游离睾酮指数联合血清GnSAF、SHBG对多囊卵巢综合征不孕患者IVF-ET治疗妊娠结局的预测价值

摘要 目的：探讨游离睾酮指数（FAI）联合血清促性腺激素平抑因子（GnSAF）、性激素结合球蛋白（SHBG）对多囊卵巢综合征（PCOS）不孕患者体外受精-胚胎移植（IVF-ET）治疗妊娠结局的预测价值。方法：选取2020年1月～2022年6月湖南省妇幼保健院生殖医学中心收治的197例PCOS不孕患者为PCOS组，根据IVF-ET治疗妊娠结局分为妊娠失败组和妊娠成功组，另选取同期68名体检健康妇女为对照组。收集PCOS不孕患者临床资料，计算FAI并检测血清GnSAF、SHBG水平。采用单因素和多因素Logistic回归分析PCOS不孕患者IVF-ET治疗妊娠结局的影响因素，采用受试者工作特征（ROC）曲线分析FAI和血清GnSAF、SHBG对PCOS不孕患者IVF-ET治疗妊娠结局的预测价值。结果：PCOS组FAI和血清GnSAF水平高于对照组，SHBG水平低于对照组（P＜0.05）。197例PCOS不孕患者IVF-ET治疗妊娠成功率为51.27%（101/197）。单因素分析显示，妊娠失败组体质指数、黄体生成素（LH）、LH/促卵泡生成素（FSH）、睾酮、抗苗勒管激素（AMH）、FAI、GnSAF高于妊娠成功组，FSH、受精率、优胚率、SHBG低于妊娠成功组（P＜0.05）。多因素Logistic回归分析显示，体质指数增加和LH、LH/FSH、AMH、FAI、GnSAF升高为PCOS不孕患者IVF-ET治疗妊娠失败的独立危险因素，SHBG升高为其独立保护因素（P＜0.05）。ROC曲线分析显示，FAI和血清GnSAF、SHBG联合预测PCOS不孕患者IVF-ET治疗妊娠结局的曲线下面积大于FAI、GnSAF、SHBG单独预测。结论：FAI和血清GnSAF、SHBG水平联合预测PCOS不孕患者IVF-ET治疗妊娠结局的价值较高。

Predictive Value of Free Testosterone Index Combined with Serum GnSAF and SHBG on Pregnancy Outcome in IVF-ET Treatment of Infertile Patients with Polycystic Ovary Syndrome

ABSTRACT Objective: To investigate the predictive value of free androgen index (FAI) combined with serum gonadotropin surge attenuation factor (GnSAF) and sex hormone-binding globulin (SHBG) on pregnancy outcome in in vitro fertilization-embryo transfer (IVF-ET) treatment for infertile patients with polycystic ovary syndrome (PCOS). Methods: 197 patients with PCOS who were admitted to the Reproductive Medicine Centre of Hunan Maternal and Child Health Hospital from January 2020 to June 2022 were selected as the PCOS group, and were divided into the pregnancy failure group and the pregnancy success group according to the pregnancy outcome of IVF-ET treatment. Another 68 healthy women in the same period were selected as the control group.Clinical data were collected from patients with PCOS infertility, FAI was calculated and serum GnSAF and SHBG levels were measured. Multi-factor logistic regression was used to analyze the factors influencing pregnancy outcome infertile patients with PCOS treated with IVF-ET. ROC curves were used to analyze the predictive value of FAI and serum GnSAF and SHBG on pregnancy outcome in PCOS infertile patients treated with IVF-ET. Results: The levels of FAI and serum GnSAF were higher and SHBG was lower in the PCOS group than in the control group (P<0.05). The success rate of IVF-ET treated pregnancies in 197 infertile patients with PCOS was 51.27% (101/197). Univariate analysis showed that body mass index, luteinizing hormone (LH), LH / follicle stimulating hormone (FSH), testosterone, anti-mullerian hormone (AMH),FAI, and GnSAF were higher in pregnancy failure group than in pregnancy success group, while FSH, fertilization rate, good embryo rate, and SHBG were lower in pregnancy success group(P<0.05). Multivariate logistic regression analysis revealed that increased body mass index and elevated LH, LH / FSH, AMH, FAI, and GnSAF were independent risk factors for pregnancy failure in infertile women with PCOS treated with IVF-ET, while increased SHBG was an independent protective factor(P<0.05). ROC curve analysis showed that the area under the curve of the combination of FAI and serum GnSAF SHBG in predicting the pregnancy outcome of IVF-ET treatment in infertile women with PCOS was larger than that predicted by FAI, GnSAF, SHBG alone. Conclusion: The combination of FAI and serum levels of GnSAF and SHBG has a high value in predicting the pregnancy outcome of IVF-ET treatment in infertile patients with PCOS.