肥胖型多囊卵巢综合征患者不孕的危险因素分析

Analysis of risk factors in infertile patients with obese polycystic ovary syndrome

摘要:

目的 探讨肥胖型多囊卵巢综合征（PCOS）患者不孕的危险因素，以提供更有效的治疗策略和预防措施。方法 选取2020年3月—2023年3月在上饶市妇幼保健院就诊的126例PCOS伴不孕患者作为PCOS组，并选取同期在该院体检的健康志愿者102例作为对照组。通过调查问卷的形式收集两组一般临床资料，采用生育问题量表（FPI）评估不孕相关的压力水平，匹兹堡睡眠质量指数（PSQI）量表评估睡眠障碍，酶联免疫吸附试验（ELISA）检测血抑制素B（INHB）、抗苗勒氏管激素（AMH）水平，电化学发光法检测促卵泡激素（FSH）、黄体生成激素（LH）、孕酮、雌二醇（E₂）、睾酮（T）、性激素结合球蛋白（SHBG），彩色多普勒超声仪计算两侧卵泡数量。采用多因素一般Logistic回归分析影响肥胖型PCOS不孕的危险因素。结果 两组受试者一般资料比较，差异无统计学意义（P >0.05）；两组受试者的体质量指数（BMI）、睡眠障碍、生育压力、两侧卵泡数量、INHB、AMH、FSH、LH、孕酮、E₂、T、SHBG水平比较，差异均有统计学意义（P <0.05）。多因素一般Logistic回归分析结果显示，BMI ［O^R =1.272（95% CI：1.153，1.402）］、睡眠障碍［O^R =3.191（95% CI：2.045，4.978）］、生育压力［O^R =1.021（95% CI：1.014，1.027）］、左侧卵巢泡数［O^R=1.092（95% CI：1.006，1.186）］、右侧卵巢泡数［O^R =1.160（95% CI：1.074，1.252）］、INHB ［O^R =1.007（95% CI：1.001，1.013）］、AMH ［O^R =1.138（95% CI：1.032，1.256）］、LH ［O^R =1.190（95% CI：1.115，1.271）］、T ［O^R =1.304（95% CI：1.173，1.450）］是肥胖型PCOS患者不孕的独立危险因素（P <0.05），FSH ［O^R =0.762（95% CI：0.670，0.867）］、孕酮［O^R=0.624（95% CI：0.463，0.841）］、E₂ ［O^R =0.994（95% CI：0.988，1.000）］、SHBG ［O^R =0.977（95% CI：0.956，0.999）］是肥胖型PCOS患者不孕的保护因素（P <0.05）；模型的受试者工作特征曲线下面积为0.972（95% CI：0.951，0.993）、敏感性为96.8%（95% CI：0.913，0.991），特异性为94.3%（95% CI：0.813，0.971），拟合曲线显示回归模型拟合效果良好。结论 肥胖型PCOS患者不孕的危险因素是BMI较高、睡眠障碍、生育压力大、两侧卵巢卵泡数增多、INHB、AMH、FSH、LH，而孕酮、E₂、SHBG为保护因素。

Abstract:

Objective To investigate the risk factors for infertility in obese patients with polycystic ovary syndrome (PCOS) to provide more effective treatment strategies and preventive measures.Methods A total of 126 PCOS patients with infertility who visited Shangrao Maternal and Child Health Hospital from March 2020 to March 2023 were selected as the PCOS group. Additionally, 102 healthy volunteers undergoing physical examination during the same period were selected as the control group. General clinical data were collected through questionnaires, and infertility-related stress levels were assessed using the Fertility Problem Inventory (FPI). The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep disorders. Serum inhibin B (INHB) and anti-Müllerian hormone (AMH) levels were measured by enzyme-linked immunosorbent assay (ELISA), while follicle-stimulating hormone (FSH), luteinizing hormone (LH), progesterone, estradiol (E₂), testosterone (T), and sex hormone-binding globulin (SHBG) were determined by electrochemiluminescence. The number of follicles on both sides was calculated using color Doppler ultrasound. Multivariate logistic regression analysis was used to identify risk factors for infertility in obese PCOS patients.Results There were no statistically significant differences in general clinical data between the two groups (P > 0.05). However, significant differences were found between the two groups in body mass index (BMI), sleep disorders, fertility stress, number of follicles on both sides, levels of INHB, AMH, FSH, LH, progesterone, E₂, T, and SHBG (P < 0.05). Multivariate logistic regression analysis revealed that BMI [O^R = 1.272 (95% CI: 1.153, 1.402)], sleep disorders [O^R = 3.191 (95% CI: 2.045, 4.978)], fertility stress [O^R = 1.021 (95% CI: 1.014, 1.027)], number of follicles in the left ovary [O^R = 1.092 (95% CI: 1.006, 1.186)], number of follicles in the right ovary [O^R = 1.160 (95% CI: 1.074, 1.252)], INHB [O^R = 1.007 (95% CI: 1.001, 1.013)], AMH [O^R = 1.138 (95% CI: 1.032, 1.256)], LH [O^R = 1.190 (95% CI: 1.115, 1.271)], and T [O^R = 1.304 (95% CI: 1.173, 1.450)] were independent risk factors for infertility in obese PCOS patients (P < 0.05). Conversely, FSH [O^R = 0.762 (95% CI: 0.670, 0.867)], progesterone [O^R = 0.624 (95% CI: 0.463, 0.841)], E₂ [O^R = 0.994 (95% CI: 0.988, 1.000)], and SHBG [O^R = 0.977 (95% CI: 0.956, 0.999)] were protective factors (P < 0.05). The area under the receiver operating characteristic (ROC) curve for the model was 0.972 (95% CI: 0.951, 0.993), with a sensitivity of 96.83% (95% CI: 0.913, 0.991) and a specificity of 94.3% (95% CI: 0.813, 0.971), indicating a good fit for the regression model.Conclusion The risk factors for infertility in obese PCOS patients include high BMI, sleep disorders, high fertility stress, increased follicle count on both sides, levels of INHB, AMH, FSH, and LH, while progesterone, E₂, and SHBG serve as protective factors.