复发性流产患者孕早期血清胰岛素抵抗指数和性激素结合球蛋白水平观察

摘要

目的 观察复发性流产(RSA)患者孕早期血清胰岛素抵抗指数(HOMA-IR)和性激素结合球蛋白(SHBG)水平.方法 选取2012年3月至2014年6月在新疆医科大学第二附属医院就诊的有RSA病史的87例孕8～10周孕妇为观察组,以同期在本院进行检测的无不良孕育史的80例孕8～10周孕妇作为对照组.记录2组患者年龄、身高、体质量、血压、孕产次等一般资料,比较2组SHBG、空腹血糖、空腹胰岛素(FINS)、HOMA-IR、雌二醇、睾酮及硫酸脱氢表雄酮(DHEAS)水平.结果 观察组与对照组孕妇舒张压、孕周、雌二醇和睾酮比较差异无统计学意义(P＞0.05),体重指数、收缩压、怀孕次数和流产次数比较差异有统计学意义[(24.1±1.2) kg/m2比(22.1±1.3) kg/m2、(118±10) mmHg(1mmHg=0.133 kPa)比(112±9) mmHg、(3.1±0.8)次比(1.8±0.6)次、(2.5±0.5)次比(0.0±0.0)次,P＜0.05];与对照组相比,观察组孕妇SHBG水平明显偏低,而空腹血糖、FINS、HOMA-IR和DHEAS明显偏高[(204±25) mmol/L比(251±30) mmol/L、(4.8±0.6) mmol/L比(4.4±0.4) mmoL/L、(13.6±2.5) mIU/L比(10.3±2.5) mIU/L、(2.9±0.7)比(2.2 ±0.5)、(4.6 ±0.5)μmol/L比(4.2 ±0.4)μmol/L,均P＜0.05].多因素Logistic回归分析结果显示,影响RSA的相关因素为体重指数[比值比(OR)=2.057,95％置信区间(CI): 1.671～96.829]、SHBG(OR=1.756,95％ CI:0.845～1.966)及DHEAS(OR=1.662,95％ CI:0.013～2.057).结论 RSA患者早孕期SHBG水平明显降低,造成雄激素水平升高,HOMA-IR升高,可能是导致RSA的原因之一.%Objective To explore the serum insulin resistance index and sex hormone binding globulin (SHBG) level in patients with recurrent spontaneous abortion (RSA) in early pregnancy.Methods Totally 87 pregnant women in early pregnancy (8-10 weeks) with recurrent abortion history from March 2012 to June 2014 were selected as observation group;80 pregnant women in early pregnancy (8-10 weeks) without adverse pregnancy history were as control group.The age, height, weight, blood pressure, gravidity and parity were recorded;the SHBG, fasting blood glucose(FBG), fasting insulin(FINS), HOMA-IR, estradiol, testosterone and dehydroepiandrosterone sulfate(DHEAS) level were compared between the two groups.Results The diastolic blood pressure, gestational weeks, estradiol and testosterone were not statistically different between the two groups (P ＞0.05);the body mass index, systolic blood pressure, gravidity and abortion times were significantly different between observation group and control group [(24.1 ±1.2) kg/m2 vs (22.1 ±1.3) kg/m2, (118 ±10) mmHg vs (112±9) mmHg, (3.1±0.8) timesvs (1.8±0.6) times, (2.5±0.5) times vs (0.0±0.0) times] (P＜ 0.05).Compared with those in control group, the SHBG was significantly lower, the levels of FBG, FINS,HOMA-IR and DHEAS were significantly higher in observation group [(204 ± 25) mmol/L vs (251 ± 30) mmol/L,(4.8±0.6) mmol/L vs (4.4 ±0.4) mmol/L, (13.6±2.5) mIU/L vs (10.3 ±2.5) mIU/L, (2.9 ±0.7) vs (2.2 ± 0.5), (4.6 ± 0.5) μmol/L vs (4.2 ± 0.4) μmol/L] (P ＜ 0.05).Multi factor Logistic regression analysis showed that the possible determinants of RSA included body mass index [odds ratio (OR) =2.057, 95％ confidence interval (CI) : 1.671-96.829], sex hormone binding globulin (OR =1.756,95％ CI: 0.845-1.966) and DHEAS (OR =1.662,95％ CI:0.013-2.057).Conclusion The SHBG level decreases significantly in RSA patients in early pregnancy, resulting in rise of androgen levels and HOMA-IR, which may be a cause of RSA.