CAJ | 학술논문

目的：探讨行体外受精－胚胎移植（IVF-ET）后不同分型的多囊卵巢综合征（PCOS）患者的妊娠结局。方法选择接受IVF-ET治疗并成功妊娠的PCOS妇女160例，及输卵管因素妇女350例进行回顾性分析，以身体质量指数（ BMI）≥或＜24kg／m2为界线分为4组：肥胖PCOS组28例（A组），非肥胖PCOS组132例（B组），肥胖输卵管因素组41例（C组），非肥胖输卵管因素组309例（ D组）。分析各组的临床特征、IVF参数、妊娠及围产儿结局。结果4组间的年龄、BMI、原发性不孕比例、不孕年限、基础促卵泡生成素（FSH）水平的差异均有统计学意义（t＝12．603，P＝0．031；t＝21．619，P＝0．000；χ2＝78．681，P＝0．000；t＝7．838，P＝0．045；t＝16．264，P＝0．020）。 B组的人绒毛膜促性腺激素（ hCG）日雌二醇（ E2）水平最高、获卵数最多，其次是A组，均多于输卵管因素组（C和D组），差异均有统计学意义（t＝28．581，P＝0．000；t＝25．492，P＝0．000）；PCOS组（A和B组）的受精率、优胚数、移植率比输卵管因素组（C和D组）低，差异均有统计学意义（t＝21．642，P＝0．000；t＝9．863，P＝0．035；χ2＝27．711，P＝0．000）。肥胖组（A和C组）妊娠期糖尿病的发病率及大于胎龄儿发生率比非肥胖组（B和D）高，差异均有统计学意义（χ2＝14．698，P＝0．002；χ2＝25．003，P＝0．000）；PCOS组（ A和B组）小于胎龄儿的发生率高于输卵管因素组（ C和D组），差异均有统计学意义（χ2＝8．086，P＝0．044）。结论在接受IVF-ET治疗的不同类型PCOS妇女中，非肥胖与肥胖PCOS的IVF参数、妊娠结局及围产儿结局有些不同，肥胖PCOS的获卵数少于非肥胖PCOS，妊娠期糖尿病和巨大儿的发生率增加，但不影响其临床妊娠率。
목적：탐토행체외수정－배태이식（IVF-ET）후불동분형적다낭란소종합정（PCOS）환자적임신결국。방법선택접수IVF-ET치료병성공임신적PCOS부녀160례，급수란관인소부녀350례진행회고성분석，이신체질량지수（ BMI）≥혹＜24kg／m2위계선분위4조：비반PCOS조28례（A조），비비반PCOS조132례（B조），비반수란관인소조41례（C조），비비반수란관인소조309례（ D조）。분석각조적림상특정、IVF삼수、임신급위산인결국。결과4조간적년령、BMI、원발성불잉비례、불잉년한、기출촉란포생성소（FSH）수평적차이균유통계학의의（t＝12．603，P＝0．031；t＝21．619，P＝0．000；χ2＝78．681，P＝0．000；t＝7．838，P＝0．045；t＝16．264，P＝0．020）。 B조적인융모막촉성선격소（ hCG）일자이순（ E2）수평최고、획란수최다，기차시A조，균다우수란관인소조（C화D조），차이균유통계학의의（t＝28．581，P＝0．000；t＝25．492，P＝0．000）；PCOS조（A화B조）적수정솔、우배수、이식솔비수란관인소조（C화D조）저，차이균유통계학의의（t＝21．642，P＝0．000；t＝9．863，P＝0．035；χ2＝27．711，P＝0．000）。비반조（A화C조）임신기당뇨병적발병솔급대우태령인발생솔비비비반조（B화D）고，차이균유통계학의의（χ2＝14．698，P＝0．002；χ2＝25．003，P＝0．000）；PCOS조（ A화B조）소우태령인적발생솔고우수란관인소조（ C화D조），차이균유통계학의의（χ2＝8．086，P＝0．044）。결론재접수IVF-ET치료적불동류형PCOS부녀중，비비반여비반PCOS적IVF삼수、임신결국급위산인결국유사불동，비반PCOS적획란수소우비비반PCOS，임신기당뇨병화거대인적발생솔증가，단불영향기림상임신솔。
Objective To investigate the pregnancy outcomes of different subtypes of polycystic ovary syndrome ( PCOS) patients after in vitro fertilization and embryo transfer ( IVF-ET) .Methods Retrospective study was conducted among 160 pregnant women with PCOS and 350 infertile women with tubal factors who undergoing IVF-ET.They were divided into four groups:28 cases in obese-PCOS group ( group A) , 132 cases in non-obese PCOS group ( group B) , 41 cases in obese tubal factor group ( group C) , and 309 cases in non-obese tubal factor group (group D) with obesity defined by body mass index (BMI) over 24kg/m2.Clinical characteristics, IVF parameters, pregnancy and perinatal outcomes were analyzed in each group.Results There were significant differences among four groups in age, BMI, proportion of primary infertility, infertility duration and basal FSH level ( t=12.603, P=0.031; t=21.619, P=0.000;χ2 =78.681, P=0.000;t=7.838, P=0.045;t=16.264, P=0.020).The E2 level in hCG day was highest in group B, and the number of retrieved oocytes was also the most, followed by group A, both of which were significantly more than tubal factor groups ( group C and D) ( t=28.581, P=0.000;t=25.492, P=0.000).The fertilization rate, the number of good embryos and the implantation rate of PCOS groups (group A and B) were lower than those of the tubal groups (group C and D), and the differences were significant (t=21.642, P=0.000;t=9.863, P=0.035;χ2 =27.711, P=0.000).The morbidity of GDM and the incidence of large for gestational age infant in obese groups (group A and C) were obviously higher than those in non-obese groups (group B and D) (χ2 =14.698, P=0.002;χ2 =25.003, P=0.000) .The incidence of small for gestational age infant was higher in the PCOS groups ( group A and B) than in the tubal factor groups (group C and D), and the difference was significant (χ2 =8.086, P=0.044).Conclusion There are some differences in IVF parameters, pregnancy and perinatal outcomes between obese and non-obese PCOS patients who undergoing IVF-ET treatment. Compared with non-obese PCOS groups, the number of retrieved oocytes of obese PCOS women is less, and the morbidity of GDM and the incidence of large for gestational age infant increases without influence on clinical pregnancy rate.