体重指数对多囊卵巢综合征患者代谢指标与妊娠结局的影响

Effects of BMI on the metabolism indexes and pregnancy outcome of patients with PCOS

目的研究不同体重指数(BMI)多囊卵巢综合征(PCOS)患者的代谢指标差异,探讨肥胖对PCOS患者妊娠结局的影响。方法选择2018年1月至2019年12月就诊行供精人工授精(AID)助孕的PCOS患者606例,根据体重指数(BMI)分为4组:低体重组90例、正常体重组190例、超重组182例、肥胖组144例。结果不同肥胖程度的PCOS患者血清FSH、LH、E2水平差异无统计学意义(P>0.05),超重组和肥胖组PCOS患者血清P、T、PRL、FPG、FINS、TG、TC和UA水平高于低体重组和正常体重组,而HDL和VD3水平低于低体重组和正常体重组,差异均有统计学意义(P<0.05);低体重组PCOS患者LH/FSH和HOMA-IR高于正常体重组(P<0.05)。超重组和肥胖组的Hcy和LDL水平高于低体重组和正常体重组(P<0.05)。不同BMI分组妊娠结局比较,低体重组妊娠率、流产率均与正常体重组接近,差异无统计学意义(P>0.05)。与正常体重组相比,随着体重的增加,HCG阳性率及临床妊娠率有逐渐降低的趋势,流产率有逐渐增高的趋势,但4组间差异均无统计学意义(P>0.05)。结论随着BMI的增加,PCOS患者的P、T和PRL逐渐增高,糖代谢的空腹血糖、胰岛素及脂代谢的TC、TG、HDL、LDL和UA多项指标出现异常,肥胖型PCOS患者体内Hcy更高,提示叶酸代谢可能受到影响;随着BMI的增高可能导致妊娠率降低,流产率增加。

Objective To investigate the effects of body mass index(BMI)on the metabolism indexes of patients with polycystic ovary syndrome(PCOS),and to explore the effects of obesity on the pregnancy outcome of patients.Methods A total of 606 women with PCOS who underwent AID assisted pregnancy were enrolled in the study.According to body mass index(BMI),these patients were divided into four groups:low body weight group(n=90),normal body weight group(n=190),overweight group(n=182),obesity group(n=144).The sex hormone levels and serum biochemical parameters were detected and compared among the four groups.Results There were no significant differences in the serum levels of FSH,LH,E2 among the four groups(P>0.05).Thre serum levels of P,T,PRL,FPG,FINS,TG,TC and UA in overweight group and obesity group were significantly higher than those in low body weight group and normal body weight group,however,the levels of HDL and VD3 were significantly lower than those in low body weight group and normal body weight group(P<0.05).Moreover the incidence of insulin resistance in low body weight group was significantly higher than that in normal body weight group(P<0.05).The serum levels of Hcy and LDL in overweight group and obesity group were significantly higher than those in low body weight group and normal body weight group(P<0.05).In addition the pregnancy rate and miscarriage rate in low body weight group were lower than those in normal body weight group,and the pregnancy rate in overweight group was lower than that in normal body weight group,and the miscarriage rate was higher than that in normal body weight group,however,the differences were not significant(P>0.05).Conclusion With the increase of BMI,the levels of P,T,PRL in patients with PCOS are increased gradually,and multiple serum biochemical parameters are abnormal,and Hcy levels are especially higher in obesity patients with PCOS,which suggests that folacin metabolism of patients may be affected.