摘要目的 探讨体外受精-胚胎移植(IVF-ET)后多囊卵巢综合征(PCOS)患者的妊娠结局及其影响因素.方法 选择IVF-ET治疗并成功单胎妊娠的患者189例,按照2003年ESHRE/ASRM鹿特丹诊断标准产生的PCOS不同表型分四组:规律排卵组、非高雄激素血症组、非PCOS组、经典PCOS组,比较各组妊娠结局的差异并分析原因.结果 4组年龄、体质量指数(BMI)、妊娠期糖尿病(GDM)、早产、胎儿出生体质量、畸形死胎率差异均无统计学意义(P均＞0.05),流产率及妊娠期高血压疾病(PIH)差异均有统计学意义(x2值分别为4.768、8.338,P均＜0.05).进一步两两比较发现,非高雄激素组流产率(14.29％与29.09％、39.53％、35.71％；P均＜0.05)和PIH(1.82％与17.14％、16.28％、17.86％:P均＜0.05)的发生均显著低于其他各组.结论 不同的表型PCOS患者卵巢功能状态不同,体内内分泌环境有差异,可导致不同的妊娠结局,而PCOS妊娠后高胰岛素和雄激素血症及妊娠后期加重的胰岛素抵抗的相互作用是PCOS患者复杂妊娠结局产生的重要原因.

abstractsObjective To investigate the pregnancy outcome and its influencing factors in patients with polycystic ovary syndrome (PCOS) after in vitro fertilization and embryo transfer (IVF-ET).Methods One hundred and eighty-nine cases of patients with single pregnancy after successful IVF-ET were selected as our subjects according to the 2003 ESHRE/ASRM Rotterdam diagnostic criteria.They were divided into four groups in accordance with PCOS phenotype:the group of regular ovulation,non hyper androgens group,non-PCO group,classic PCOS group.Differences pregnancy outcomes were recorded.Results There were no significant differences among four groups in terms of age,body mass index (BMI),Gestational diabetes mellitus (GDM),preterm delivery,fetal birth weight,malformations stillbirth (all P ＞ 0.05).The abortion rate and pregnancy induced hypertension(PIH) showed significant differences (x2 =4.768,8.338,P ＜ 0.05).A further two two comparison,in non Kaohsiung hormone group,the abortion rate(14.29％ and 29.09％,39.53％,35.71％ ; P ＜0.05) and PIH (1.82％ and 17.14％,16.28 ％,17.86％ ; P ＜ 0.05) were significantly lower than those in the other groups occurred.Conclusion Different phenotypes of PCOS patients had different ovarian function status.Endocrine environment difference might lead to a different outcome of pregnancy.The interaction of insulin resistance in patients with PCOS with high insulin,androgen hyperlipidemia,insulin resistance in late pregnancy played important roles in pregnancy outcomes.