昼夜节律紊乱对PCOS患者性激素及IVF-ET结局的影响  

Impact of circadian rhythm disorder on hormones and IVF-ET outcomes in PCOS patients

作　　者：林玲 胡文惠 毛蕾 Lin Ling;Hu Wenhui;Mao Lei(Department of Reproductive Health and Infertility,Liangshan Yi Autonomous Prefecture Combined Traditional Chinese and Western Medicine Hospital,Liangshan Sichuan 615000;Center of Reproductive Medicine,Jinjiang District Maternal and Child Health Hospital,Chengdu Sichuan 610000,P.R.China)

机构地区：[1]凉山彝族自治州中西医结合医院生殖健康与不孕不育科,四川凉山615000 [2]成都市锦江区妇幼保健院生殖医学中心,四川成都610000

出　　处：《中国计划生育和妇产科》2025年第3期52-57,共6页Chinese Journal of Family Planning & Gynecotokology

基　　金：四川省科研课题计划(项目编号:S20033)。

摘　　要：目的探讨昼夜节律紊乱对多囊卵巢综合征(PCOS)患者性激素及体外受精-胚胎移植(IVF-ET)结局的影响。方法选取2021年1月至2023年12月凉山彝族自治州中西医结合医院收治的昼夜节律紊乱PCOS合并不孕患者100例(昼夜节律紊乱组),按照1∶1比例选择同期非昼夜节律紊乱PCOS合并不孕患者100例(昼夜节律正常组),根据IVF-ET结局将PCOS合并不孕患者分为结局不良组(86例)和结局良好组(114例)。检测性激素水平并收集IVF-ET相关指标,点二列相关系数分析PCOS患者昼夜节律紊乱与血清性激素水平的相关性;以PCOS患者IVF-ET结局为因变量,多因素非条件Logistic回归确定昼夜节律紊乱对其的影响,并绘制受试者工作特征曲线分析昼夜节律紊乱对其的预测效能。结果与昼夜节律正常组比较,昼夜节律紊乱组血清睾酮(T)、促黄体生成素(LH)、LH/FSH、抗苗勒管激素(AMH)水平升高,雌二醇(E_(2))、促卵泡生成素(FSH)水平降低(P均<0.05)。PCOS患者昼夜节律紊乱与血清T、LH、LH/FSH、AMH水平呈正相关(r=0.416、0.390、0.445、0.396,P均<0.05),与E_(2)、FSH水平呈负相关(r=-0.389、-0.375,P均<0.05)。与昼夜节律正常组比较,昼夜节律紊乱组获卵数、受精率、优胚率、临床妊娠率降低(P均<0.05)。调整混杂因素后(T、E_(2)、LH/FSH、AMH、获卵数、受精率、优胚率),昼夜节律紊乱(OR=7.885,95%CI:3.631-17.123,P<0.001)是PCOS患者IVF-ET结局不良的独立危险因素。昼夜节律紊乱预测PCOS患者IVF-ET结局不良的曲线下面积为0.745(95%CI:0.679-0.804),敏感度、特异度分别为77.91%、71.05%。结论昼夜节律紊乱与PCOS患者性激素紊乱和IVF-ET结局不良密切相关,昼夜节律紊乱对PCOS患者IVF-ET结局不良具有一定预测效能。Objective To investigate the effect of circadian rhythm disorder on sex hormones and in vitro fertilization-embryo transfer(IVF-ET)outcomes in patients with polycystic ovary syndrome(PCOS).Methods We selected 100 patients with PCOS and infertility combined with circadian rhythm disorder(circadian rhythm disorder group)from January 2021 to December 2023 in Liangshan Yi Autonomous Prefecture Combined Traditional Chinese and Western Medicine Hospital.Patients with PCOS and infertility but without circadian rhythm disorder(normal circadian rhythm group)in the same period were also selected according to a 1∶1 ratio.Based on IVF-ET outcomes,PCOS patients were divided into a poor outcome group(86 cases)and a good outcome group(114 cases).Serum hormone levels were measured,and IVF-ET related indicators were collected.The correlation between circadian rhythm disorder and serum hormone levels in PCOS patients was analyzed using point biserial correlation.Multivariate unconditional Logistic regression was used to determine the effect of circadian rhythm disorder on IVF-ET outcomes,and receiver operating characteristic(ROC)curves were plotted to analyze the predictive efficacy of circadian rhythm disorder on IVF-ET outcomes.Results Compared with the normal circadian rhythm group,the circadian rhythm disorder group had higher serum levels of testosterone(T),luteinizing hormone(LH),LH/FSH ratio,and anti-Müllerian hormone(AMH),and lower levels of estradiol(E_2)and follicle-stimulating hormone(FSH)(all P<0.05).Circadian rhythm disorder in PCOS patients was positively correlated with serum T,LH,LH/FSH,and AMH levels(r=0.416,0.390,0.445,0.396,all P<0.05)and negatively correlated with E_(2)and FSH levels(r=-0.389,-0.375,all P<0.05).Compared with the normal circadian rhythm group,the circadian rhythm disorder group had reduced numbers of oocytes retrieved,fertilization rates,embryo quality rates,and clinical pregnancy rates(all P<0.05).After adjusting for confounding factors(T,E_2,LH/FSH,AMH,number of oocytes retrieved,fertilizat

关 键 词：多囊卵巢综合征 昼夜节律紊乱 性激素 体外受精-胚胎移植 妊娠结局 

分 类 号：R711.75[医药卫生—妇产科学]