摘要
目的:探讨胰岛素抵抗(IR)对不明原因反复种植失败(URIF)患者妊娠结局的影响,并评估二甲双胍的潜在治疗价值。方法:回顾性分析2019年1月至2022年2月在柳州市妇幼保健院及广西医科大学第一附属医院生殖中心接受体外授精/卵泡浆内单精子注射—胚胎移植(IVF/ICSI-ET)治疗的335例URIF患者的临床资料。根据是否接受二甲双胍治疗分为二甲双胍组和对照组,每组又根据IR稳态模型评估(HOMA-IR)指数分为IR组与非IR组。主要结局为活产率,次要结局包括临床妊娠率及早期妊娠丢失率。采用多因素logistic回归分析方法分析影响URIF患者妊娠结局的危险因素。结果:IR组早期妊娠丢失率高于非IR组(24.11%vs.13.77%,P<0.05),但两组活产率及临床妊娠率比较,差异无统计学意义(26.79%vs.30.43%,P=0.526;38.39%vs.42.75%,P=0.486)。校正混杂因素后,IR仍是早期妊娠丢失的独立危险因素(OR=1.385,95%CI:1.035~2.508,P<0.05)。二甲双胍治疗可降低IR组早期妊娠丢失率(15.63%vs.30.36%,P<0.05)。结论:IR是URIF患者早期妊娠丢失的独立危险因素,二甲双胍或可通过改善IR提高妊娠维持率,但其对活产结局的长期影响需进一步验证。
Objective:To investigate the impact of insulin resistance(IR)on pregnancy outcomes in patients with unexplained recurrent implantation failure(URIF)and evaluate the potential therapeutic value of metformin.Methods:A retrospective analysis was performed on the clinical data of 335 patients with URIF who underwent in vitro fertilization/intracytoplasmic sperm injection-embryo transfer(IVF/ICSI-ET)treatment at Liuzhou Municipal Maternity and Child Health Care Hospital and Guangxi Reproductive Medical Center of the First Affiliated Hospital of Guangxi Medical University between January 2019 and February 2022.Patients were stratified into metformin and control groups according to whether they received metformin treatment,with further subdivision based on homeostasis model assessment of IR(HOMA-IR)index into IR and non-IR subgroups.The primary outcome was live birth rate;the secondary outcomes included clinical pregnancy rate and early pregnancy loss rate.Multivariate logistic regression analysis was used to identify the risk factors affecting pregnancy outcomes in URIF patients.Results:The IR group showed significantly higher early pregnancy loss rate than non-IR group(24.11%vs.13.77%,P<0.05),while there were no statistically significant differences in the live birth rate and clinical pregnancy rate between the two groups(30.43%vs.26.79%,P=0.526;42.75%vs.38.39%,P=0.486).After adjusting for confounding factors,IR remained an independent risk factor for early pregnancy loss(OR=1.385,95%CI:1.035-2.508,P<0.05);metformin treatment reduced the early pregnancy loss rate in the IR group(15.63%vs.30.36%,P<0.05).Conclusion:IR is an independent risk factor for early pregnancy loss in URIF patients.Metformin may improve pregnancy maintenance by ameliorating IR,though its long-term effects on live birth require further validation.
作者
马文红
曾中虹
杨一华
李蓉
磨丹
MA Wenhong;ZENG Zhonghong;YANG Yihua;LI Rong;MO Dan(Nanning Maternity and Child Health Care Hospital,Nanning 530011,China;Guangxi Reproductive Medical Center,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China;Center for Reproductive Medicine,Peking University Third Hospital,Beijing 100191,China;Liuzhou Municipal Maternity and Child Health Care Hospital,Liuzhou 545001,China)
出处
《广西医科大学学报》
2025年第4期567-573,共7页
Journal of Guangxi Medical University
基金
国家自然科学基金资助项目(No.82360308)。
关键词
不明原因反复种植失败
胰岛素抵抗
二甲双胍
妊娠结局
unexplained recurrent implantation failure
insulin resistance
metformin
pregnancy outcomes
