| 110 | 1 | 98 |
| 下载次数 | 被引频次 | 阅读次数 |
目的 探讨血脂水平对排卵障碍患者冻融胚胎移植(FET)周期妊娠结局的影响。方法 回顾性分析2017年1月到2023年5月在苏州市立医院遗传与生殖中心行辅助生殖助孕治疗、采用卵泡期拮抗剂方案促排卵且年龄<38岁的排卵障碍患者的首个FET周期的临床资料，共459个周期。根据血清中甘油三脂(TG)、总胆固醇(TC)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)水平将患者分为两组：血脂正常组(212个周期)和血脂异常组(247个周期)。比较两组患者首次FET周期的一般资料、实验室指标及妊娠结局，并对妊娠结局进行多因素Logistic回归分析。结果 血脂异常组的不孕年限、体质量指数(BMI)、TG、TC、LDL-C、促性腺激素(Gn)总量、Gn天数均显著高于血脂正常组，HDL-C显著低于血脂正常组(P<0.05)。两组患者的获卵数、受精方式、正常受精率(2PN率)、囊胚形成率、优质囊胚率、可移植胚胎率比较均无显著性差异(P>0.05)。两组间比较，移植卵裂胚、囊胚比例及移植日子宫内膜厚度均无显著性差异(P>0.05)。血脂异常组的种植率(49.2%vs. 58.5%)及活产率(44.1%vs. 57.5%)显著低于血脂正常组(P<0.05),早期流产率显著高于血脂正常组(18.6%vs. 10.1%)(P<0.05)。多因素Logistic回归分析显示，血脂异常是流产率[OR=2.679,95%CI(1.304,5.503)]和活产率[OR=0.588,95%CI(0.398,0.868)]的独立影响因素(P<0.05)。结论 血脂异常对排卵障碍患者FET周期的妊娠结局可能存在不利影响，导致其活产率降低、流产率升高。
Abstract：Objective:To investigate the impact of blood lipid levels on pregnancy outcomes in patients with ovulatory disorders during frozen-thawed embryo transfer(FET) cycles.Methods:Patients aged less than 38 years and suffering from ovulation disorders were recruited at the Genetic and Reproductive Center of Suzhou Municipal Hospital from January 2017 to May 2023. The patients underwent ART with antagonist regimen during follicular phase. Their first FET cycles were included in this study, 459 totally. Based on serum triglyceride(TG),total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C),and low-density lipoprotein cholesterol(LDL-C) levels, the patients were categorized into two groups as a normal blood lipid group(212 cycles) and a dyslipidemia group(247 cycles). The demographic characteristics, laboratory parameters, and pregnancy outcomes between these two groups were compared for the first FET cycle, followed by multivariate logistic regression analysis for pregnancy outcomes.Results:The duration of infertility, body mass index(BMI),the levels of TG,TC and LDL-C,total gonadotropin(Gn) dosage, and days of Gn administration were significantly higher in the dyslipidemia group than those in the normal blood lipid group, while the HDL-C level was significantly lower than the latter(P<0.05). There were no significant differences between the two groups in terms of the number of oocytes retrieved, fertilization method, normal fertilization rate(2PN rate),blastocyst formation rate, high-quality blastocyst rate, and the rate of transferable embryos(P>0.05). Additionally, there were no significant differences in the proportion of cleaved embryos and blastocysts transferred, as well as endometrial thickness on the day of embryo transfer(ET) between the two groups(P>0.05). The implantation rate(49.2% vs. 58.5%) and live birth rate(44.1% vs. 57.5%) were significantly lower in the dyslipidemia group compared to the normal blood lipid group(P<0.05),whereas the early miscarriage rate was significantly higher in the dyslipidemia group(18.6% vs. 10.1%,P<0.05). Multivariate logistic regression analysis indicated that dyslipidemia was an independent factor for the miscarriage rate[OR=2.679,95%CI(1.304,5.503),P<0.05] and live birth rate[OR=0.588,95%CI(0.398,0.868),P<0.05].Conclusions:Dyslipidemia may adversely affect pregnancy outcomes in patients with ovulatory disorders undergoing FET cycles, leading to a reduction in live birth rates and an increase in miscarriage rates.
[1] 李立明，饶克勤，孔灵芝，等.中国居民2002年营养与健康状况调查[J].中华流行病学杂志，2005,26:478-484.
[2] Lu Y,Zhang H,Lu J,et al.Prevalence of dyslipidemia and availability of lipid-lowering medications among primary health care settings in China[J].JAMA Netw Open,2021,4:e2127573.
[3] Yang T,Zhao J,Zhang Q,et al.Associations between dyslipidaemia and pregnancy outcomes in the first complete cycle of IVF/ICSI:a real-world analysis[J/OL].Reprod Biomed Online,2021,43:1095-1105.
