子宫内膜异位症患者血清性激素和性激素结合蛋白水平与不孕不育的关系  

The Relationship Between Serum Sex Hormones and Sex Hormone Binding Protein Levels and Infertility in Patients with Endometriosis

作　　者：范文秀 梅欢 陆杭铖 曹景云 邹小飞 FAN Wenxiu;MEI Huan;LU Hangcheng;CAO Jingyun;ZOU Xiaofei(Department of Reproductive Technology,Changzhou Maternal and Child Health Hospital,Nanjing Medical University Changzhou Medical Center,Changzhou,Jiangsu 213000,China;Department of General Gynecology,Changzhou Maternal and Child Health Hospital,Nanjing Medical University Changzhou Medical Center,Changzhou,Jiangsu 213000,China)

机构地区：[1]南京医科大学常州医学中心,常州市妇幼保健院生育技术科,江苏常州213000 [2]南京医科大学常州医学中心,常州市妇幼保健院普通妇科,江苏常州213000

出　　处：《转化医学杂志》2024年第4期544-547,共4页Translational Medicine Journal

基　　金：常州市卫健委青年项目(QN202243)。

摘　　要：目的探讨子宫内膜异位症患者血清性激素和性激素结合蛋白(SHBG)水平与不孕不育的关系。方法回顾性分析2022年1月至2023年12月在常州市妇幼保健院确诊为子宫内膜异位症的患者88例。依据患者不孕不育症情况分为不孕不育组(n=41)和孕育正常组(n=47)。比较2组患者的一般资料;采用酶联免疫吸附法(ELISA)对血清促黄体生成素(LH)、雌二醇(E2)、卵泡刺激成素(FSH)和SHBG的水平进行测定;Logistic回归分析子宫内膜异位症患者不孕不育的影响因素;受试者工作特征(ROC)曲线分析血清性激素和SHBG对子宫内膜异位症患者发生不孕不育的评估价值。结果不孕不育组与孕育正常组患者的年龄、体质量指数(BMI)、病程、合并疾病、痛经史、人工流产或宫腔操作史比较差异无统计学意义(P>0.05)。不孕不育组患者血清LH、E2、FSH水平高于孕育正常组(P<0.05);不孕不育组患者血清SHBG水平低于孕育正常组(P<0.05)。Logistic回归分析结果显示,LH、E2、FSH均为子宫内膜异位症患者发生不孕不育的危险因素(P<0.05),SHBG为子宫内膜异位症患者发生不孕不育的保护因素(P<0.05)。ROC曲线分析结果显示,LH、E2、FSH、SHBG及四者联合对子宫内膜异位症患者发生不孕不育预测的灵敏度分别为70.73%、78.05%、73.17%、85.37%、90.24%,特异度分别为93.62%、87.23%、91.49%、63.83%、93.62%,曲线下面积(AUC)分别为0.889、0.867、0.860、0.811、0.959。且LH、E2、FSH、SHBG四者联合的预测价值高于单独预测(Z_(四者联合-LH)=2.157,P=0.031;Z_(四者联合-E2)=2.542,P=0.011;Z_(四者联合-FSH)=2.357,P=0.018;Z_(四者联合-SHBG)=3.469,P=0.001)。结论患有不孕不育的子宫内膜异位症患者血清LH、E2、FSH水平均升高,SHBG水平降低,LH、E2、FSH及SHBG对子宫内膜异位症患者发生不孕不育具有预测效能,且四者联合的预测价值优于单独预测。Objective To explore the relationship between serum sex hormones and sex hormone binding protein(SHBG)levels and infertility in patients with endometriosis.Method A retrospective analysis was conducted on 88 patients diagnosed with endometriosis at our hospital from January 2022 to December 2023.Patients were divided into an infertility group(n=41)and a normal pregnancy group(n=47)based on their infertility status,and the general clinical data of the two groups were compared.Enzyme-linked immunosorbent assay(ELISA)was used to measure the levels of serum luteinizing hormone(LH),estradiol(E2),follicle-stimulating hormone(FSH),and SHBG.Logistic regression analysis was performed to identify the influencing factors of infertility in patients with endometriosis.The evaluation value of receiver operating characteristic(ROC)analysis was evaluated for serum sex hormones and SHBG in the occurrence of infertility in patients with endometriosis.Results There was no statistically significant difference in age,body mass index(BMI),course of disease,comorbidities,history of dysmenorrhea,number of abortions,or history of uterine cavity surgery between the infertile and normal pregnancy groups(P>0.05).The serum LH,E2,and FSH levels of patients in the infertility group were higher than those in the normal pregnancy group(P<0.05).The serum SHBG levels of patients in the infertility group were lower than those in the normal pregnancy group(P<0.05).The results of logistic multivariate analysis showed that LH,E2,and FSH were all risk factors for infertility in patients with endometriosis(P<0.05),while SHBG was a protective factor for infertility in patients with endometriosis(P<0.05).The ROC curve analysis results showed that the sensitivity of LH,E2,FSH,SHBG,and their combination in predicting infertility in patients with endometriosis was 70.73%,78.05%,73.17%,85.37%,and 90.24%,respectively.The specificity was 93.62%,87.23%,91.49%,63.83%,and 93.62%,respectively.The AUC was 0.889,0.867,0.860,0.811,and 0.959,respectively.The combined p

关 键 词：子宫内膜异位症 性激素 性激素结合蛋白 不育 女性 预测效能 Logistic模型 ROC曲线 曲线下面积 

分 类 号：R711.71[医药卫生—妇产科学]