血Hcy水平对PCOS患者FET治疗流产风险的预测价值  

Predictive value of serum HCY level on the risk of miscarriage in patients with PCOS undergoing FET

作　　者：林仲珊 姜小花 俞淑君 郭培培[1,2,3] 周平 曹云霞[1,2,3] 魏兆莲 Lin Zhongshan;Jiang Xiaohua;Yu Shujun;Guo Peipei;Zhou Ping;Cao Yunxia;Wei Zhaolian(Reproductive Medicine Center,Dept of Obstetrics and Gynecology,The First Affiliated Hospital of Anhui Medical University,Hefei 230022;Anhui Province Key Laboratory of Reproductive Health and Genetics,Hefei 230032;Biopreservation and Artificial Organs,Anhui Provincial Engineering Research Center,Anhui Medical University,Hefei 230032)

机构地区：[1]安徽医科大学第一附属医院妇产科生殖医学中心,合肥230022 [2]安徽医科大学生殖健康与遗传安徽省重点实验室,合肥230032 [3]安徽省生命资源保存与人工器官工程技术研究中心,合肥230032

出　　处：《安徽医科大学学报》2022年第9期1503-1507,共5页Acta Universitatis Medicinalis Anhui

基　　金：安徽省重点研究与开发计划项目(编号:202104j07020036)。

摘　　要：目的探讨血同型半胱氨酸(Hcy)水平对多囊卵巢综合征(PCOS)患者行冻融胚胎移植(FET)治疗后流产的预测价值。方法回顾性分析首次行FET治疗的536例PCOS患者和550例输卵管因素非PCOS患者(对照组)临床资料,比较两组间的基础资料和妊娠结局。对PCOS患者中流产组与活产组的基础资料进行比较,分析Hcy对PCOS患者FET治疗后流产的预测价值。结果与对照组比较,PCOS组的体质量指数(BMI)、睾酮(T)、Hcy、空腹胰岛素(FINS)、胰岛素抵抗的稳态模型(HOMA-IR)、总胆固醇(TC)、获卵数及流产率升高,而高密度脂蛋白胆固醇(HDL-C)、优质胚胎率及活产率降低,差异有统计学意义(P<0.05);与PCOS患者中活产组比较,流产组患者Hcy、FINS及HOMA-IR升高,差异有统计学意义(P<0.05);Hcy、FINS、HOMA-IR均是PCOS患者流产的独立危险因素,且Hcy对PCOS患者流产的预测价值高于FINS和HOMA-IR,其ROC曲线下面积(AUC)为0.829(95%CI=0.755~0.902,P<0.001),最佳临界值为15.975μmol/L,灵敏度为79.0%,特异度为87.4%,对PCOS患者流产具有较高的预测价值。结论PCOS患者多伴有血Hcy水平明显升高,血Hcy水平对FET治疗后流产具有重要的预测价值。Objective To investigate the predictive value of serum homocysteine(HCY)level on the risk of miscarriage in polycystic ovary syndrome(PCOS)patients undergoing frozen-thawed embryo transfer(FET).Methods 536 PCOS patients and 550 non-PCOS patients with fallopian tube factors(control group)retrospectively were analyzed.The basic characteristics and pregnancy outcomes were compared between the two groups.Also,the basic characteristics between the miscarriage group and the live birth group in PCOS patients were compared.The predictive value of Hcy on the miscarriage of PCOS patients after FET treatment was analyzed.Results Compared with the control group,body mass index(BMI),testosterone(T),Hcy,fasting insulin(FINS),homeostasis model assessment of insulin resistance(HOMA-IR),total cholesterol(TC),number of retrieved oocytes and miscarriage rate increased in PCOS group,while high density lipoprotein-cholesterol(HDL-C),high-quality embryo rate and live birth rate decreased,and the differences were statistically significant(P<0.05).Among PCOS patients,Hcy,FINS and HOMA-IR increased in the miscarriage group compared with live birth group,and the differences were statistically significant(P<0.05).Hcy,FINS and HOMA-IR were independent risk factors for miscarriage in PCOS patients,and the predictive value of Hcy for miscarriage in PCOS patients was greater than FINS and HOMA-IR,and the area under ROC curve(AUC)was 0.829(95%CI=0.755-0.902,P<0.001),the cut-off value was 15.975μmol/L with a 79.0%sensitivity and a 87.4%specificity,which indicated high predictive value for miscarriage in patients with PCOS.Conclusion Serum Hcy level significantly increased in PCOS patients,which has an important predictive value for miscarriage after FET treatment.

关 键 词：多囊卵巢综合征 同型半胱氨酸 妊娠结局 流产 

分 类 号：R711.6[医药卫生—妇产科学]