胰岛素抵抗指数对PCOS不孕患者IVF-ET治疗妊娠结局的预测

摘要

目的 探讨胰岛素抵抗指数(HOMA-IR)对多囊卵巢综合征(PCOS)不孕患者行体外受精-胚胎移植(IVF-ET)治疗妊娠结局的预测价值.方法 回顾性分析2014年8月～2016年8月在湖北医药学院附属人民医院生殖医学中心接受IVF-ET治疗的PCOS患者86例的临床资料,根据HOMA-IR分为两组:观察组(胰岛素抵抗组)44例,HOMA-IR≥1.66;对照组(非胰岛素抵抗组)42例,HOMA-IR＜1.66.比较两组患者的一般资料、体重指数(BMI)、游离睾酮指数(FTI)、空腹胰岛素(INS)、空腹血糖(Glu)、促排卵情况、妊娠结局等;对影响PCOS患者IVF-ET妊娠结局的因素进行Logistic回归分析.结果 观察组BMI、FTI、Glu、INS、HOMA-IR显著高于对照组,差异有统计学意义(P＜0.01);观察组获卵数低于对照组,差异有统计学意义(P＜0.05);观察组临床妊娠率、活产率显著低于对照组,差异有统计学意义(P＜0.05);两组正常受精率、优质胚胎率、胚胎着床率、卵巢过度刺激综合征发生率、早期流产率比较,差异无统计学意义(P＞0.05).PCOS患者年龄、不孕年限、BMI是妊娠结局的独立危险因素(P＜0.05),AMH是妊娠结局的保护因素(P＜0.05).结论 PCOS患者行IVF-ET助孕治疗过程中,HOMA-IR值越低其妊娠结局可能越好.%Objective To investigate the predictive value of homeostasis model assessment insulin resistance (HOMA-IR) on the pregnancy outcome in infertility patients with polycystic ovary syndrome (PCOS) undergoing in vitro fertilization and embryo transfer (IVF-ET).Methods The clinical data of 86 patients with PCOS treated with IVF-ET from August 2014 to August 2016 at the Reproductive Medicine Center of People's Hospital of Hubei Medical College were analyzed retrospectively.According to HOMA-IR,those patients were divided into two groups including the observation group (in sulin Resistant group,HOMA-IR≥ 1.66,n =44) and control group (non-insulin resistance group,HOMA-IR ＜1.66,n =42).The general situation,controlled ovarian hyperstimulation,pregnancy outcome and complications were compared in the two groups.Logistic regression analysis was performed on the factors influencing the outcome of IVF-ET in patients with PCOS.Results The levels of BMI,lFTI,Glu,INS and HOMA-IR in the observation group were significantly higher than those in the control group (P ＜ 0.01),and the number of oocytes retrieved,the clinical pregnancy rate and live birth rate was significantly lower in the observation group (P ＜ 0.05).There was no significant difference in the normal fertilization rate,high quality embryo rate,embryo implantation rate,OHSS incidence,and early abortion rate between the two groups (P ＞ 0.05).The BMI,age and infertility duration were risk factors on pregnancy outcome of patients with PCOS undergoing IVF-ET (P ＜ 0.05),however AMH was protective factor (P ＜ 0.05).Conclusion The lower HOMA-IR value may be a better predictor for a better pregnancy outcome in patients with PCOS undergoing IVF-ET.