代谢手术对肥胖合并多囊卵巢综合征不孕妇女自然妊娠率的影响：一项回顾性研究。

The impact of metabolic surgery on natural conception rates in women with infertility, obesity and polycystic ovary syndrome: a retrospective study.

机构信息

Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai, China.

Department of Metabolic and Bariatric Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.

出版信息

Surg Obes Relat Dis. 2024 Mar;20(3):237-243. doi: 10.1016/j.soard.2023.09.024. Epub 2023 Sep 27.

DOI:10.1016/j.soard.2023.09.024

PMID:37867048

Abstract

BACKGROUND

Women with obesity and polycystic ovary syndrome (OPOS) are at high risk for infertility. However, the reproductive effects of metabolic surgery on women with infertility and OPOS have not been fully elucidated.

OBJECTIVES

We investigated the natural conception rates after metabolic surgery, and the variables associated with infertility in women with OPOS.

SETTING

Shanghai Sixth People's Hospital, Shanghai, China.

METHODS

This study included 72 women with infertility and OPOS who underwent metabolic surgery and were followed up for 4 years after surgery. Finally, 54 patients completed the study. Reproductive outcomes were assessed, along with changes in anthropometric parameters and metabolic indices before and 1 year after surgery (prepregnancy). Logistic regression analysis was used to identify variables influencing natural conception and delivery outcomes.

RESULTS

After metabolic surgery, 35 patients (64.8%) became pregnant naturally, while 16 were still unable to conceive naturally. Preoperative body mass index (BMI) tended to be lower in the natural conception group than in the no natural conception group (38.9 ± 6.9 versus 43.6 ± 11.0 kg/m, P = .070) and there were no significant differences in weight loss between the 2 groups after surgery. Logistic regression analysis showed that the BMI 1 year after surgery (prepregnancy) was an independent predictor of natural conception, and receiver operating characteristic analysis showed that a BMI of 27.0 kg/m was the optimal cutoff for predicting successful natural conception after surgery.

CONCLUSIONS

Metabolic surgery can improve fertility in women with OPOS. Patients with a BMI < 27.0 kg/m 1 year after surgery (prepregnancy) are more likely to become pregnant naturally and give birth.

摘要

背景

肥胖合并多囊卵巢综合征（PCOS）的女性存在较高的不孕风险。然而，代谢手术对不孕合并 PCOS 女性的生殖影响尚未完全阐明。

目的

我们旨在研究代谢手术后自然妊娠率，以及与 PCOS 不孕相关的变量。

地点

中国上海第六人民医院。

方法

本研究纳入 72 例接受代谢手术的不孕合并 PCOS 女性，术后随访 4 年。最终有 54 例患者完成研究。评估生殖结局，并比较手术前后（妊娠前）的人体测量参数和代谢指标变化。采用 logistic 回归分析识别影响自然妊娠和分娩结局的变量。

结果

代谢手术后，35 例（64.8%）患者自然妊娠，16 例仍无法自然妊娠。自然妊娠组的术前体质量指数（BMI）倾向于低于未自然妊娠组（38.9 ± 6.9 比 43.6 ± 11.0 kg/m2，P =.070），且术后两组间体重减轻无显著差异。logistic 回归分析显示，术后 1 年（妊娠前）BMI 是自然妊娠的独立预测因子，ROC 分析显示 BMI 为 27.0 kg/m2 时是预测术后成功自然妊娠的最佳截断值。