接受供卵的不孕症患者血脂异常对临床结局的影响

Effect of dyslipidemia on clinical outcome of infertility patients receiving donor eggs

目的探讨血脂异常对接受供卵的不孕症患者卵母细胞胞质内单精子注射-胚胎移植(ICSI-ET)临床结局的影响。方法选择南京医科大学第一附属医院2007年4月至2020年12月期间接受供卵并行ICSI-ET治疗的患者共118例,根据三酰甘油、血清胆固醇、高密度脂蛋白(HDL)、低密度脂蛋白水平分为血脂异常组(35例)及血脂正常组(83例),并采用1∶1的倾向性评分匹配校正体质指数(BMI)及年龄的影响,回顾性分析两组患者的一般情况及临床结局;进一步针对患者年龄、BMI进行分层并分析血脂组成成分与临床结局之间的关系。结果(1)匹配前血脂异常组与血脂正常组比较,血脂异常组患者的BMI较血脂正常组显著升高[分别为(23.5±2.4)、(22.4±2.7)kg/m^(2)],胚胎种植率较血脂正常组显著降低[分别为13.6%(8/59)、27.3%(36/132)],差异均有统计学意义(P均<0.05)。(2)对两组患者进行年龄和BMI的倾向性评分匹配后分析发现,两组患者的不孕年限、妊娠次数、流产次数、移植胚胎数、子宫内膜准备方案、移植日子宫内膜厚度及优质胚胎率分别比较,均无明显差异(P均>0.05);而血脂异常组生化妊娠率[28.6%(10/35)]、胚胎种植率[13.6%(8/59)]及活产率[20.0%(7/35)]较血脂正常组显著降低,差异均有统计学意义(P均<0.05);临床妊娠率较血脂正常组仅有降低趋势(P>0.05)。(3)分层分析结果显示,年龄≤35岁的接受供卵患者中,较临床妊娠者,未临床妊娠者的HDL水平显著下降[分别为(1.8±0.5)、(1.5±0.3)mmol/L],差异有统计学意义(P<0.05);BMI>24 kg/m^(2)的接受供卵患者中,较临床妊娠者,未临床妊娠者的HDL水平仅有下降趋势(P>0.05)。结论血脂异常显著降低了接受供卵不孕症患者的生化妊娠率、胚胎种植率及活产率;特别是年龄≤35岁的接受供卵患者,HDL水平降低与不良妊娠结局密切相关。

Objective To explore the effect of dyslipidemia on the clinical outcome of intracytoplasmic sperm injection-embryo transfer(ICSI-ET)in infertility patients receiving donor eggs.Methods A total of 118 patients were selected to receive egg donors and ICSI-ET at the First Affiliated Hospital of Nanjing Medical University between April 2007 and December 2020.According to the levels of triacylglycerol,serum cholesterol,high density lipoprotein(HDL),and low density lipoprotein,they were divided into dyslipidemia group(35 cases)and normal blood lipids group(83 cases).The influence of body mass index(BMI)and age was adjusted by 1∶1 propensity score matching,and the general condition and clinical outcome of the two groups were analyzed retrospectively.Finally,the relationship between lipid composition and clinical outcome was analyzed according to patients′age and BMI.Results(1)Comparing the pre-matching dyslipidemia group with the normal blood lipids group,the BMI of the dyslipidemia group was significantly higher than that of the normal blood lipids group[(23.5±2.4)vs(22.4±2.7)kg/m^(2)],and the embryo implantation rate was significantly lower than that of the normal blood lipids group[13.6%(8/59)vs 27.3%(36/132)],the differences were statistically significant(both P<0.05).(2)There were no significant differences in years of infertility,number of pregnancies,number of abortions,number of transplanted embryos,protocol of endometrial preparation,endometrial thickness on transplantation day and high quality embryo rate between the two groups,through propensity score matching(all P>0.05).The biochemical pregnancy rate[28.6%(10/35)],embryo implantation rate[13.6%(8/59)]and live birth rate[20.0%(7/35)]in dyslipidemia group were significantly lower than those in the normal blood lipids group(P<0.05).The clinical pregnancy rate was lower than that of the normal blood lipids group(P>0.05).(3)The results of stratified analysis showed that the level of HDL in the clinically non-pregnant group was significantly lower than that in the pregnant group in patients≤35 years old[(1.5±0.3)vs(1.8±0.5)mmol/L;P<0.05].In the overweight recipient patients,the level of HDL of the clinically non-pregnant group was lower than that of the pregnant group(P>0.05).Conclusions Dyslipidemia significantly reduces the biochemical pregnancy rate,embryo implantation rate and live birth rate in patients with receiving donor eggs.Especially in patients aged≤35 years old,the reduction of HDL is closely related to adverse pregnancy outcomes.