多囊卵巢综合征患者卵泡液25(OH)D、网膜素Ｇ1、IGFＧ1水平与体外受精成功率关系的多因素分析

Multivariate analysis of the relationship between follicular fluid 25(OH)D, omentinＧ1, IGFＧ1 levels and in vitro fertilization success rate in patients with polycystic ovary syndrome

摘要

目的 探究多囊卵巢综合征(PCOS)患者卵泡液25Ｇ羟基维生素D[25(OH)D]、网膜素Ｇ1(OmentinＧ1)、胰岛素样生长因子Ｇ1(IGFＧ1)水平与体外受精(IVF)成功率的关系。方法 选取2022年3月至2024年3月在齐齐哈尔市第一医院接受治疗的112例PCOS患者为研究对象,对其进行追踪随访,记录其临床妊娠情况及患者的卵泡液25(OH)D、OmentinＧ1、IGFＧ1水平,并以中位水平为界将其分组,对组间胚胎进行评估,并比较IVF的妊娠成功率.采用多因素Logistic回归分析患者卵泡液25(OH)D、OmentinＧ1、IGFＧ1水平与IVF成功率关系。结果 本研究共纳入112例PCOS患者,最终临床妊娠61例,临床妊娠率为54．46％.高25(OH)D组患者的IVF正常受精率、D3优质胚胎形成率、D5优质囊胚形成率、临床妊娠率均高于低25(OH)D组,差异有统计学意义(χ²/t值介于-7．606~4．356之间,P＜0．05);低OmentinＧ1组患者的临床妊娠率高于高OmentinＧ1组(χ²＝6．084,P＜0．05),但组间IVF正常受精率、D3优质胚胎形成率、D5优质囊胚形成率组间比较差异无统计学意义(P＞0．05);高IGFＧ1组的D3优质胚胎形成率、D5优质囊胚形成率高于低IGFＧ1组(t值分别为-6．220、-6．330,P＜0．05),但组间IVF正常受精率、临床妊娠率组间差异无统计学意义(P＞0．05);多因素Logistic回归分析结果表明高25(OH)D水平及低OmentinＧ1水平均有利于患者成功妊娠(OR值分别为2．232、0．385,P＜0．05)。结论 在PCOS患者中,高25(OH)D水平可以提高IVF成功率,低OmentinＧ1水平有助于增加临床妊娠率,IGFＧ1水平对IVF成功率的直接影响较小,但可以提高优质胚胎形成率.在PCOS患者的IVF治疗中,监测和调整这些指标有助于提高妊娠成功率.

Abstract

Objective To investigate the relationship between follicular fluid levels of 25Ｇhydroxyvitamin D [25(OH)D], omentinＧ1, and insulinＧlike growth factorＧ1 (IGFＧ1) and the success rate of in vitro fertilization (IVF) in patients with polycystic ovary syndrome (PCOS). Methods A total of 112 PCOS patients treated at The First Hospital of Qiqihar between March 2022 and March 2024 were enrolled and followed up. Clinical pregnancy outcomes, as well as follicular fluid levels of 25(OH)D, omentinＧ1, and IGFＧ1, were recorded. Based on the median levels of each indicator, patients were divided into high and low groups. Embryo quality and IVF pregnancy success rates were compared between the groups. Multivariate Logistic regression analysis was used to assess the associations between the levels of 25(OH)D, omentinＧ1, IGFＧ1 and IVF success. Results A total of 112 PCOS patients were included in this study, and 61 patients were finally clinically pregnant, with a clinical pregnancy rate of 54．46％. The IVF normal fertilization rate, D3 highＧquality embryo formation rate, D5 highＧquality blastocyst formation rate and clinical pregnancy rate in the high 25(OH)D group were higher than those in the low 25(OH)D group, and the differences were statistically significant (χ²/t value ranged from -7．606 to 4．356, P＜0．05). The clinical pregnancy rate of patients in the low omentinＧ1 group was higher than that in the high omentinＧ1 group (χ²＝6．084, P＜0．05), but there was no significant difference in IVF normal fertilization rate, D3 highＧquality embryo formation rate, D5 highＧquality blastocyst formation rate between groups (P＞0．05). The D3 highＧquality embryo formation rate and D5 highＧquality blastocyst formation rate in the high IGFＧ1 group were higher than those in the low IGFＧ1 group (t＝1．2, 2．3 and 4．5, respectively, P＜0．05). Multivariate Logistic regression analysis showed that high 25(OH)D level and low OmentinＧ1 level were beneficial to successful pregnancy (OR＝2．232 and 0．385, respectively, P＜0．05). Conclusion In PCOS patients, high 25(OH)D level can improve the success rate of IVF, low OmentinＧ1 level is helpful to increase the clinical pregnancy rate, and IGFＧ1 level has little direct effect on the success rate of IVF, but it can improve the rate of highＧquality embryo formation. Monitoring and adjusting these indicators can help to improve the success rate of pregnancy in IVF treatment of PCOS patients.

