超重多囊卵巢综合征患者血清抗苗勒管激素水平升高是发生早产的独立危险因素。
Elevated Anti-Müllerian Hormone Is an Independent Risk Factor for Preterm Birth Among Patients With Overweight Polycystic Ovary Syndrome.
机构信息
The Reproductive Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
出版信息
Front Endocrinol (Lausanne). 2021 Dec 8;12:788000. doi: 10.3389/fendo.2021.788000. eCollection 2021.
OBJECTIVE
To explore whether elevated anti-Müllerian hormone (AMH) levels affect the rate of preterm birth (PTB) among PCOS patients with different BMIs.
METHODS
In this retrospective cohort study, patients with PCOS who had undergone IVF/ICSI from January 2017 to December 2019 were included for potential evaluation. A total of 2368 singleton live births from PCOS patients were included. According to the BMI, all the PCOS patients were divided into two groups: BMI<24 kg/m and BMI≥24 kg/m. In total, 1339 PCOS patients with a BMI<24 kg/m were grouped according to their serum AMH levels: ① <2.71 ng/ml (n=333), ② 2.71-4.08 ng/ml (n=330), ③ 4.09-6.45 ng/ml (n=351), and ④ >6.45 ng/ml (n=325). Additionally, 1029 cycles of patients with a BMI≥24 kg/m were grouped according to the serum AMH level: ① <2.71 ng/ml (n=255), ② 2.71-4.08 ng/ml (n=267), ③ 4.09-6.45 ng/ml (n=239), and ④ >6.45 ng/ml (n=268), with <2.71 ng/ml being considered the reference group. The grouping was based mainly on the interquartile range of serum AMH levels. The primary outcome of the study was PTB. The secondary outcomes were low birth weight (LBW), small for gestational age (SGA), macrosomia and large for gestational age (LGA).
RESULTS
Regarding PCOS patients with a BMI<24 kg/m, compared with the PTB rate of the AMH <2.71 ng/ml group, the PTB rates of the different groups were not significantly different (AMH 2.71-4.08, AOR (95% CI)=1.01 (0.52-2.00), P=0.99; AMH 4.09-6.45, AOR (95% CI)=0.93 (0.45-1.91), P=0.85; AMH>6.45, AOR (95% CI)=0.78 (0.35-1.73), P=0.54). Regarding PCOS patients with a BMI ≥24 kg/m, compared with the PTB rate of the AMH <2.71 ng/ml group, the PTB rate of the AMH>6.45 ng/ml group was significantly higher (OR=2.47; 95% CI=1.34-4.55). After multiple logistic regression analysis, the risk of PTB in the AMH>6.45 ng/ml group was 2.1 times that in the AMH<2.71 ng/ml group (AOR=2.1, 95% CI=1.01-4.37, P=0.04). However, no statistically significant difference was found in the rate of SGA, LBW, macrosomia or LGA among patients in the different serum AMH groups.
CONCLUSION
For PCOS patients, a BMI≥24 kg/m plus serum AMH>6.45 ng/ml (75th percentile) is an independent risk factor for PTB.
目的
探讨不同 BMI 的多囊卵巢综合征（PCOS）患者中，血清抗苗勒管激素（AMH）水平升高是否会影响早产（PTB）的发生率。
方法
本回顾性队列研究纳入了 2017 年 1 月至 2019 年 12 月接受体外受精/卵胞浆内单精子注射（IVF/ICSI）的 PCOS 患者进行潜在评估。共纳入 2368 例 PCOS 患者的单胎活产。根据 BMI，将所有 PCOS 患者分为两组：BMI<24 kg/m 和 BMI≥24 kg/m。共有 1339 名 BMI<24 kg/m 的 PCOS 患者根据血清 AMH 水平分组：①<2.71ng/ml（n=333），②2.71-4.08ng/ml（n=330），③4.09-6.45ng/ml（n=351），和④>6.45ng/ml（n=325）。此外，根据血清 AMH 水平，将 1029 个 BMI≥24 kg/m 的患者的周期分组：①<2.71ng/ml（n=255），②2.71-4.08ng/ml（n=267），③4.09-6.45ng/ml（n=239），和④>6.45ng/ml（n=268），<2.71ng/ml 为参考组。分组主要基于血清 AMH 水平的四分位间距。主要结局为 PTB。次要结局为低出生体重（LBW）、小于胎龄儿（SGA）、巨大儿和大于胎龄儿（LGA）。
结果
对于 BMI<24kg/m 的 PCOS 患者，与 AMH<2.71ng/ml 组的 PTB 发生率相比，不同组的 PTB 发生率无显著差异（AMH 2.71-4.08，AOR（95%CI）=1.01（0.52-2.00），P=0.99；AMH 4.09-6.45，AOR（95%CI）=0.93（0.45-1.91），P=0.85；AMH>6.45，AOR（95%CI）=0.78（0.35-1.73），P=0.54）。对于 BMI≥24kg/m 的 PCOS 患者，与 AMH<2.71ng/ml 组相比，AMH>6.45ng/ml 组的 PTB 发生率显著升高（OR=2.47；95%CI=1.34-4.55）。经多因素逻辑回归分析，AMH>6.45ng/ml 组的 PTB 风险是 AMH<2.71ng/ml 组的 2.1 倍（AOR=2.1，95%CI=1.01-4.37，P=0.04）。然而，不同血清 AMH 组的 SGA、LBW、巨大儿或 LGA 发生率无统计学差异。
结论
对于 PCOS 患者，BMI≥24kg/m 伴血清 AMH>6.45ng/ml（75 百分位）是 PTB 的独立危险因素。
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