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目的探讨影响多囊卵巢综合征(PCOS)的危险因素及其对体外受精-胚胎移植(IVF-ET)助孕活产率的影响。方法选取2015年7月-2016年7月在中山市博爱医院生殖中心就诊的月经稀发女性169例为研究对象,其中行IVF-ET的PCOS患者86例为观察组,行IVF-ET的非PCOS患者83例为对照组。比较两组患者的临床特征、病史及雌激素水平情况,综合分析诱导PCOS的危险因素,并比较两组患者的助孕妊娠情况及活产率。结果观察组体质量、BMI值均明显高于对照组,多毛、痤疮、初潮后2~3年仍月经稀、生活压力大和饮食不规律发生率均高于对照组,存在PCOS家族史者明显高于对照组,差异有统计学意义(P<0.01);两组患者孕酮、黄体生成素、游离睾酮、胰岛素及血糖水平比较,差异有统计学意义(P<0.01)。多因素Logistic回归分析显示,BMI、PCOS家族史、不良生活饮食习惯、生活压力过大及孕酮、黄体生成素和游离睾酮水平均是影响引发PCOS的高危因素。观察组临床妊娠率及最终活产率均低于对照组,差异有统计学意义(P<0.05)。进一步进行多因素Logistic回归分析显示,影响PCOS患者助孕活产率的危险因素包括PCOS患者BMI、孕酮及黄体生成素水平(P<0.05)。结论肥胖、PCOS家族史、雌激素水平低等是PCOS发病的高危因素,且PCOS患者BMI、孕酮及黄体生成素会影响其IVF-ET助孕活产率。临床针对月经稀发者应积极改善饮食习惯、缓解生活压力、控制体质量、控制血糖、控制激素水平,降低PCOS的发生率,提高IVF-ET助孕活产率。
Objective To investigate the risk factors of polycystic ovary syndrome (PCOS) and its influence on the live birth rate of IVF-ET. Methods From July 2015 to July 2016, 169 cases of oligomenorrhea women who visited the Reproductive Center of Pok Oi Hospital of Zhongshan were enrolled. 86 cases of PCOS patients who underwent IVF-ET were selected as observation group and IVF-ET 83 cases of PCOS patients as control group. The clinical features, medical history and estrogen levels were compared between the two groups. The risk factors for inducing PCOS were analyzed comprehensively. The pregnancy-assisted pregnancy and live birth rate were compared between the two groups. Results Body mass and BMI in observation group were significantly higher than those in control group. Hirschsprung and acne were still observed in 2 ~ 3 years after menarche. Menstrual thinning, life stress and irregular diet were higher than those in control group. There were significant differences between the two groups in the levels of progesterone, luteinizing hormone, free testosterone, insulin and blood glucose (P <0.01). Multivariate Logistic regression analysis showed that the family history of BMI, PCOS, adverse life and eating habits, over-life stress and the levels of progesterone, luteinizing hormone and free testosterone all were the risk factors of PCOS. The clinical pregnancy rate and the final live birth rate in the observation group were lower than those in the control group, with statistical significance (P <0.05). Further multivariate Logistic regression analysis showed that the risk factors that influence the live birth rate of PCOS patients include BMI, progesterone and luteinizing hormone in PCOS patients (P <0.05). Conclusions Obesity, family history of PCOS and low estrogen level are the risk factors of PCOS. The BMI, progesterone and luteinizing hormone in PCOS patients affect the IVF-ET assisted pregnancy rate. In clinical practice, patients with menstrual thinning should actively improve their eating habits, relieve stress, control body weight, control blood sugar, control hormone levels, reduce the incidence of PCOS and increase the IVF-ET assisted pregnancy.