关键词

多囊卵巢综合征 / 卵泡液 / 25Ｇ羟基维生素D / 网膜素Ｇ1 / 胰岛素样生长因子Ｇ1 / 体外受精 / 妊娠成功率

Key words

polycystic ovary syndrome / follicular fluid / 25Ｇhydroxyvitamin D / omentinＧ1 / insulinＧlike growth factorＧ1 / in vitro fertilization / pregnancy success rate

参考文献

[1] Sadeghi H M, Adeli I, Calina D, et al. Polycystic ovary syndrome: a comprehensive review of pathogenesis, management, and drug repurposing[J]. Int J Mol Sci, 2022, 23(2): 583.

[2] Guan C, Zahid S, Minhas A S, et al. Polycystic ovary syndrome: a “risk-enhancing” factor for cardiovascular disease[J]. Fertil Steril, 2022, 117(5): 924-935.

[3] Carson S A, Kallen A N. Diagnosis and management of infertility: a review[J]. JAMA, 2021, 326(1): 65-76.

[4] 刘亚琦, 曾海京, 袁月, 等. 新型体脂指数与多囊卵巢综合征患者胰岛素抵抗及IVF/ICSI临床结局的相关性研究[J]. 兰州大学学报(医学版), 2023, 49(4): 58-65.

[5] Alanya Tosun Ş, Gurbuz T, Cebi A, et al. Association of increased levels of omentin-1 and carotid intima-media thickness with early signs of cardiovascular risk in patients with polycystic ovary syndrome: a prospective case control study[J]. J Obstet Gynaecol Res, 2022, 48(1): 169-177.

[6] 于婉莹, 曾彬, 崔静, 等. 血清胰岛素样生长因子Ｇ1、DＧ二聚体水平与不孕症患者体外受精Ｇ胚胎移植妊娠丢失的关系[J]. 中国性科学, 2022, 31(10): 83-86.

[7] Contreras-Bolívar V, García-Fontana B, García-Fontana C, et al. Mechanisms involved in the relationship between vitamin D and insulin resistance: impact on clinical practice[J]. Nutrients, 2021, 13(10): 3491.

[8] 郎鹏, 时晓丹, 张军强. 辅助生殖领域中的精准医学[J]. 国际生殖健康/计划生育杂志, 2021, 40(2): 121-125, 146.

[9] 倪潇潇, 王颖, 闫艺之, 等. 高龄多囊卵巢综合征患者IVF/ICSI-ET助孕结局研究[J]. 中华生殖与避孕杂志, 2022, 42(10): 1046-1057.

[10] 贾晓丽, 梁思颖, 缪可言. 生活方式干预对超重或肥胖多囊卵巢综合征患者IVF/ICSI临床结局的影响[J]. 中华健康管理学杂志, 2023, 17(12): 916-920.

[11] Shan C, Zhu Y C, Yu J, et al. Low serum 25-hydroxyvitamin D levels are associated with hyperandrogenemia in polycystic ovary syndrome: a cross-sectional study[J]. Front Endocrinol (Lausanne), 2022, 13: 894935.

[12] Lerchbaum E, Theiler-Schwetz V, Kollmann M, et al. Effects of vitamin D supplementation on surrogate markers of fertility in PCOS women: a randomized controlled trial[J]. Nutrients, 2021, 13(2): 547.

[13] Moin A S M, Sathyapalan T, Atkin S L, et al. Inflammatory markers in non-obese women with polycystic ovary syndrome are not elevated and show no correlation with vitamin D metabolites[J]. Nutrients, 2022, 14(17): 3540.

[14] 徐燕, 李晶. 孕早期妇女血清人吻素、网膜素Ｇ1和Lipasin水平检测对早期预测妊娠期糖尿病发生风险的价值[J]. 现代检验医学杂志, 2022, 37(3): 119-123, 181.

[15] 任海霞, 杨凡. 孕早期血清Asprosin和Omentin-1对妊娠期糖尿病的预测价值[J]. 中国妇幼健康研究, 2021, 32(9): 1304-1309.

[16] Khademi Z, Pourreza S, Hamedi-Shahraki S, et al. Association between selenium and circulating adipokine levels in patients with polycystic ovary syndrome[J]. Biol Trace Elem Res, 2024, 202(8): 3442-3448.

[17] Seymen C M, Yar Saglam A S, Elmazoglu Z, et al. Involvement of endometrial IGF-1R/IGF-1/Bcl-2 pathways in experimental polycystic ovary syndrome: identification of the regulatory effect of melatonin[J]. Tissue Cell, 2021, 73: 101585.

[18] Chen C, Jiang X, Ding C, et al. Downregulated lncRNA HOTAIR ameliorates polycystic ovaries syndrome via IGF-1 mediated PI3K/Akt pathway[J]. Gynecol Endocrinol, 2023, 39(1): 2227280.

[19] Fu Y, Sun Q, Zhu K, et al. Elevated insulin-like growth factor-1-induced female rats perpetuate the polycystic ovary syndrome phenotype: pathological mechanism of insulin-like growth factor-1 in polycystic ovary syndrome[J]. Gynecol Obstet Invest, 2023, 88(3): 143-149.

基金资助

黑龙江省卫生健康委员会科研课题(20210505020059)