≥35岁、多囊卵巢综合征分型、空腹胰岛素水平偏高、空腹血糖水平偏高、血清睾酮水平偏高、血清叶酸水平偏低、妊娠前一次促排卵后血清Hcy水平偏高及血清IGFBP-1水平偏低均是多囊卵巢综合征患者孕早期自然流产的危险因素(P<0.01)。妊娠前一次促排卵后血清Hcy水平联合血清IGFBP-1水平预测多囊卵巢综合征患者孕早期自然流产的敏感度、ROC曲线下面积均高于单独预测(P<0.01)。结论多囊卵巢综合征孕早期自然流产患者血清Hcy水平偏高,IGFBP-1水平偏低,二者均与多囊卵巢综合征患者孕早期自然流产密切相关,并对多囊卵巢综合征患者孕早期自然流产的发生具有较好的预测价值,联合检测时的预测效能更高。

Objective To explore the value of combined detection of serum homocysteine(Hcy)and insulin-like growth factor-binding protein-1(IGFBP-1)in prediction of early spontaneous abortion in patients with polycystic ovary syndrome(PCOS).Methods A total of 165 patients with PCOS,who had undergone ovarian stimulation treatment and successfully clinical pregnancy between March 2018 and May 2020,were selected to detect serum levels of Hcy and IGFBP-1.According to the occurrence of spontaneous abortion in early pregnancy,the patients were divided into early pregnancy spontaneous abortion group and non-spontaneous abortion group,and serum levels of Hcy and IGFBP-1 after the last time of ovarian stimulation treatment before pregnancy were compared between two groups.The risk factors of spontaneous abortion in early pregnancy of patients with PCOS were analyzed by using multivariate Logistic regression analysis,and predictive values of single and combined detection of serum levels of Hcy and IGFBP-1 in early pregnancy of patients with PCOS were analyzed by using receiver operating characteristic(ROC)curve.Results Compared with those at admission,serum Hcy level was significantly lower,while serum IGFBP-1 level was significantly higher in PCOS patients after the last time of ovarian stimulation treatment before pregnancy(P<0.01).Compared with those in non-spontaneous abortion group,serum level of Hcy was significantly higher,while serum level of IGFBP-1 was significantly lower after the last time of ovarian stimulation treatment before pregnancy in spontaneous abortion group(P<0.01).The incidence rate of spontaneous abortion in early pregnancy was 28.48%.Age equal or more than 35 years old,classification of PCOS,high level of fasting insulin,high level of fasting blood glucose,high level of serum testosterone,low level of serum folate,high level of serum Hcy after the last time of ovarian stimulation treatment before pregnancy and low level of serum IGFBP-1 were risk factors of spontaneous abortion in patients with PCOS in early pregnancy(P<0.01).The sensitivity and area under ROC curve(AUC)of serum Hcy combined with IGFBP-1 in prediction of spontaneous abortion in patients with PCOS in early pregnancy were significantly higher than those by the two indexes alone(P<0.01).Conclusion Serum levels of Hcy are higher and IGFBP-1 are lower in PCOS patients with early pregnancy spontaneous abortion.Both of them are closely related to early pregnancy spontaneous abortion of patients with PCOS,and they have better predictive values for the occurrence of early pregnancy spontaneous abortion in patients with PCOS,and the predictive efficiency of combined detection is better.