不同高雄激素血症表型多囊卵巢综合征患者的基线特征及针药联合促排卵后妊娠结局分析

Analysis of baseline features of polycystic ovary syndrome patients with different hyperandrogenism phenotypes and pregnancy outcomes after acupuncture combined with medication for ovulation induction

目的:通过比较不同高雄激素血症(HA)表型下多囊卵巢综合征(PCOS)患者的一般临床特征和生化指标,中医证候的分布以及针刺联合枸橼酸克罗米芬促排卵后的妊娠结局,以求探索临床最敏感的雄激素指标。方法:选择“针刺联合克罗米芬对PCOS不孕妇女活产的影响临床试验(PCOSACt)”948例受试者数据,根据总睾酮(TT)值和游离雄激素指数(FAI)值将患者分为:单TT升高为A组(143例)、单FAI升高为B组(160例)、两者均升高为C组(295例)、均不升高为D组(350例)。结果:A组BMI、WC、WHR、黑棘皮评分、FAI、FINS、HOMA-IR、TG、APOB、IR、高血脂症和脾虚痰湿型的发生率显著低于B、C组;SHBG、HDL-c和APOA1和肾虚肝郁型发生率显著高于B、C组(P<0.05)。B组收缩压和舒张压显著高于A组,AMH、LH、LH/FSH、TT显著低于A、C两组,BMI、FINS、HOMA-IR、TG和高脂血症发生率显著高于C组,TC、HDL-c、LDL-c、APOA1显著低于C组,痰瘀互结型发生率显著高于D组(P<0.05)。C组月经周期显著高于A组,排卵率、受孕率、临床妊娠率显著低于A、D组,活产率显著低于D组(P<0.05)。D组收缩压、舒张压、月经周期、TT、FT、FAI在各组最低;肾虚肝郁型发生率显著高于B、C组(P<0.05)。结论:TT升高常伴有更严重的性激素紊乱;FAI升高常伴有更严重的肥胖和糖脂代谢紊乱;二者同时升高并不会比单FAI升高时的代谢紊乱严重,但其排卵率、受孕率、临床妊娠率、活产率最低。

Objective:To identify the most sensitive androgen index of polycystic ovary syndrome(PCOS)under different hyperandrogenemia(HA)phenotypes by comparing general clinical and biochemical indexes,the distribution of traditional Chinese medicine syndromes,and pregnancy outcomes after acupuncture combine with clomifene ciarate.Methods:The data of 948 cases of‘clinical trial effect of acupuncture and clomiphene on the live birth of anovulatory women with polycystic ovary syndrome’were involved,and according to the total testosterone(TT)value and free androgen index(FAI)value,the patients were divided into 4 groups:group A(143 patients)with single TT increase,group B(160 patients)with single FAI increase,group C(295 patients)with both increases,and group D(350 patients)with neither increase.Results:Body mass index(BMI),waist circumference(WC),waist-hip ratio(WHR),acanthosis black score,FAI,fasting insulin(FINS),HOMAIR,triglycerides(TG),apolipoprotein B(APOB),the incidence of insulin resistance(IR),hyperlipidemia and spleen deficiency and phlegm dampness syndrome in group A were significantly lower than in groups B and C;the levels of sex hormone binding globulin(SHBG),high density lipoprotein-cholesterol(HDL-c)and apolipoprotein A1(APOA1)and the incidence of kidney deficiency and liver depression type were significantly higher than groups B and C(P<0.05).Group B had considerably greater SBP and DBP than group A,anti-Müllerian hormone(AMH),luteinizing hormone(LH),LH/follicle stimulating hormone(FSH)and TT were significantly lower than groups A and C,BMI,FINS,homeostasis model assessment of insulin resistance(HOMAIR),TG and the incidence of hyperlipidemia were significantly higher than those of group C,and total cholesterol(TC),HDL-c,low density lipoprotein-cholesterol(LDL-c)and APOA1 were significantly lower than those of group C,the incidence of phlegmblood stasis syndrome was significantly higher than that of group D(P<0.05).The menstrual cycle of group C was significantly longer than that of group A,the ovulation,conception and clinical pregnancy rate were significantly lower than those of groups A and D,and the live birth rate was significantly lower than that of group D(P<0.05).The SBP,DBP,menstrual cycle,TT,free testosterone(FT),FAI were all lowest in group D,and the incidence of kidney deficiency and liver depression were significantly more common than that of groups B and C(P<0.05).Conclusion:Elevated TT is often associated with more severe sex hormone disturbances,while FAI is connected with more serious obesity and disorders in the metabolism of glucose and lipid.When both of them are elevated at the same time,the metabolism is not worse than that of single FAI increase,but the ovulation,conception,clinical pregnancy and live birth rate are the worst in these groups.