不同月经稀发程度PCOS不孕患者的基线特征及妊娠结局的差异

目的： 探讨不同月经稀发程度多囊卵巢综合征（polycystic ovary syndrome，PCOS）不孕患者的人体测量指标、性激素及代谢差异，以及针刺联合克罗米芬促排卵助孕后的妊娠结局差异。方法： 选择针刺联合克罗米芬治疗多囊卵巢综合征不孕症患者（PCOSAct）临床试验中月经稀发的受试者948例，根据月经周期天数分为A组（36~59 d）423例、B组（60~89 d）311例、C组（90~179 d）167例和D组（≥180 d）47例，比较各组的人体测量指标、性激素及糖脂代谢水平，并分析各组妊娠结局的差异。结果： 月经稀发程度严重者，往往伴有更高的体质量指数、腰臀比、黑棘皮评分、右侧卵巢体积、黄体生成素、黄体生成素/卵泡刺激素、总睾酮、游离睾酮、游离睾酮指数、空腹血糖、空腹胰岛素、稳态模型评估的胰岛素抵抗指数、三酰甘油和载脂蛋白B（P<0.05），胰岛素抵抗及代谢综合征的发生率也有所增加（P<0.05）。同时还伴有更低的性激素结合球蛋白、排卵率及生化妊娠率（P<0.05）。各组的临床妊娠率、活产率及围生期不良事件发生率差异无统计学意义（P>0.05）。多因素二元Logistic回归分析发现月经周期为PCOS患者排卵和生化妊娠的独立影响因素。结论： PCOS月经稀发程度严重者（尤以≥90 d）更易出现内分泌和糖脂代谢紊乱，并且可能对妊娠结局造成一定的影响。

Differences in Baseline Characteristics and Pregnancy Outcomes among Infertile Patients with PCOS at Different Degrees of Oligomenorrhea

Objective: To compare the anthropometric indexes, sex hormones and metabolism of infertile patients with polycystic ovary syndrome (PCOS) at different degrees of oligomenorrhea, and to analyze the pregnancy outcomes after the ovulation induction with acupuncture-assisted clomiphene protocol. Methods: 948 participants with oligomenorrhea in PCOSAct clinical trial were selected. According to the days of menstrual cycle, they were divided into 4 groups: 423 cases in the group A (36-59 days), 311 cases in the group B (60-89 days), 167 cases in the group C (90-179 days) and 47 cases in the group D (≥180 days). The anthropometric indexes, sex hormones, glucose and lipid metabolism were compared, and the pregnancy outcomes were analyzed. Results: The longer the menstrual cycle, the higher the body mass index, waist-hip ratio, black acanthosis score, right ovarian volume, luteinizing hormone, luteinizing hormone/follicle-stimulating hormone, total testosterone, free testosterone, free androgen index, fasting plasma glucose, fasting insulin, homeostatic model assessment values for insulin resistance, triglyceride and apolipoprotein B (all P<0.05). The incidences of insulin resistance and metabolic syndrome were also increased with the extension of menstrual cycle (both P<0.05), while the sex hormone-binding globulin, ovulation rate and biochemical pregnancy rate were decreased (all P<0.05). There were no significant differences in the clinical pregnancy rate, live birth rate and the incidence of perinatal adverse events among the groups (all P>0.05). Multivariate binary logistic regression analysis showed that the menstrual cycle was an independent influencing factor for ovulation and biochemical pregnancy in PCOS patients. Conclusions: The more severe the degree of oligomenorrhea (especially more than 90 days), the more prone to endocrine, glucose and lipid metabolism disorders. Oligomenorrhea may affect adversely the pregnancy outcomes.