多囊卵巢综合征患者冷冻胚胎第一周期移植妊娠结局的影响因素分析

Analysis of factors affecting the pregnancy outcome of frozen embryo transfer cycle in patients with polycystic ovary syndrome

目的探讨可能导致多囊卵巢综合征(PCOS)患者不同妊娠结局的危险因素,为临床治疗提供依据。方法该研究包括了988例因PCOS导致不孕并于河北医科大学第二医院接受冷冻胚胎第一周期移植的患者。根据其妊娠结局分为6组:PCOS临床妊娠组(n=595)、PCOS未临床妊娠组(n=393);PCOS活产组(n=525)、PCOS妊娠丢失组(n=463);PCOS流产组(n=70)、PCOS继续妊娠组(n=525)。比较其年龄,不孕年限,体重指数(BMI),基础性激素水平[雌激素(E_(2))、促黄体生成素(LH)、孕激素(P)、睾酮(T)、抗缪勒氏管激素(AMH)],甲状腺功能[促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)]、脂代谢水平[总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)、载脂蛋白A1(Apo-A1)、载脂蛋白B(Apo-B)、脂蛋白a(Lp(a)],空腹血糖水平(GLU),移植日子宫内膜厚度,移植胚胎数的差异,通过多元logistic回归分析得到影响PCOS患者妊娠结局的独立危险因素,并通过平滑曲线拟合以及阈值效应分析进一步量化其对妊娠结局的影响程度。结果活产组患者BMI、FSH、E_(2)、T、TG、LDL-C水平以及高脂血症患病率明显高于妊娠丢失组(P<0.05);LH、FT4、GLU水平明显低于妊娠丢失组(P<0.05)。多因素logistic回归分析显示FSH、LDL-C、LH及患有高脂血症是PCOS患者活产的独立影响因素(P<0.05)。其中,FSH、LDL-C以及高脂血症为危险因素,LH为保护因素。平滑曲线拟合显示:FSH水平对PCOS患者活产率的影响呈先下降后上升的曲线关系,LDL-C水平对PCOS活产率的影响呈波动下降的曲线关系,LH水平对活产率的影响呈上升,后波动下降的趋势。结论FSH、LDL-C以及高脂血症为影响PCOS患者活产的危险因素,而LH水平为影响PCOS患者活产与否的保护因素,提示临床医生应尽量控制PCOS患者FSH、LH水平,积极纠正血脂异常。

Objective To identify the risk factors for pregnant outcomes in patients with polycystic ovary syndrome(PCOS),thus providing references for clinical management.Methods A total of 988 patients with PCOS-induced infertility who received the first cycle of frozen embryo transfer(FET)in the Second Hospital of Hebei Medical University were recruited.They were divided into 6 groups according to their pregnancy outcomes:group of PCOS clinical pregnancy(n=595),group of PCOS non-clinical pregnancy(n=393),group of PCOS live birth(n=525),group of PCOS pregnancy loss(n=463),group of PCOS abortion(n=70),and group of PCOS continued pregnancy(n=525).Their age,infertility duration,body mass index(BMI),Estradiol(E-2),luteinizing hormone(LH),progesterone(P),testosterone(T),anti-Mullerian hormone(AMH),thyroid-stimulating hormone(TSH),free triiodothyronine(FT3),free thyroxine(FT4),total cholesterol(TC),triglycerides(TG),high-density lipoprotein cholesterol(H-DLC),low-density lipoprotein cholesterol(L-DLC),apolipoprotein A1(Apo-A1),apolipoprotein B(Apo B),lipoprotein a(Lp(a)),fasting serumglucose(GLU),the endometrial thickness on the day of FET,and the number of transferred embryos were compared.Multivariable logistic regression analysis was performed to identify independent risk factors for the pregnancy outcome of PCOS patients,and their influences on pregnant outcomes were further quantitively detected by the smooth-curve fitting and threshold effect analysis.Results BMI,FSH,E-2,T,TG and L-DLC levels and the prevalence of hyperlipidemia in the group of PCOS live birth were significantly higher than those in the group of PCOS pregnancy loss,while LH,FT4 and GLU levels were significantly lower(all P<0.05).Multivariate logistic regression analysis showed that FSH,L-DLC,LH and hyperlipidemia were significantly correlated with live birth in PCOS patients(P<0.05).Among them,FSH,L-DLC and hyperlipidemia were risk factors,and LH was a protective factor for live birth in PCOS patients.The smooth-curve fitting analyzed showed a curved relationship of FSH level with the live birth rate of PCOS patients,which was firstly decreased and then increased.L-DLC level presented a curved relationship with the live birth rate of PCOS patients,which was a downward and fluctuating trend.The effect of LH level on the live birth rate of PCOS patients increased at first and then showed a downward and fluctuating trend.Conclusion FSH,L-DLC and hyperlipidemia are risk factors for live birth in PCOS patients,while LH level is a protective factor.Our findings recommended that FSH and LH levels should be controlled in PCOS patients and dyslipidemia should be actively corrected.