Effects of hyperhomocysteinaemia and metabolic syndrome on reproduction in women with polycystic ovary syndrome: a secondary analysis
Effects of hyperhomocysteinaemia and metabolic syndrome on reproduction in women with polycystic ovary syndrome: a secondary analysis
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DOI：
10.1016/j.rbmo.2018.12.046
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发表时间：
2019-06-01
影响因子：
4
通讯作者：
Wu, Xiaoke
中科院分区：
文献类型：
--
作者：
Chang, Hui;Xie, Liangzhen;Wu, Xiaoke
研究问题：多囊卵巢综合征（PCOS）妇女高同型半胱氨酸血症（HHCY）、代谢综合征和生殖结局之间的关系是什么？结果：高同型半胱氨酸（HCY）与高体重指数（BMI）、高游离睾酮（FT）、低FSH、低空腹血糖（FBG）相关（P < 0.001; P < 0.001; P = 0.005; P < 0.001）和排卵率（OR 0.59，95% CI 0.41至0.86; OR 0.57，95% CI 0.39至0.83，分别为第2和3个三分位数与第1个三分位数）。HHCY组雌二醇水平低于对照组，游离睾酮水平高于对照组（P = 0.04; P < 0.001）。代谢综合征组LH、LH FSH比值、性激素结合球蛋白均低于对照组（P均< 0.001）。在HHCY组中，与对照组相比，治疗调整后排卵率降低，中晚期妊娠丢失率增加（OR 1.678，95%CI 1.04至2.70; OR 0.03，95%CI 0.00至0.42）。与对照组相比，代谢综合征组调整治疗后排卵、受孕、妊娠、中晚期妊娠丢失率和活产率均显著降低（OR 1.76，95% CI 1.15至2.70; OR 1.75，95% CI 1.15至2.65; OR 2.09，95% CI 1.27至3.44; OR 0.02，95% CI 0.00至0.33; OR 2.42（95%CI 1.42 ~ 4.10），调整治疗和性激素因素后，妊娠率、妊娠丢失率和活产率仍有显著差异（OR 1.77，95% CI 1.05 - 2.99; OR 0.14，95% CI 0.02 - 0.82; OR 2.02，95% CI 1.16 - 3.50）。在PCOS患者中，HHCY导致妊娠丢失增加和排卵减少，代谢综合征与排卵、受孕、妊娠流产和活产，这表明这两种情况导致不同生殖阶段的缺陷。
Research question: What is the association between hyperhomocysteinaemia (HHCY), metabolic syndrome, and reproductive outcomes among women with polycystic ovary syndrome (PCOS).Design: A secondary analysis of PCOSAct with 21 sites in China. A total of 1000 women with PCOS were enrolled; 936 women with baseline homocysteine (HCY) were analysed.Results: Higher HCY was associated with higher body mass index, free testosterone and lower FSH, fasting glucose (P < 0.001; P < 0.001; P = 0.005; P < 0.001) and ovulation rate among all participants (OR 0.59, 95% CI 0.41 to 0.86; OR 0.57, 95% CI 0.39 to 0.83 tertiles 2 and 3 versus tertile 1, respectively). The HHCY group had lower oestradiol and higher free testosterone (P = 0.04; P < 0.001) than the controls. In the metabolic syndrome group, LH, LH-FSH ratio and sex hormone-binding globulin were lowest in the metabolic syndrome group (all P < 0.001). In the HHCY group, ovulation rate decreased and the second or third trimester pregnancy loss rate increased compared with controls (OR 1.678, 95% CI 1.04 to 2.70; OR 0.03, 95% CI 0.00 to 0.42) with treatment adjustment. Compared with the controls, ovulation, conception, pregnancy, second or third trimester pregnancy loss and live birth rates were statistically lower in the metabolic syndrome group after adjusting treatment (OR 1.76, 95% CI 1.15 to 2.70; OR 1.75, 95% CI 1.15 to 2.65; OR 2.09, 95% CI 1.27 to 3.44; OR 0.02, 95% CI 0.00 to 0.33; OR 2.42 95% CI 1.42 to 4.10), and pregnancy, pregnancy loss and live birth rates remained significantly different after adjusting for treatment and sex-hormone factors (OR 1.77, 95% CI 1.05 to 2.99; OR 0.14, 95% CI 0.02 to 0.82; OR 2.02, 95% CI 1.16 to 3.50).Conclusions: In women with PCOS, HHCY contributes to increased pregnancy loss and reduced ovulation, and metabolic syndrome was related to defects in ovulation, conception, pregnancy, pregnancy loss and live birth, indicating that the two conditions lead to defects at various reproductive stages.