【摘 要】
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目的 探讨血清雄激素水平和代谢综合征相关指标对多囊卵巢综合征(PCOS)患者早期妊娠结局的影响.方法 选择在天津医科大学第二医院确诊为PCOS的患者1 18例,根据早期妊娠是否发生胚胎丢失分为PCOS胚胎丢失组(A组,n=62)和PCOS胚胎正常发育组(B组,n=56),比较两组妇女血清雄激素水平和代谢综合征相关指标,并对影响PCOS患者早期胚胎发育的高危因素行逐步Logistic回归分析.结果
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目的 探讨血清雄激素水平和代谢综合征相关指标对多囊卵巢综合征(PCOS)患者早期妊娠结局的影响.方法 选择在天津医科大学第二医院确诊为PCOS的患者1 18例,根据早期妊娠是否发生胚胎丢失分为PCOS胚胎丢失组(A组,n=62)和PCOS胚胎正常发育组(B组,n=56),比较两组妇女血清雄激素水平和代谢综合征相关指标,并对影响PCOS患者早期胚胎发育的高危因素行逐步Logistic回归分析.结果 (1)A组的腰围(WC)、舒张压(DBP)、空腹胰岛素(FINS)、空腹血糖(FBG)和甘油三酯(TG)均高于B组(P均＜0.05)；性激素结合球蛋白(SHBG)和高密度脂蛋白(HDL)均低于B组(P均＜0.05)；收缩压(SBP)、睾酮(T)、胆固醇(TC)和低密度脂蛋白(LDL)两组间差异无统计学意义(P均＞0.05).(2)A组的体质指数(BMI)、游离睾酮指数(FAI)、稳态胰岛素评价指数(HOMR-IR)和动脉硬化指数(AI)均高于B组(P均＜0.05).(3)两组PCOS患者的血清T水平与WC、DBP、FINS、FBG无明显相关性(r=0.177,0.168,0.153,0.165,P均＞0.05)；与HDL呈显著负相关(r=-0.254,P＜0.05).血清SHBG水平与WC、DBP、FINS、FBG呈显著负相关(r=-0.435,-0.375,-0.306,-0.285；P均＜0.05)；与HDL呈显著正相关(r=0.387,P＜0.05).多元线性回归分析显示,WC和FINS对血清SHBG水平有显著影响(t=-1.977,-3.332；P均＜0.05).(4)影响胚胎丢失相关因素的Logistic回归分析结果显示,SHBG是PCOS患者发生胚胎丢失的影响因素(OR=1.037,95％CI为1.014～1.061,P＜0.05),FINS是PCOS患者发生胚胎丢失的影响因素(OR=0.854, 95％CI为0.763～0.956,P＜0.05).(5)当FINS以14.9uIu/ml为临界值时,FINS对PCOS患者发生胚胎丢失预测的敏感度为80.6％,特异度为76.8％结论 高雄激素血症和异常的糖脂代谢状态与胚胎停育的发生密切相关,FINS水平可以作为预测PCOS患者早期妊娠结局的一个可选指标.
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