摘要
目的:研究超重肥胖型多囊卵巢综合征(PCOS)不孕症患者糖脂代谢及血清性激素、抗米勒管激素(AMH)、同型半胱氨酸(HCY)水平与临床妊娠的关系。方法:回顾性选取2021年8月至2024年2月郑州大学附属郑州中心医院收治的105例超重肥胖型PCOS不孕症患者(研究组)及同期50例超重肥胖不伴PCOS人群(对照组)的临床资料,比较两组糖脂代谢、血清性激素与AMH、HCY水平,研究组按随访结局分为临床妊娠亚组(55例)、临床未妊娠亚组(50例),分析不同组各指标的相关性及各指标对妊娠结局的预测价值。结果:研究组空腹血糖(FPG)、胰岛素抵抗指数(HOMA-IR)、载脂蛋白A1(ApoA1)、载脂蛋白B(ApoB)、总胆固醇(TC)、甘油三酯(TG)分别为(5.14±0.52)mmol/L、4.22±0.45、(2.06±0.27)g/L、(1.95±0.32)g/L、(6.11±0.65)mmol/L、(2.65±0.28)mmol/L,明显高于对照组[(4.68±0.51)mmol/L、1.18±0.19、(1.84±0.21)g/L、(1.47±0.18)g/L、(4.82±0.53)mmol/L、(2.07±0.26)mmol/L;t=5.180、45.803、5.074、9.878、11.846、12.331,P<0.001]。研究组高密度脂蛋白胆固醇(HDL-C)为(0.89±0.10)mmol/L,明显低于对照组[(1.03±0.15)mmol/L;t=6.885,P<0.001]。研究组血清卵泡刺激素(FSH)、黄体生成素(LH)、LH/FSH、睾酮(T)、AMH及HCY分别为(6.24±0.65)mIU/mL、(9.85±1.02)mIU/mL、1.60±0.17、(0.78±0.10)ng/mL、(13.18±1.42)ng/mL、(11.84±1.26)μmol/L,明显高于对照组[(4.89±0.52)mIU/mL、(7.63±0.79)mIU/mL、1.54±0.16、(0.55±0.13)ng/mL、(6.73±0.75)ng/mL、(6.57±0.68)μmol/L;t=12.851、13.566、2.093、12.114、30.144、27.686,P<0.05]。研究组血清AMH与LH/FSH、T呈正相关(r=0.657、0.746,P<0.05),HCY与FSH、T呈正相关(r=0.715、0.567,P<0.05)。临床妊娠亚组血清LH、LH/FSH、AMH、HCY水平分别为(9.55±0.97)mIU/mL、1.52±0.16、(12.88±1.41)ng/mL、(10.91±1.15)μmol/L,明显低于临床未妊娠亚组[(10.18±1.14)mIU/mL、1.63±0.17、(13.52±1.36)ng/mL、(12.86±1.34)μmol/L;t=3.568、3.921、2.362、9.348,P<0.05]。LH/FSH、AMH及HCY水平升高为超重肥胖型PCOS不孕症患者临床未妊娠的危险因素(OR=1.756、1.817、1.647,P<0.05);LH/FSH、AMH、HCY联合预测超重肥胖PCOS患者临床未妊娠的ROC曲线下面积为0.854,高于各指标单独预测结果(曲线下面积分别为0.776、0.812、0.803)。结论:超重肥胖型PCOS不孕症患者糖脂代谢、性激素紊乱较严重,且AMH及HCY水平升高;AMH和HCY水平与临床妊娠关系密切。
Objective:To investigate the relationship of serum glucose and lipid metabolism,sex hormones,anti-Müllerian hormone(AMH),homocysteine(HCY),and clinical pregnancy in overweight/obese infertile patients with polycystic ovary syndrome(PCOS).Methods:A retrospective analysis was conducted on 105 overweight/obese infertile patients with PCOS(study group)and 50 overweight/obese individuals without PCOS(control group)admitted to Zhengzhou Central Hospital Affiliated to Zhengzhou University from Aug.2021 to Feb.2024.The two groups were compared in terms of glucose and lipid metabolism,serum sex hormones,AMH,and HCY levels.The study group was further divided into clinical pregnancy subgroup(n=55)and clinical non-pregnancy subgroup(n=50)based on follow-up outcomes.The correlation of various indicators,and their predictive value for pregnancy outcomes were analyzed.Results:The fasting plasma glucose(FPG),insulin resistance index(HOMA-IR),apolipoprotein A1(ApoA1),apolipoprotein B(ApoB),total cholesterol(TC),and triglyceride(TG)levels in the