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多囊卵巢综合征患者卵胞质内单精子注射周期低卵子成熟率的相关因素分析
高文怡, 柳静, 李采霞, 张艳茹, 金鑫, 邓云, 朱瑾
中国实用妇科与产科杂志 ›› 2026, Vol. 42 ›› Issue (7) : 745-749.
PDF(1509 KB)
PDF(1509 KB)
多囊卵巢综合征患者卵胞质内单精子注射周期低卵子成熟率的相关因素分析
Analysis of related factors for low oocyte maturation rate in polycystic ovary syndrome patients undergoing intracytoplasmic sperm injection cycles
目的 探讨卵子成熟率对多囊卵巢综合征（PCOS）患者卵胞质内单精子注射（ICSI）周期胚胎发育及临床结局的影响，并分析其相关因素。方法 回顾性分析2020年1月至2025年12月于中国人民解放军联勤保障部队第904医院首次行ICSI周期的490例PCOS患者临床资料。根据维也纳共识所示卵子成熟率能力值将患者分成两组：A组（≥75%）与B组（<75%）。比较两组间基线资料、胚胎发育情况及临床结局的差异。采用受试者工作特征（ROC）曲线评估卵子成熟率对临床结局的预测价值并确定最佳截断值。采用多因素二元logistic回归分析筛选低卵子成熟率的独立影响因素。结果 两组患者基线资料差异无统计学意义（P>0.05）。随着卵子成熟率的降低，正常受精率、D3优质胚胎率、囊胚形成率、临床妊娠率及活产率均下降（P<0.05）。ROC曲线分析显示，卵子成熟率预测临床妊娠率的曲线下面积（AUC）为0.617[95%置信区间（CI） 0.566~0.668，P<0.05]，预测活产的AUC为0.621（95% CI 0.571~0.670，P<0.05），最佳截断值均为86.82%。多因素logistic回归分析显示，基础抗米勒管激素（AMH）[比值比（OR）=1.258，95% CI 1.010~1.566，P=0.04]、睾酮（T）（OR=13.447，95% CI 2.411~74.980，P<0.01）以及获卵数（OR=1.104，95% CI 1.022~1.193，P=0.01）是低卵子成熟率的独立风险因素，而基础雌二醇（E2）与T的交互项是其保护因素（OR=0.942，95% CI 0.899~0.988，P=0.01）。结论 PCOS患者ICSI周期中，较低的卵子成熟率对胚胎质量及临床结局不利。基础AMH、T、获卵数是低卵子成熟率的独立风险因素，基础E2可削弱高雄激素的负面影响。
Objective To investigate the impact of oocyte maturation rate on embryonic development and clinical outcomes in polycystic ovary syndrome （PCOS） patients undergoing intracytoplasmic sperm injection （ICSI） cycles，and to analyze its related factors. Methods A retrospective analysis was performed on the clinical data of 490 PCOS patients undergoing their first ICSI cycle in the 904th Hospital of the Joint Logistic Support Force of PLA from January 2020 to December 2025. Patients were divided into two groups according to the minimum performance （competence） levels for oocyte maturation rate recommended by the Vienna consensus：Group A （≥ 75%） and Group B （< 75%）. Baseline characteristics，embryonic development，and clinical outcomes were compared between the two groups. The receiver operating characteristic （ROC） curves were used to evaluate the predictive value of oocyte maturation rate for clinical outcomes and to determine the optimal cutoff value. Multivariate binary logistic regression analysis was used to identify independent influencing factors associated with low oocyte maturation rate. Results No statistically significant differences were observed in baseline characteristics between the two groups （P>0.05）. As the oocyte maturation rate decreased，the rates of normal fertilization，Day 3 high-quality embryos，blastocyst formation，clinical pregnancy，and live birth all declined （P<0.05）. ROC curve analysis revealed that the area under the curve （AUC） for oocyte maturation rate in predicting clinical pregnancy rate was 0.617 （95% CI 0.566-0.668，P<0.05），and for predicting live birth it was 0.621 （95% CI 0.571-0.670，P<0.05），with an optimal cutoff value of 86.82% for both. Multivariate logistic regression analysis showed that basal anti-Müllerian hormone （AMH） （OR=1.258，95% CI 1.010-1.566，P=0.04），testosterone （T） （OR=13.447，95% CI 2.411-74.980，P<0.01），and the number of retrieved oocytes （OR=1.104，95% CI 1.022-1.193，P=0.01） were independent risk factors for low oocyte maturation rate，while the interaction term between basal estradiol （E2） and T was a protective factor （OR=0.942，95% CI 0.899-0.988，P=0.01）. Conclusions In ICSI cycles of PCOS patients，a low oocyte maturation rate adversely affects embryo quality and clinical outcomes. Basal AMH，T，and the number of retrieved oocytes are independent risk factors for low oocyte maturation rate，while basal E2 may mitigate the negative impact of hyperandrogenism.
卵子成熟率 / 多囊卵巢综合征 / 卵胞质内单精子注射 / 临床结局
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所有作者均声明不存在利益冲突
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