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[血脂异常对接受供卵的不孕症患者临床结局的影响]

[Effect of dyslipidemia on clinical outcome of infertility patients receiving donor eggs].

作者信息

Zhang Y, Wen C H, Xia X R, Wang J, Xia M, Qian Y, Shu L, Liu J Y, Wang D W, Ma X

机构信息

Center for Clinical Reproductive Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.

出版信息

Zhonghua Fu Chan Ke Za Zhi. 2022 Sep 25;57(9):686-691. doi: 10.3760/cma.j.cn112141-20220125-00045.

Abstract

To explore the effect of dyslipidemia on the clinical outcome of intracytoplasmic sperm injection-embryo transfer (ICSI-ET) in infertility patients receiving donor eggs. A total of 118 patients were selected to receive egg donors and ICSI-ET at the First Affiliated Hospital of Nanjing Medical University between April 2007 and December 2020. According to the levels of triacylglycerol, serum cholesterol, high density lipoprotein (HDL), and low density lipoprotein, they were divided into dyslipidemia group (35 cases) and normal blood lipids group (83 cases). The influence of body mass index (BMI) and age was adjusted by 1∶1 propensity score matching, and the general condition and clinical outcome of the two groups were analyzed retrospectively. Finally, the relationship between lipid composition and clinical outcome was analyzed according to patients' age and BMI. (1) Comparing the pre-matching dyslipidemia group with the normal blood lipids group, the BMI of the dyslipidemia group was significantly higher than that of the normal blood lipids group [(23.5±2.4) vs (22.4±2.7) kg/m], and the embryo implantation rate was significantly lower than that of the normal blood lipids group [13.6% (8/59) vs 27.3% (36/132)], the differences were statistically significant (both <0.05). (2) There were no significant differences in years of infertility, number of pregnancies, number of abortions, number of transplanted embryos, protocol of endometrial preparation, endometrial thickness on transplantation day and high quality embryo rate between the two groups, through propensity score matching (all >0.05). The biochemical pregnancy rate [28.6% (10/35)], embryo implantation rate [13.6% (8/59)] and live birth rate [20.0% (7/35)] in dyslipidemia group were significantly lower than those in the normal blood lipids group (<0.05). The clinical pregnancy rate was lower than that of the normal blood lipids group (>0.05). (3) The results of stratified analysis showed that the level of HDL in the clinically non-pregnant group was significantly lower than that in the pregnant group in patients ≤ 35 years old [(1.5±0.3) vs (1.8±0.5) mmol/L; <0.05]. In the overweight recipient patients, the level of HDL of the clinically non-pregnant group was lower than that of the pregnant group (>0.05). Dyslipidemia significantly reduces the biochemical pregnancy rate, embryo implantation rate and live birth rate in patients with receiving donor eggs. Especially in patients aged ≤35 years old, the reduction of HDL is closely related to adverse pregnancy outcomes.

摘要

探讨血脂异常对接受供卵的不孕患者卵胞浆内单精子注射-胚胎移植(ICSI-ET)临床结局的影响。选取2007年4月至2020年12月在南京医科大学第一附属医院接受供卵及ICSI-ET的118例患者。根据三酰甘油、血清胆固醇、高密度脂蛋白(HDL)和低密度脂蛋白水平,将其分为血脂异常组(35例)和血脂正常组(83例)。采用1∶1倾向评分匹配对体重指数(BMI)和年龄的影响进行校正,回顾性分析两组的一般情况和临床结局。最后,根据患者年龄和BMI分析血脂成分与临床结局的关系。(1)血脂异常组与血脂正常组匹配前比较,血脂异常组BMI显著高于血脂正常组[(23.5±2.4) vs (22.4±2.7)kg/m²],胚胎着床率显著低于血脂正常组[13.6%(8/59) vs 27.3%(36/132)],差异均有统计学意义(均<0.05)。(2)通过倾向评分匹配后,两组在不孕年限、妊娠次数、流产次数、移植胚胎数、子宫内膜准备方案、移植日子宫内膜厚度及优质胚胎率方面差异均无统计学意义(均>0.05)。血脂异常组的生化妊娠率[28.6%(10/35)]、胚胎着床率[13.6%(8/59)]和活产率[20.0%(7/35)]均显著低于血脂正常组(<0.05)。临床妊娠率低于血脂正常组(>0.05)。(3)分层分析结果显示,≤35岁患者中,临床未妊娠组HDL水平显著低于妊娠组[(1.5±0.3) vs (1.8±0.5)mmol/L;<0.05]。超重受者中,临床未妊娠组HDL水平低于妊娠组(>0.05)。血脂异常显著降低接受供卵患者的生化妊娠率、胚胎着床率和活产率。尤其是≤35岁患者,HDL降低与不良妊娠结局密切相关。

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