炎症标志物与不孕流行率相关：NHANES 2013-2020 的横断面分析。

Inflammatory markers are associated with infertility prevalence: a cross-sectional analysis of the NHANES 2013-2020.

机构信息

Foshan Clinical Medical School of Guangzhou University of Chinese Medicine, Foshan, Guangdong, China.

TCM Gynecology Department, Foshan Fosun Chancheng Hospital, Chancheng District, Foshan, Guangdong, China.

出版信息

BMC Public Health. 2024 Jan 18;24(1):221. doi: 10.1186/s12889-024-17699-4.

DOI:10.1186/s12889-024-17699-4

PMID:38238731

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10797998/

Abstract

BACKGROUND

Inflammation exerts a critical role in the pathogenesis of infertility. The relationship between inflammatory parameters from peripheral blood and infertility remains unclear. Aim of this study was to investigate the association between inflammatory markers and infertility among women of reproductive age in the United States.

METHODS

Women aged 20-45 were included from the National Health and Nutrition Examination Survey (NHANES) 2013-2020 for the present cross-sectional study. Data of reproductive status was collected from the Reproductive Health Questionnaire. Six inflammatory markers, systemic immune inflammation index (SII), lymphocyte count (LC), product of platelet and neutrophil count (PPN), platelet-lymphocyte ratio (PLR), neutrophil-lymphocyte ratio (NLR) and lymphocyte-monocyte ratio (LMR) were calculated from complete blood counts in mobile examination center. Survey-weighted multivariable logistic regression was employed to assess the association between inflammatory markers and infertility in four different models, then restricted cubic spline (RCS) plot was used to explore non-linearity association between inflammatory markers and infertility. Subgroup analyses were performed to further clarify effects of other covariates on association between inflammatory markers and infertility.

RESULTS

A total of 3,105 women aged 20-45 was included in the final analysis, with 431 (13.88%) self-reported infertility. A negative association was found between log2-SII, log2-PLR and infertility, with an OR of 0.95 (95% CI: 0.78,1.15; p = 0.60), 0.80 (95% CI:0.60,1.05; p = 0.10), respectively. The results were similar in model 1, model 2, and model 3. Compared with the lowest quartile (Q1), the third quartile (Q3) of log2-SII was negatively correlation with infertility, with an OR (95% CI) of 0.56 (95% CI: 0.37,0.85; p = 0.01) in model 3. Similarly, the third quartile (Q3) of log2-PLR was negatively correlation with infertility, with an OR (95% CI) of 0.61 (95% CI: 0.43,0.88; p = 0.01) in model 3. No significant association was observed between log2-LC, log2-PPN, log2-NLR, log2-LMR and infertility in model 3. A similar U-shaped relationship between log2-SII and infertility was found (p for non-linear < 0.05). The results of subgroup analyses revealed that associations between the third quartile (Q3) of log2-SII, log2-PLR and infertility were nearly consistent.

CONCLUSION

The findings showed that SII and PLR were negatively associated with infertility. Further studies are needed to explore their association better and the underlying mechanisms.

摘要

背景

炎症在不孕的发病机制中起着关键作用。外周血炎症参数与不孕之间的关系仍不清楚。本研究旨在探讨美国育龄妇女炎症标志物与不孕之间的关系。

方法

本横断面研究纳入了 2013-2020 年国家健康和营养调查（NHANES）中 20-45 岁的女性。生殖状况数据来自生殖健康问卷。在移动体检中心从全血细胞计数中计算出 6 种炎症标志物，包括系统免疫炎症指数（SII）、淋巴细胞计数（LC）、血小板和中性粒细胞乘积（PPN）、血小板-淋巴细胞比（PLR）、中性粒细胞-淋巴细胞比（NLR）和淋巴细胞-单核细胞比（LMR）。采用问卷调查加权多变量逻辑回归评估四个不同模型中炎症标志物与不孕之间的关系，然后使用限制立方样条（RCS）图探索炎症标志物与不孕之间的非线性关系。进一步进行亚组分析，以阐明其他协变量对炎症标志物与不孕之间关系的影响。

结果

最终纳入了 3105 名 20-45 岁的女性，其中 431 名（13.88%）自我报告不孕。SII 和 PLR 与不孕呈负相关，比值比（OR）分别为 0.95（95%可信区间：0.78，1.15；p=0.60）和 0.80（95%可信区间：0.60，1.05；p=0.10）。这些结果在模型 1、模型 2 和模型 3 中均相似。与最低四分位数（Q1）相比，SII 的第三四分位数（Q3）与不孕呈负相关，OR（95%可信区间）为 0.56（95%可信区间：0.37，0.85；p=0.01），在模型 3 中。同样，PLR 的第三四分位数（Q3）与不孕呈负相关，OR（95%可信区间）为 0.61（95%可信区间：0.43，0.88；p=0.01），在模型 3 中。在模型 3 中，log2-LC、log2-PPN、log2-NLR 和 log2-LMR 与不孕之间无显著相关性。log2-SII 和不孕之间存在类似的 U 形关系（p 非线性<0.05）。亚组分析的结果表明，log2-SII 和 log2-PLR 的第三四分位数（Q3）与不孕的关系几乎一致。