[4] Liu Z,Cong J,Liu X,et al.Dyslipidemia is negatively associated with the cumulative live-birth rate in patients without PCOS following IVF/ICSI[J].Front Physiol,2021,12:713356.
[5] 张婉君，卜志勤，史昊，等.血脂异常对非PCOS不孕患者IVF/ICSI-ET妊娠结局的影响[J].生殖医学杂志，2022,31:1654-1660.
[6] Hynes JS,Weber JM,Truong T,et al.Body mass index is negatively associated with a good perinatal outcome after in vitro fertilization among patients with polycystic ovary syndrome:a national study[J].F S Rep,2023,4:77-84.
[7] 中国成人血脂异常防治指南制订联合委员会.中国成人血脂异常防治指南[J].中华心血管病杂志，2007,35:390-419.
[8] Gardner DK,Schoolcraft WB.Culture and transfer of human blastocysts[J].Curr Opin Obstet Gynecol,1999,11:307-311.
[9] Rao A,Satheesh A,Nayak G,et al.High-fat diet leads to elevated lipid accumulation and endoplasmic reticulum stress in oocytes,causing poor embryo development[J].Reprod Fertil Dev,2020,32:1169-1179.
[10] Jiang H,Chen L,Tian T,et al.Inflammation mediates the effect of adiposity and lipid metabolism indicators on the embryogenesis of PCOS women undergoing in vitro fertilization/intracytoplasmic sperm injection[J].Front Endocrinol(Lausanne),2023,14:1198602.
[11] Browne RW,Bloom MS,Shelly WB,et al.Follicular fluid high density lipoprotein-associated micronutrient levels are associated with embryo fragmentation during IVF[J].J Assist Reprod Genet,2009,26:557-560.
[12] Yang F,Mao W,Ge YM,et al.Hyperlipidemia is negatively associated with pregnancy outcomes in patients following frozen-thawed embryo transfer:A retrospective study[J].Health Sci Rep,2024,7:e1947.
[13] Costa-Urrutia P,Colistro V,Franco-Trecu V,et al.Dyslipidemia,obesity,and ethnicity in Mexican children[J].Int J Environ Res Public Health,2021,18:12659.
[14] 李宣，丁卫，刘嘉茵，等.血脂异常对多囊卵巢综合征患者IVF/ICSI妊娠结局的影响[J].中华妇产科杂志，2018,53:402-408.
[15] Legro RS,Kunselman AR,Dunaif A.Prevalence and predictors of dyslipidemia in women with polycystic ovary syndrome[J].Am J Med,2001,111:607-613.
[16] Wild RA,Rizzo M,Clifton S,et al.Lipid levels in polycystic ovary syndrome:systematic review and meta-analysis[J].Fertil Steril,2011,95:1073-1079.
[17] Liu Q,Xie YJ,Qu LH,et al.Dyslipidemia involvement in the development of polycystic ovary syndrome[J].Taiwan J Obstet Gynecol,2019,58:447-453.
[18] He Y,Lu Y,Zhu Q,et al.Influence of metabolic syndrome on female fertility and in vitro fertilization outcomes in PCOS women[J].Am J Obstet Gynecol,2019,221:138.
[19] Yang F,Lu JC,Shen T,et al.Effect of hyperlipidemia on the outcome of in vitro fertilization in non-obese patients with polycystic ovary syndrome[J].Front Endocrinol(Lausanne),2023,14:1281794.
[20] 张园，文彩荷，夏心如，等.接受供卵的不孕症患者血脂异常对临床结局的影响[J].中华妇产科杂志，2022,57:686-691.
[21] Pavlicev M,Wagner GP,Chavan AR,et al.Single-cell transcriptomics of the human placenta:inferring the cell communication network of the maternal-fetal interface[J].Genome Res,2017,27:349-361.
[22] Savaris RF,Groll JM,Young SL,et al.Progesterone resistance in PCOS endometrium:a microarray analysis in clomiphene citrate-treated and artificial menstrual cycles[J].J Clin Endocrinol Metab,2011,96:1737-1746.
[23] 王蔚，高鸿祥，童步高，等.高脂血症对血浆t-PA和PAI-1活性的影响[J].复旦学报(医学版),2003,30:400-401,403.
[24] Salazar Garcia MD,Sung N,Mullenix TM,et al.Plasminogen activator inhibitor-1 4G/5G polymorphism is associated with reproductive failure:Metabolic,hormonal,and immune profiles[J].Am J Reprod Immunol,2016,76:70-81.
基本信息:
中图分类号:R714.8
引用信息:
[1]王文娟,郑爱燕,高靓,等.血脂水平对排卵障碍患者冻融胚胎移植妊娠结局的影响[J].生殖医学杂志,2024,33(12):1557-1563.
基金信息:
江苏省医学重点学科/实验室建设单位项目(JSDW202214)
2024-12-15
2024-12-15