高雄激素血症对PCOS患者新鲜周期胚胎移植妊娠结局的影响  

Effect of hyperandrogenism on pregnancy outcomes of fresh cycle embryo transfer in patients with polycystic ovary syndrome

作　　者：李卓[1] 杨纨[1] 杨蕊[1] 李蓉[1] Li Zhuo;Yang Wan;Yang Rui;Li Rong(Reproductive Medical Center,Department of Obstetrics and Gynecology,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院妇产科生殖医学中心,北京100191

出　　处：《中华生殖与避孕杂志》2023年第6期606-611,共6页Chinese Journal of Reproduction and Contraception

基　　金：北京市科技计划(Z191100006619085)。

摘　　要：目的:探究高雄激素血症对多囊卵巢综合征(polycystic ovarian syndrome,PCOS)患者进行新鲜周期移植后妊娠结局的影响。方法:回顾性队列研究分析2015年1月至2019年12月期间在北京大学第三医院妇产科生殖医学中心进行新鲜胚胎移植助孕的876例PCOS患者的临床资料,根据助孕治疗前血清雄激素水平是否升高(血清睾酮≥2.53 nmol/L或/和雄烯二酮≥11.5 nmol/L)分为高雄激素组(n=274)及非高雄激素组(n=602),比较两组患者妊娠结局,观察高雄激素血症对早期流产及早产妊娠结局的影响。结果:高雄激素组患者年龄[(30.23±3.63)岁]、体质量指数[(25.66±4.16)kg/m 2]、黄体生成素/卵泡刺激素水平(1.38±0.95)与非高雄激素组患者[(31.22±3.76)岁,P<0.001;(24.45±4.06)kg/m 2,P<0.001;0.99±2.06,P=0.004]相比,差异均有统计学意义。高雄激素组早期流产率[28.8%(79/274)]、早产率19.6%(32/163)与非高雄激素组[18.8%(113/602),P=0.001;8.9%(41/459),P<0.001]相比明显升高,活产率59.5%(163/274)比非高雄激素组[76.2%(459/602),P<0.001]明显下降。多因素分析调整混杂因素后结果仍具有统计学意义,高雄激素组患者活产率明显下降(a OR=2.248,95%CI:1.641~3.080),早期流产风险(a OR=1.869,95%CI:1.329~2.630)、早产风险(a OR=0.403,95%CI:0.240~0.675)明显增加。高雄激素是早期流产、活产和早产的独立影响因素。结论:高雄激素血症增加PCOS患者辅助生殖助孕后早期流产及早产风险,降低活产率。Objective To explore the effect of hyperandrogenism on the reproductive outcomes of patients with polycystic ovarian syndrome(PCOS).MethodsThis retrospective cohort study enrolled 876 patients with PCOS who underwent fresh in vitro fertilization/intracytoplasmic sperm injection at the Reproductive Medicine Center of Department of Obstetrics and Gynecology,Peking University Third Hospital.The patients were divided into hyperandrogenism group(n=274)and non-hyperandrogenism group(n=602)according to the androgen serum androgen levels(serum testosterone≥2.53 nmol/L or/and androstenedione≥11.5 nmol/L).The pregnancy outcomes of women with and without hyperandrogenism were compared.Multiple logistic regression models were used to eliminate essential impacts on early miscarriage and preterm birth outcomes.ResultsThere were significant differences in the age[(30.23±3.63)years vs.(31.22±3.76)years,P<0.001],body mass index[(25.66±4.16)kg/m2 vs.(24.45±4.06)kg/m2,P<0.001],luteinizing hormone/follicle-stimulating hormone(1.38±0.95vs.0.99±2.06,P=0.004)of patients between hyperandrogenism group and non-hyperandrogenism group(all P<0.05).Patients in hyperandrogenism group had higher rates of early miscarriage[28.8%(79/274)vs.18.8%(113/602,P=0.001],preterm birth[19.6%(32/163)vs.8.9%(41/459),P<0.001]and lower rate of live birth[59.5%(163/274)vs.76.2%(459/602),P<0.001]than those of non-hyperandrogenism group.After multivariate analysis adjusted for confounding factors including age,the conclusion remained unchanged.Compared with non-hyperandrogenism group,the live birth rate in hyperandrogenism group was significantly decreased(aOR=2.248,95%CI:1.641-3.080),while the risks of early miscarriage(aOR=1.869,95%CI:1.329-2.630)and preterm birth(aOR=0.403,95%CI:0.240-0.675)in hyperandrogenism group were significantly increased.Hyperandrogenism was an independent factor for the above pregnancy outcomes.ConclusionPCOS patients with hyperandrogenism may have higher rates of early miscarriage and preterm birth than those without hypera

关 键 词：高雄激素血症 多囊卵巢综合征 胚胎移植 早期流产 早产 活产 

分 类 号：R714.8[医药卫生—妇产科学] R711.75[医药卫生—临床医学]