促卵泡激素与孕卵指数在不同临床表型多囊卵巢综合征不孕患者中的差异及与促排卵结局的关系

Differences of follicle-stimulating hormone and pregnant progesterone-oocyte-index in infertility patients with different clinical phenotypes of polycystic ovary syndrome and their relationship with ovulation induction outcome

摘要

目的 探讨促卵泡激素(FSH)与孕卵指数(POI)在不同临床表型多囊卵巢综合征(PCOS)不孕患者中的差异及与促排卵结局的关系。方法 选取2020年9月至2023年9月于广州中医药大学第一附属医院就诊的150例年龄在20~40岁的PCOS不孕患者为PCOS不孕组,同期健康体检者140例为对照组.收集并统计所有研究对象的一般资料、激素指标、超声指标等相关临床数据.根据鹿特丹分型标准,将PCOS不孕组分为A、B、C、D四种临床表型.通过随机森林算法筛选影响因素并纳入多因素回归分析模型.采用多因素Logistics回归法、分层交互检验法、多元线性回归法、限制性立方样条模型、bootstrap法的中介效应,分析FSH与POI在不同临床表型PCOS不孕患者中促排卵结局之间的关系。结果 PCOS不孕组与对照组的体质量指数(BMI)、糖尿病史、高血脂史的分布,以及月经周期、卵巢体积、FSH、睾酮(T)、雌二醇(E₂)、促黄体生成素(LH)、抗苗勒氏管激素(AMH)、空腹血糖(FPG)、空腹胰岛素(FINS)、胰岛素抵抗(IR)、卵泡计数(AFC)、POI水平比较,差异均有统计学意义(χ²=40.368~48.489、t=4.706~49.326,P<0.05).四种临床表型中BMI的分布,以及月经周期、卵巢体积、FSH、T、E₂、LH、AMH、AFC、POI水平比较,差异均有统计学意义(χ²=13.423、F=2.810~53.509,P<0.05);在不同临床表型PCOS不孕患者中,FSH、POI水平在B型患者中最高.随机森林算法分析显示,FSH、POI、AMH为前三位不同临床表型PCOS不孕患者促排卵结局的重要影响因素.多因素Logistic回归分析显示,FSH、POI、AMH均是不同临床表型PCOS不孕患者促排卵结局的独立影响因素,OR(95%CI)分别为:3.712(1.124~4.589)、2.658(1.006~2.985)、2.359(1.131~4.103),P<0.05.中介效应分析显示,POI对不同临床表型PCOS不孕患者促排卵结局具有直接影响,并且FSH部分介导了POI对不同临床表型PCOS不孕患者促排卵结局的影响,总效应值β_总=0.343,中介效应占总效应的52.77%。结论 在不同临床表型的PCOS不孕患者中,FSH、POI水平在B型患者中最高,FSH、POI水平与不同临床表型PCOS不孕患者促排卵结局不良风险显著相关.

Abstract

Objective To investigate the differences between follicle stimulating hormone (FSH) and progesterone-oocyte-index (POI) in infertility patients with polycystic ovary syndrome (PCOS) and their relationship with ovulation induction outcomes. Methods A total of 150 PCOS infertility patients aged 20-40 years old who were treated in the First Affiliated Hospital of Guangzhou University of Chinese Medicine from September 2020 to September 2023 were selected as the PCOS infertility group, and 140 healthy subjects were selected as the control group. The general data, hormone indexes, ultrasound indexes and other related clinical data of all subjects were collected and statistically analyzed. According to the Rotterdam classification criteria, the PCOS infertility group was divided into four types: A, B, C, and D. The influencing factors were screened by random forest algorithm and included in the multivariate regression analysis model. The mediating effect of multivariate logistics regression method, hierarchical interaction test, multiple linear regression method, restrictive cubic spline model and bootstrap method was used to analyze the relationship between FSH and POI in ovulation induction outcomes in patients with PCOS infertility with different clinical phenotypes. Results There were significant differences in BMI, history of diabetes mellitus, history of hyperlipidemia, menstrual cycle, ovarian volume, FSH, T, E₂, LH, AMH, FPG, FINS, IR, AFC, and POI levels between the PCOS infertility group and the control group (χ²=40.368-48.489, t=4.706-49.326, P<0.05). Among patients with PCOS infertility with different clinical phenotypes, the levels of FSH and POI were the highest in patients with type B. Random forest algorithm analysis showed that FSH, POI and AMH were the important influencing factors for ovulation induction outcomes in the top three patients with PCOS infertility with different clinical phenotypes. Multivariate Logistic regression analysis showed that FSH, POI, and AMH were independent influencing factors for ovulation induction outcomes in patients with PCOS infertility with different clinical phenotypes, and the OR (95%CI) were 3.712 (1.124-4.589), 2.658 (1.006-2.985), and 2.359 (1.131-4.103), respectively, and P<0.05. The mediating effect analysis showed that POI had a direct effect on the ovulation induction outcome of infertile patients with PCOS with different clinical phenotypes, and FSH partially mediated the effect of POI on ovulation induction in infertile patients with PCOS with different clinical phenotypes, with a total effect size of β=0.343 and a mediating effect accounting for 52.77% of the total effect. Conclusion Among patients with PCOS infertility with different clinical phenotypes, the levels of FSH and POI are the highest among patients with type B, and the levels of FSH and POI are significantly associated with the risk of adverse ovulation induction outcomes in patients with PCOS infertility with different clinical phenotypes.

关键词

多囊卵巢综合征 / 不孕症 / 促卵泡激素 / 孕卵指数 / 促排卵结局

Key words

polycystic ovary syndrome / infertility / follicle-stimulating hormone / progesterone-oocyte-index / ovulation induction outcomes

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