中国实用妇科与产科杂志

中国实用妇科与产科杂志 ›› 2012, Vol. 28 ›› Issue (12): 928-931.

• 论著 • 上一篇    下一篇

中心型肥胖对多囊卵巢综合征不孕患者体外受精结局的影响

李予，马芸，陈晓莉，杨冬梓   

  1. 作者单位：中山大学孙逸仙纪念医院妇产科生殖中心，广东 广州510120
  • 出版日期:2012-12-02 发布日期:2012-11-19
  • 通讯作者: 杨冬梓
  • 基金资助:

    基金项目：广东省人口和计划生育委员会科研基金资助(2010242)

Central obesity had adverse effect on in vitro fertilization treatment in women with polycystic ovary syndrome.

LI Yu， MA Yun，CHEN Xiao-li，YANG Dong-zi.   

  • Online:2012-12-02 Published:2012-11-19
  • Contact: Yang Dong-zi

PDF

摘要：

目的：探讨中心型肥胖对多囊卵巢综合征(PCOS)不孕患者体外受精(IVF)结局的影响。方法：回顾性分析2009-2010年中山大学孙逸仙纪念医院 PCOS不孕患者行IVF治疗的188个新鲜周期，按照是否为中心型肥胖分为腰围≥80 cm组(70个周期)和腰围<80 cm组(118个周期)，比较两组基础内分泌代谢和IVF的临床及实验室参数。结果：腰围≥80 cm与腰围<80 cm组相比，体重指数(BMI)、腰臀比增加，血游离雄激素指数(FAI)高，性激素结合球蛋白(SHBG)低，空腹葡萄糖、空腹胰岛素、稳态胰岛素评价指数(HOMA-IR)、2 h口服葡萄糖耐量试验(OGTT2h)葡萄糖及胰岛素高，胰岛素抵抗、空腹血糖受损(IFG)、糖耐量异常(IGT)的发生率高，三酰甘油(TG)高、高密度脂蛋白(HDL)低，差异均有统计学意义(P<0.05)。校正BMI后，腰围与空腹胰岛素、HOMA-IR及FAI呈正相关(P<0.01);促性腺激素(Gn)用量[(2014.8±825.8)U vs.(1491.2±558.9)U ]及天数[(12.5±4.0)d vs.(10.7±3.0)d]增加(P<0.01)，峰值雌二醇水平低[(8492.7±4771.2)pmol/L vs.(11918.1±5329.0)pmol/L，P<0.001]，诱发卵子成熟的人绒毛膜促性腺激素(HCG)用量多(P=0.011)而成熟卵泡及获卵数少[(11.6±5.7)个vs.(13.8±7.3)个，P<0.05];胚胎种植率降低(24.3% vs.36.3%，P=0.019)，早期流产率增加(38.5% vs.7.5%，P=0.002)，临床妊娠率差异无统计学意义(40.6% vs.55.2%， P=0.07)。校正年龄及病因，Logistic回归分析显示HOMA-IR是PCOS患者IVF妊娠后早期流产的风险因素(OR=0.143，95%CI=0.026~0.768，P=0.023)。结论：中心型肥胖PCOS患者胰岛素抵抗和高雄激素血症更显著，糖脂代谢紊乱发生率高，负面影响PCOS患者IVF促排卵的反应，且胚胎种植率下降、早期流产率增加。

　　

　　　　　　　

关键词: 多囊卵巢综合征, 中心型肥胖, 体外受精, 妊娠结局

Abstract:

Reproductive Medicine Centre， Department of Gynecology and Obstetrics， Sun Yatsen Memorial Hospital of Sun Yatsen University， Guangzhou 510120， ChinaObjective：To determine whether central obesity has adverse effect on IVF treatment in women with polycystic ovary syndrome (PCOS). Methods：A retrospective study was performed in women undergoing IVF treatment with PCOS.Totally 188 IVF cycles were analyzed，and baseline characteristics，IVF parameters and treatment outcome were compared between women with waist circumstance (WC) of≥80cm (n=70) vs.those with WC of <80cm (n=118). Results：Central obesity women with PCOS had higher BMI and waisthip ratio，elevated free androgen index，more severe insulin resistance according to HOMA-IR and metabolic disorders including impaired fasting glucose，impaired glucose tolerance and dyslipidemia (P<0.05).After controlling BMI，WC was positive correlated with fasting insulin level，HOMA-IR and free androgen index (P<0.01).During IVF treatment they need more dose of gonadotrophin [(2014.8±825.8)U vs.(1491.2±558.9)U] but lower peak estradiol level [(8492.7±4771.2)pmol/L vs.(11918.1±5329.0)pmol/L，P<0.001]and less number of mature follicles (9.6±4.6 vs.11.5±5.2) and oocytes retrieved (11.6±5.7 vs.13.8±7.3)(P<0.05).And after IVF treatment，they had lower implantation rate (24.3% vs.36.3%，P<0.05) and increased early spontaneous miscarriage rate (38.5%vs.7.5%，P<0.05).Their clinical pregnancy rate showed no significantly difference (40.6%vs.55.2%，P=0.07). Fertilization rate，cleavage rate，available embryo and good embryo rates showed no significant differences.After controlling female age and primary infertility diagnosis，Logistic regression analysis showed that HOMAIR was the risk factor of early spontaneous miscarriage for PCOS women after IVF treatment，OR=0.143(95%CI=0.026~0.768，P=0.023). Conclusion：Central obesity deteriorates endocrinal and metabolic disorders,and had adverse effects on ovarian stimulation and pregnancy outcome in women with PCOS after IVF.

Key words: polycystic ovary syndrome, central obesity, in vitro fertilization, pregnancy outcome

中图分类号: