性激素结合球蛋白对多囊卵巢综合征患者行IVF-ET促排卵效果及妊娠结局的预测

Predictive value of sex hormone binding globulin on ovulation induction and pregnancy outcome in patients with polycystic ovary syndrome after IVF-ET

关键词:  性激素结合球蛋白  多囊卵巢综合征  体外受精-胚胎移植  促排卵  妊娠结局

Key words:  sex hormone binding globulin  polycystic ovary syndrome  IVF-ET  controlled ovarian hyperstimulation  pregnancy outcomes

摘要:

目的 探讨性激素结合球蛋白（SHBG）对多囊卵巢综合征（PCOS）患者行体外受精-胚胎移植（IVF-ET）助孕治疗的促排卵效果及妊娠结局的预测价值。方法 收集2015年1月至2017年12月就诊于湖北医药学院附属人民医院生殖医学中心行IVF-ET助孕治疗的181例PCOS不孕患者的临床资料。将患者分为三组：低SHBG组：SHBG<18.2 nmol/L，30例。高SHBG组：SHBG>135.5 nmol/L，29例。正常SHBG组：18.2 nmol/L≤SHBG≤135.5 nmol/L，122例。比较三组患者的一般资料、促排卵情况及妊娠结局。结果 随着血清SHBG水平升高，BMI、基础LH/FSH、FAI降低，基础FSH升高，各组间差异有统计学意义（P<0.05）；随着血清SHBG水平增高，PCOS不孕患者的正常受精率、胚胎着床率、临床妊娠率及活产率增高，Gn量及流产率降低，差异也均存在统计学意义（P<0.05），但优质胚胎率及早产率三组间差异无统计学意义（P>0.05） 。血清SHBG水平与BMI （r=-0.389， P<0.001）、基础LH/FSH （r=-0.225， P=0.002）、FAI （r=-0.606， P<0.001）及Gn量 （r=-0.209， P=0.005）呈负相关，与基础FSH（r=0.205， P=0.006）呈正相关。结论 PCOS不孕患者在IVF-ET助孕治疗中，血清SHBG水平越高，助孕效果越好。

Abstract:

Objective To evaluate the predict value of sex hormone binding globulin (SHBG) on controlled ovarian hyperstimulation and pregnancy outcome in patients with polycystic ovary syndrome (PCOS), who underwent in vitro fertilization & embryo transfer (IVF-ET). Methods The clinical data and pregnancy outcomes of 181 patients with PCOS infertility were collected in the reproductive medicine center of Shiyan Renmin hospital of Hubei University of Medicine from January 2015 to December 2017. These patients were divided into three groups, including low SHBG group (SHBG<18.2 nmol/L, n=30), high SHBG group (SHBG>135.5 nmol/L, n=29), and normal SHBG group (18.2 nmol/L≤SHBG≤135.5 nmol/L, n=122). The general data, controlled ovarian hyperstimulation, and pregnancy outcomes were compared among the three groups. Results In PCOS infertile patients, with the increase of serum SHBG level, BMI, basal LH/FSH and FAI decreased and basal FSH increased; the difference was statistically significant among the groups (P<0.05). The normal fertilization rate, embryo implantation rate, clinical pregnancy rate and live birth rate increased and Gn amount and abortion rate decreased; the difference was significant (P<0.05). However, there was no significant difference in the rate of high-quality embryo and preterm birth among the groups (P>0.05). Serum SHBG level was negatively correlated with BMI (r=-0.389, P<0.001), basal LH/FSH (r=-0.225, P=0.002), FAI (r=-0.606, P<0.001) and Gn (r=-0.209, P=0.005), and positively correlated with basal FSH (r=0.205, P=0.006); the difference was statistically significant (P<0.05). Conclusion The higher the serum SHBG level, the better the effect of IVF-ET assisted pregnancy in PCOS patients.