PCOS患者内脏脂肪与IVF-ET结局的相关性以及体重干预的效果分析-东南大学学报医学版

PCOS患者内脏脂肪与IVF-ET结局的相关性以及体重干预的效果分析

单位：南通市妇幼保健院生殖医学中心, 江苏南通 226019

分类号：R711.75

出版年·卷·期（页码）：2019·38·第三期（456-460）

摘要：

目的：研究多囊卵巢综合征（PCOS）患者内脏脂肪与体外受精-胚胎移植（IVF-ET）结局的相关性，并观察体重干预对临床结局的影响。方法：选择2016年8月至2017年7月于本中心初次行IVF-ET助孕的PCOS患者180例，其中非内脏型肥胖患者62例（设为A组），内脏型肥胖患者118例随机分为常规组（B组，60例）和体重管理组（C组，58例）。A、B组患者确诊后即开始接受IVF-ET治疗，C组患者予半年体重管理后开始接受IVF-ET治疗。测定、计算各组患者肥胖相关指标包括体质指数（BMI）、腰围（WC）、腰臀比（WHR）、总体脂肪率和内分泌生殖激素包括血促卵泡刺激素（FSH）、促黄体生成素（LH）、雌二醇（E₂）水平，随访各组患者的受精情况及临床结局。结果：（1）3组患者年龄、不孕时间、血FSH和E₂水平差异无统计学意义（P>0.05），B、C组BMI、WC、WHR、总体脂肪率、内脏脂肪和血LH水平明显高于A组（P<0.05）；（2） A组患者获卵数、受精率、优胚率、临床妊娠率明显高于B组（P<0.05），流产率和中重度卵巢过度刺激综合征（OHSS）发生率明显低于B组（P<0.05）；（3） C组患者经6个月体重管理后BMI、WC、WHR、总体脂肪率、内脏脂肪水平和血LH水平均显著降低（P<0.05），血FSH和E₂水平较管理前差异无统计学意义（P>0.05）；（4） C组患者经6个月体重管理后进行IVF-ET，获卵数、受精率、优胚率、临床妊娠率较B组患者显著增加（P<0.05），流产率和中重度OHSS发生率较B组患者显著降低（P<0.05）。结论：内脏型肥胖PCOS患者IVF-ET临床结局较差，而体重管理可改善IVF-ET临床结局。

Objective:To study the correlation between visceral fat and in vitro fertilization and embryo transfer(IVF-ET) outcome in patients with polycystic ovary syndrome(PCOS), and to observe the effect of weight intervention on clinical outcome. Methods:From August 2016 to July 2017, a total of 180 women with PCOS who received IVF-ET for the first time in the center were included in this study, including 62 patients with non-visceral obesity(group A) and 118 patients with visceral obesity. The patients with visceral obesity were randomly divided into routine group(group B, n=60) and weight management group(group C, n=58). Patients in group A and group B began to receive IVF-ET treatment after diagnosis, while patients in group C received IVF-ET treatment after half-year weight management. Obesity-related indicators(body mass index(BMI), waist circumference(WC), waist hip ratio(WHR) and total fat percentage), endocrine reproductive hormone follicle stimulating hormone(FSH), luteinizing hormone(LH) and estradiol 2(E₂) were measured in each group, and the fertilization and clinical outcomes of the patients in each group were followed up. Results:(1) The age, pregnancy time, FSH and E₂ levels in three groups were not significant different(P>0.05), but BMI, WC, WHR, total fat percentage, visceral fat and LH levels were significantly higher in group B and C than those in group A(P<0.05). (2) The number of retrieved oocytes, and the rate of fertilization, excellent embryo and clinical pregnancy in group A were significantly higher than those in group B(P<0.05), and the incidence of abortion and moderate to severe OHSS was significantly lower than that in group B(P<0.05). (3) BMI, WC, WHR, total fat percentage, visceral fat level and LH level were significantly lower in group C after 6 months of weight management(P<0.05), while FSH and E₂ levels were not significantly different from those before weight management with no statistical significance(P>0.05). (4) Patients in group C underwent IVF-ET after 6 months of weight management. The number of retrieved oocytes, and the rate of fertilization, excellent embryo and clinical pregnancy were significantly increased compared with those in group B(P<0.05),and the incidence of abortion and moderate to severe OHSS was significantly lower than those in group B(P<0.05). Conclusion:The clinical outcome of IVF-ET in patients with visceral obesity and polycystic ovary syndrome is poor, and the weight management can improve the clinical outcome of IVF-ET.

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