多囊卵巢综合征孕妇的低度慢性炎症：一项前瞻性对照临床研究。

Low-grade chronic inflammation in pregnant women with polycystic ovary syndrome: a prospective controlled clinical study.

作者信息

Palomba Stefano, Falbo Angela, Chiossi Giuseppe, Orio Francesco, Tolino Achille, Colao Annamaria, La Sala Giovanni Battista, Zullo Fulvio

机构信息

Units of Obstetrics and Gynecology (S.P., A.F., G.C., G.B.L.S.) IRCCS-Arcispedale Santa Maria Nuova, 42123 Reggio Emilia, Italy; Department of Endocrinology (F.O.), University "Parthenope" of Naples, 80100 Naples, Italy; Department of Endocrinology (F.O.), University "Ruggi d'Aragona," 84131 Salerne, Italy; Departments of Obstetrics and Gynecology (A.T.) and Endocrinology (A.C.), University "Federico II" of Naples, 80131 Naples, Italy; University of Modena and Reggio Emilia (G.B.L.S.), 41100 Modena, Italy; and Department of Obstetrics and Gynecology (F.Z.), University "Magna Graecia" of Catanzaro, 88100 Catanzaro, Italy.

出版信息

J Clin Endocrinol Metab. 2014 Aug;99(8):2942-51. doi: 10.1210/jc.2014-1214. Epub 2014 May 29.

DOI:10.1210/jc.2014-1214

PMID:24873996

Abstract

CONTEXT

Polycystic ovary syndrome (PCOS) and pregnancy are conditions characterized by an increased low-grade chronic inflammation state. A higher incidence of pregnancy complications has been detected in pregnant PCOS women.

OBJECTIVE

The objective of the study was to test the hypothesis that the low-grade chronic inflammation state typical of PCOS patients persists during gestation and is exacerbated by pregnancy and contributes to the increased risk of obstetric/neonatal complications.

DESIGN

This was a prospective controlled clinical study.

SETTING

The study was conducted at the Academic Department of Obstetrics and Gynecology of the "Pugliese-Ciaccio" Hospital of Catanzaro (Catanzaro, Italy).

PATIENTS

One hundred fifty pregnant PCOS women and 150 age- and body mass index-matched healthy pregnant controls participated in the study.

INTERVENTIONS

INTERVENTIONS included serial clinical, biochemical, and ultrasonographic assessments before and throughout pregnancy.

MAIN OUTCOME MEASURES

Serum levels of white blood cell count (WBC), C-reactive protein (CRP), and ferritin were measured.

RESULTS

Pregnant women with PCOS had higher WBC, CRP, and ferritin levels at study entry and at all gestational ages than controls. Changes in serum WBC and ferritin levels were significantly higher in PCOS than in controls starting from the 12th week of gestation whereas those in CRP from the 20th week of gestation. By multivariable Cox proportional hazard analysis, in the PCOS group, a significant association with the risk of adverse obstetric/neonatal outcomes was found for WBC [hazard ratio (HR) 1.52, 95% confidence interval (CI) 1.31-1.64; P = .010], CRP (HR 1.19, 95% CI 1.06-1.34; P = .019), and ferritin levels (HR 1.12, 95% CI 1.03-1.26; P = .011).

CONCLUSIONS

In PCOS patients, the low-grade chronic inflammation persists during gestation and is exacerbated by pregnancy, and it is associated with adverse pregnancy outcomes.

摘要

背景

多囊卵巢综合征（PCOS）和妊娠均以低度慢性炎症状态增加为特征。已检测到PCOS孕妇中妊娠并发症的发生率较高。

目的

本研究的目的是检验以下假设：PCOS患者典型的低度慢性炎症状态在妊娠期间持续存在，并因妊娠而加剧，且会导致产科/新生儿并发症风险增加。

设计

这是一项前瞻性对照临床研究。

地点

该研究在意大利卡坦扎罗市“普列塞-恰乔”医院妇产科进行。

患者

150名PCOS孕妇和150名年龄及体重指数匹配的健康孕妇对照组参与了该研究。

干预措施

干预措施包括在妊娠前及整个孕期进行系列临床、生化和超声评估。

主要观察指标

测量血清白细胞计数（WBC）、C反应蛋白（CRP）和铁蛋白水平。

结果

患有PCOS的孕妇在研究开始时及所有孕周的WBC、CRP和铁蛋白水平均高于对照组。从妊娠第12周起，PCOS患者血清WBC和铁蛋白水平的变化显著高于对照组，而CRP水平从妊娠第20周起显著高于对照组。通过多变量Cox比例风险分析，在PCOS组中，发现WBC[风险比（HR）1.52，95%置信区间（CI）1.31-1.64；P = 0.010]、CRP（HR 1.19，95%CI 1.06-1.34；P = 0.019）和铁蛋白水平（HR 1.12，95%CI 1.03-1.26；P = 0.011）与不良产科/新生儿结局风险显著相关。