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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≥80cm组(70个周期)和腰围<80cm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≥80cm与腰围<80cm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)、2h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)Uvs.(1491.2±558.9)U]及天数[(12.5±4.0)dvs.(10.7±3.0)d]增加(P<0.01),峰值雌二醇水平低[(8492.7±4771.2)pmol/Lvs.(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%CI0.026～0.768,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。
Objective To investigate the effect of central obesity on in vitro fertilization (IVF) outcome in women with polycystic ovary syndrome (PCOS) infertility. Methods A retrospective analysis of 2009-2010 Sun Yat-sen Memorial Hospital of Sun Yat-sen IVF treatment of PCOS infertility in patients with 188 fresh cycles, according to whether the central obesity is divided into waist circumference ≥ 80cm group (70 cycles) and waist circumference <80cm group (118 Cycles) were compared between the two groups based on endocrine metabolism and IVF clinical and laboratory parameters. Results Compared with the 80cm waist circumference group, body mass index (BMI), waist-to-hip ratio, elevated free and androgen index (FAI), low SHBG, fasting glucose, fasting insulin, HOMA-IR, OGTT2h, high glucose and insulin, high insulin resistance, impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) were observed in the 2h oral glucose tolerance test High and high density lipoprotein (HDL) low, the difference was statistically significant (P <0.05). The waist circumference was positively correlated with fasting insulin, HOMA-IR and FAI after adjusting for BMI (P <0.01); the dosage of Gn [(2014.8 ± 825.8) Uvs. (1491.2 ± 558.9) U] (P <0.001), and the peak estradiol level was lower (P <0.01) than that of the control group (P <0.001) Mature human follicular gonadotropin (HCG) was used in a large amount (P = 0.011) and the number of oocytes retrieved was less ([(11.6 ± 5.7) vs (13.8 ± 7.3), P <0.05] (24.3% vs.36.3%, P = 0.019), the rate of early miscarriage increased (38.5% vs.7.5%, P = 0.002), and there was no significant difference in clinical pregnancy rates (40.6% vs.55.2%, P = 0.07 ). Logistic regression analysis showed that HOMA-IR was a risk factor for early miscarriage after IVF pregnancy in PCOS patients (OR = 0.143, 95% CI0.026-0.768, P = 0.023). Conclusion The central obesity PCOS patients with insulin resistance and hyperandrogenism more significant, the high incidence of dyslipidemia, PCF patients negatively affect IVF ovulation response, and embryo implantation rate decreased early abortion rate increased.