新型体脂指数与多囊卵巢综合征患者胰岛素抵抗及IVF/ICSI临床结局的相关性研究

Correlation of the new body fat index with insulin resistance and the clinical outcomes of IVF/ICSI in patients with the polycystic ovary syndrome

目的研究新型体脂指数对多囊卵巢综合征(PCOS)患者发生胰岛素抵抗(IR)的筛查价值并探索效能较好的指数与体外受精/卵细胞质内单精子注射(IVF/ICSI)临床结局之间的相关性。方法回顾性纳入首次行IVF/ICSI的245例PCOS患者,按照稳态模型胰岛素抵抗指数(HOMA-IR)水平,分为IR组与非IR组,比较2组基础资料,分析差异指标对IR的筛查价值。按照脂质蓄积指数(LAP)诊断切点将患者分为高LAP组与低LAP组,比较2组患者IVF/ICSI的临床结局,分析LAP与结局指标的相关性。结果LAP和内脏脂肪指数(VAI)对IR有良好的筛查价值:其曲线下面积(AUC)分别为0.783和0.724。高LAP组较低LAP组有着更高的促性腺激素(Gn)总量和早期流产率、更低的获卵率、第二次减数分裂中期(MⅡ)卵率、卵子利用率、第三天(D3)优质胚胎率和临床妊娠率。LAP与Gn总量呈正相关,与MⅡ卵率、双原核受精率、卵子利用率、D3优质胚胎率呈负相关。上述结果均具有统计学意义(P<0.05)。结论PCOS患者的LAP和VAI对IR有良好的筛查价值,高LAP与IVF/ICSI的不良临床结局相关。

Objective To study the screening value of the new body fat index for insulin resistance(IR)in infertile patients with polycystic ovary syndrome(PCOS),and to analyze the correlation between the index which had better screening value and the clinical outcomes of in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI).Methods A total of 245 infertile females with PCOS were included and analyzed retrospectively who had undergone IVF/ICSI for the first time.According to the level of a homeostasis model assessment of insulin resistance index(HOMA-IR),patients were divided into the IR group and non-IR group.The levels of basic information were compared between the two groups.Factors with significant differences were analyzed to define the screening value for IR.The patients were split into a high lipid accumulation product(LAP)group and nor-LAP group according to the cut-off point of LAP.The clinic outcomes of IVF/ICSI in two groups were compared,and the correlation between LAP and outcome indexes analyzed.Results LAP and visceral adiposity index(VAI)were both valuable in diagnosing IR:The area under the curve(AUC)of LAP was 0.783,and the AUC of VAI was 0.724.Compared with the nor-LAP group,the high LAP group had higher levels of total amounts of gonadotropin(Gn)and early abortion rate,and lower rates of oocyte retrieval,metaphase Ⅱ(MⅡ)oocyte,oocyte utilization,high-quality embryos on the third day(D3)and clinical pregnancy.LAP was positively correlated with the total amount of Gn and negatively correlated with rates of MⅡ oocyte,two pronuclei fertilization,oocyte utilization,and D3 high-quality embryos.The above results were statistically significant(P<0.05).Conclusion LAP and VAI of infertile patients with PCOS have good screening value for IR,and exorbitant LAP is related to the negative clinical outcomes of IVF/ICSI.