多囊卵巢综合征不孕伴胰岛素抵抗患者行IVF/ICSI-ET的临床结局分析  

Application of IVF/ICSI-ET in infertility patients with polycystic ovary syndrome combined with insulin resistance

作　　者：胥博 谢文燕[1] 付秀虹[1] 邵帅 陈媛 白爱红[1] 李荣香[1] Xu Bo;Xie Wenyan;Fu Xiuhong;Shao Shuai;Chen Yuan;Bai Aihong;Li Rongxiang(Center for Reproductive Medicine and Genetics,Luohe Central Hospital,Henan Key Laboratory of Fertility Protection and Aristogenesis,the First Affiliated Hospital of Luohe Medical College,Luohe 462000,China)

机构地区：[1]漯河市中心医院生殖医学与遗传中心、市厅共建河南省生育力保护和优生重点实验室、漯河医学高等专科学校第一附属医院,漯河462000

出　　处：《中华内分泌外科杂志》2022年第1期93-97,共5页Chinese Journal of Endocrine Surgery

基　　金：河南2018年科技发展计划项目(182102310577);漯河医学高等专科学校2020年度创新创业发展能力提升工程科研类项目(2020-LYZKYZD005)。

摘　　要：目的分析多囊卵巢综合征(PCOS)不孕伴胰岛素抵抗(IR)患者行体外受精/卵胞浆内单精子显微注射-胚胎移植(IVF/ICSI-ET)的临床结局分析。方法回顾性纳入2018年1月至2020年12月在漯河市中心医院行IVF/ICSI-ET的257例PCOS不孕患者,按照稳态模型评估胰岛素抵抗指数(HOMA-IR)水平(中位数2.5),将患者分为IR组(HOMA-IR≥2.5,130例)与非IR组(HOMA-IR<2.5,127例)。比较两组的基础性激素[促卵泡生成素(FSH)、促黄体生成素(LH)、雌二醇(E2)、睾酮(T)、孕激素(P)、抗苗勒管激素(AMH)]水平及窦卵泡数,空腹、服糖后30、60、120min时血糖及胰岛素水平,助孕妊娠结局指标[促性腺激素(Gn)使用时间及剂量、获卵数、受精率、优质胚胎率、卵巢过度刺激症(OHSS)发生率、着床率、临床妊娠率、生化妊娠率、流产率、活产率及妊娠期并发症];对临床结局的影响因素进行Logistic回归分析。结果IR组的基础LH[(8.86±1.60)mIU/ml vs(6.54±1.12)mIU/ml]、T[(63.20±7.47)ng/dl vs(52.11±5.69)ng/dl]水平均明显高于非IR组(P<0.05);不同时间点IR组的血糖及胰岛素水平均明显高于非IR组(P<0.05);IR组的Gn使用剂量[(1947.35±129.13)IU vs(1522.70±88.41)IU]、流产率[32.69%(17/52)vs 13.70%(10/73)]均明显高于非IR组(P<0.05),临床妊娠率[40.00%(52/130)vs 57.48%(73/127)]及活产率[51.92%(27/52)vs 72.60%(53/73)]均明显低于非IR组(P<0.05)。Logistic回归分析显示:年龄、BMI、基础LH、基础T、HOMA-IR是PCOS不孕患者行IVF/ICSI-ET临床结局的独立危险因素(P<0.05),基础AMH及Gn用量是临床结局的保护因素(P<0.05)。结论IR能对PCOS不孕患者行IVF/ICSI-ET的临床结局产生不良影响,HOMA-IR是临床结局的危险因素,对于PCOS不孕患者应当及时评估IR情况。Objective To analyze the clinical outcome of vitro fertilization/intracytoplasmic sperm injection-embryo transfer(IVF/ICSI-ET)in infertile patients with polycystic ovary syndrome(PCOS)combined with insulin resistance(IR).Methods A total of 257 PCOS infertile patients undergoing IVF/ICSI-ET from Jan.2018 to Dec.2020 were included and retrospectively analyzed.The patients were divided into IR group(HOMA-IR≥2.5,130 cases)and non-IR group(HOMA-IR<2.5,127 cases)according to the level(median 2.5)of homeostasis model assessment of insulin resistance index(HOMA-IR).The levels of basic sex hormones[follicular stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E2),testosterone(T),progestational hormone(P),anti-mullerian hormone(AMH)]and numbers of basic sinus follicles,levels of blood glucose and insulin at 30min,60min and 120min after glucose administration and fasting and proconceptive pregnancy outcome indicators[gonadotropin(Gn)use time and dose,number of eggs obtained,fertilization rate,high-quality embryonic rate,occurrence rate of ovarian hyperstimulation syndrome(OHSS),implantation rate,clinical pregnancy rate,biochemical pregnancy rate,abortion rate,live birth rate and pregnancy complications]were compared between the two groups.The influencing factors of clinical outcomes were analyzed by Logistic regression.Results The levels of basic LH[(8.86±1.60)mIU/ml vs(6.54±1.12)mIU/ml],T[(63.20±7.47)ng/dl vs(52.11±5.69)ng/dl]in IR group was significantly higher than those in non-IR group(P<0.05).At different time-point,the levels of blood glucose and insulin in IR group were significantly higher than those in non-IR group(P<0.05).The Gn dose[(1947.35±129.13)IU vs(1522.70±88.41)IU]and abortion rate[32.69%(17/52)vs 13.70%(10/73)]in IR group was significantly higher than those in non-IR group(P<0.05),and the clinical pregnancy rate[40.00%(52/130)vs 57.48%(73/127)]and live birth rate[51.92%(27/52)vs 72.60%(53/73)]was significantly lower than those in non-IR group(P<0.05).Logistic regression analysis showed tha

关 键 词：不孕症 多囊卵巢综合征 胰岛素抵抗 体外受精/卵胞浆内单精子显微注射-胚胎移植 临床结局 

分 类 号：R713[医药卫生—妇产科学]