PCOS患者外周血甾体激素水平与卵泡细胞成熟及助孕结局的关系分析

Relationship between levels of peripheral blood steroid hormones and follicle cells maturity,pregnancy outcomes in PCOS patients

目的探讨多囊卵巢综合征(PCOS)患者外周血甾体激素水平与卵泡细胞成熟及助孕结局的关系分析。方法选取159例因PCOS不孕患者作为观察组,另选取同期因输卵管因素不孕的患者40例作为对照组。两组患者均拟行体外受精-胚胎移植(IVF)计划。在促性腺激素刺激1周后,患者进行外周血甾体激素水平[雌二醇(E_(2))、孕酮(P)、睾酮(T)]和卵泡大小的检测,比较两组患者外周血甾体激素水平、卵泡细胞成熟数和临床妊娠率,分析PCOS患者外周血甾体激素水平与卵泡细胞成熟度及IVF结局的关系。结果观察组患者外周血E_(2)、P水平低于对照组,T水平高于对照组(t分别=2.52、2.44、-13.31,P均<0.05);观察组卵泡成熟数水平低于对照组(t=14.44,P<0.05);PCOS患者外周血E_(2)、P水平与卵泡成熟数水平呈正相关(r分别=0.49、0.28,P均<0.05);外周血T水平与卵泡成熟数呈负相关(r=-0.33,P<0.05)。观察组临床妊娠率为49.06%(78/159)低于对照组的67.50%(27/40),差异有统计学意义(χ^(2)=4.36,P<0.05)。观察组中PCOS妊娠者E_(2)、P水平高于未妊娠者,T水平低于未妊娠者(t分别=-2.09、-3.80、12.52,P均<0.05);联合检测外周血E_(2)、P、T水平可提高预测IVF结局的价值,灵敏度为83.33%,特异度为72.84%。结论PCOS患者存在甾体激素E_(2)、P、T水平紊乱现象,可能影响卵泡发育,外周血E_(2)、P、T水平的联合检测对卵泡发育情况及IVF结局具有较好的评估价值。

Objective To explore the relationship between levels of peripheral blood steroid hormones and follicle cells maturity,pregnancy outcomes in patients with polycystic ovary syndrome(PCOS).Methods A total of 159 patients with infertility due to PCOS and 40 patients with infertility due to fallopian tube were enrolled as observation group and control group,respectively.Both groups underwent elective in vitro fertilization-embryo transfer(IVF).After 1 week of gonadotropin stimulation,the levels of peripheral blood steroid hormones[estradiol(E_(2)),progesterone(P),testosterone(T)]and follicle size were detected.The levels of peripheral blood steroid hormones,follicle cells maturity and clinical pregnancy rate were compared between the two groups.The relationship between steroid hormones and follicle cells maturity,IVF outcomes was analyzed.Results The levels of peripheral blood E_(2) and P in observation group were lower than those in control group,while T level was higher than that in control group(t=2.52,2.44,-13.31,P<0.05).The level of follicle cells maturity in observation group was lower than that in control group(t=14.44,P<0.05).The levels of E_(2) and P in PCOS patients were positively correlated with follicle cells maturity(r=0.49,0.28,P<0.05),while T level was negatively correlated with follicle cells maturity(r=-0.33,P<0.05).The clinical pregnancy rate in observation group was lower than that in control group[49.06%(78/159)vs 67.50%(27/40)](χ^(2)=4.36,P<0.05).The levels of E_(2) and P in PCOS patients with pregnancy were higher than those without pregnancy,while T level was lower than that without pregnancy(t=-2.09,-3.80,12.52,P<0.05).Combined detection of E_(2),P and T levels in peripheral blood could improve the value of predicting IVF outcome,with a sensitivity of 83.33%and a specificity of 72.84%.Conclusion The levels of steroid hormones(E_(2),P,T)are disordered in PCOS patients,which may affect the development of follicles.The combined detection of E_(2),P and T levels in peripheral blood has a good evaluation value for follicular development and IVF outcome.