study group[(5.14±0.52)mmol/L,4.22±0.45,(2.06±0.27)g/L,(1.95±0.32)g/L,(6.11±0.65)mmol/L and(2.65±0.28)mmol/L]were significantly higher than those in the control group[(4.68±0.51)mmol/L,1.18±0.19,(1.84±0.21)g/L,(1.47±0.18)g/L,(4.82±0.53)mmol/L and(2.07±0.26)mmol/L;t=5.180,45.803,5.074,9.878,11.846,12.331,P<0.001].High-density lipoprotein cholesterol(HDL-C)level in the study group[(0.89±0.10)mmol/L]was significantly lower than that in the control group[(1.03±0.15)mmol/L;t=6.885,P<0.001].Serum follicle-stimulating hormone(FSH),luteinizing hormone(LH),LH/FSH,testosterone(T),AMH and HCY levels in the study group[(6.24±0.65)mIU/mL,(9.85±1.02)mIU/mL,1.60±0.17,(0.78±0.10)ng/mL,(13.18±1.42)ng/mL and(11.84±1.26)μmol/L]were significantly higher than those in the control group[(4.89±0.52)mIU/mL,(7.63±0.79)mIU/mL,1.54±0.16,(0.55±0.13)ng/mL,(6.73±0.75)ng/mL and(6.57±0.68)μmol/L;t=12.851,13.566,2.093,12.114,30.144,27.686,P<0.05].In the study group,serum AMH was positively correlated with LH/FSH and T(r=0.657,0.746,P<0.05),and HCY was positively correlated with FSH and T(r=0.715,0.567,P<0.05).The level of serum LH,LH/FSH,AMH and HCY in the clinical pregnancy subgroup[(9.55±0.97)mIU/mL,1.52±0.16,(12.88±1.41)ng/mL and(10.91±1.15)μmol/L]were significantly lower than those in the clinical non-pregnancy subgroup[(10.18±1.14)mIU/mL,1.63±0.17,(13.52±1.36)ng/mL and(12.86±1.34)μmol/L;t=3.568,3.921,2.362,9.348,P<0.05].Elevated levels of LH/FSH,AMH and HCY are risk factors for clinical non-pregnancy in infertile patients with overweight and obese PCOS(OR=1.756,1.817,1.647,P<0.05).The area under the ROC curve of the combined prediction of LH/FSH,AMH and HCY for clinical non-pregnancy in overweight/obese PCOS patients was 0.854,which was higher than the individual prediction results of each index(0.776,0.812,0.803).Conclusions:Overweight/obese infertile patients with PCOS have more severe disturbances in glucose and lipid metabolism as well as in sex hormone indicators.In addition,AMH and HCY levels are elevated in these patients.Both indicators are closely related to clinical pregnancy and worthy of detection.
作者
李阳
柳璐璐
林震
Li Yang;Liu Lulu;Lin Zhen(Clinical Laboratory Department,Zhengzhou Central Hospital Affiliated to Zhengzhou University,Zhengzhou,Henan 450007,China)
出处
《感染、炎症、修复》
2025年第4期265-270,共6页
Infection Inflammation Repair
关键词
肥胖
多囊卵巢综合征
不孕症
糖脂代谢
性激素
抗米勒管激素
同型半胱氨酸
妊娠
Obesity
Polycystic ovary syndrome
Infertility
Glucose and lipid metabolism
Sex hormone
Anti-Müllerian hormone
Homocysteine
Pregnancy
