多囊卵巢综合征(PCOS)患者行辅助生殖治疗(ART)的自然流产风险高于无PCOS患者,然而,目前尚无明确的危险因素与接受ART的PCOS患者的高自然流产率相关.本研究旨在评估相关危险因素对PCOS患者自然流产的影响。根据PICOS原则制定和组织临床问题。
对所有已发表的关于PCOS和Embase自然流产的研究进行了系统评价和荟萃分析,PubMed,WebofScience和Cochrane图书馆。相关危险因素包括体重指数(BMI)、年龄,胰岛素抵抗(IR),雄激素过多症,和染色体畸变。所有患者均使用鹿特丹标准诊断为PCOS。主要终点是流产和活产率。固定效应模型用于分析同质数据,对异质性数据进行亚组和敏感性分析。对异质性的来源进行了评估,并采用随机效应模型对异质性进行总结。
在1836篇检索到的文章中,22例符合资格,并包括在11182例患者的分析中。高BMI(OR=1.48,95%CI[1.32,1.67],MD=1.35,95%CI[0.58,2.12])和胰岛素抵抗(MD=0.32,95%CI[0.15,0.49])与接受ART的PCOS患者自然流产风险增加相关。年龄较大(OR=0.29,95%CI[0.29,0.44],MD=2.01,95%CI[0.04,4.18]),胚胎染色体畸变(OR=0.75,95CI[0.31,1.77]),和高雄激素血症(MD=0.10,95%CI[-0.02,0.22])与PCOS患者的高自然流产率无关。BMI亚组分析表明,超重和肥胖对接受ART的PCOS患者自然流产的影响无统计学意义(OR=1.34,95%[0.97,1.85])。
高BMI和胰岛素抵抗是PCOS患者接受ART的自然流产风险增加的两个危险因素。减轻体重和减轻胰岛素抵抗可能会降低这些接受ART的患者的自然流产率。
The risk of spontaneous abortion in patients with polycystic ovary syndrome (PCOS) undergoing assisted reproductive treatment (ART) is higher than that in patients without PCOS, however, no definitive risk factors have been confirmed to associate with the high spontaneous abortion rate in PCOS patients undergoing ART. This study was performed to assess the impact of relevant risk factors on spontaneous abortion in patients with PCOS. Clinical questions were formulated and organized according to the PICOS principle.
A systematic
review and meta-analysis were conducted on all published studies on PCOS and spontaneous abortion in Embase, PubMed, Web of Science and Cochrane Library. Related risk factors included body mass index (BMI), age, insulin resistance (IR), hyperandrogenism, and chromosome aberrations. All patients were diagnosed as PCOS using the Rotterdam criteria. The primary endpoint was miscarriage and live birth rate. Fixed-effect models were used to analyze homogeneous data, and subgroup and sensitivity analyses were performed on heterogeneous data. The source of heterogeneity was evaluated, and the random effect model was used to summarize the heterogeneity.
Among 1836 retrieved articles, 22 were eligible and included in the analysis with 11182 patients. High BMI (OR = 1.48, 95% CI [1.32, 1.67], MD = 1.35, 95% CI [0.58,2.12]) and insulin resistance (MD = 0.32, 95% CI [0.15, 0.49]) were associated with an increased risk of spontaneous abortion in PCOS patients undergoing ART. Older age (OR = 0.29, 95% CI [0.29, 0.44], MD = 2.01, 95% CI [0.04, 4.18]), embryonic chromosomal aberrations (OR = 0.75, 95%CI [0.31,1.77]), and hyperandrogenism (MD = 0.10, 95% CI [- 0.02, 0.22]) were not associated with the high spontaneous abortion rate in patients with PCOS. A subgroup analysis of BMI showed that there was no statistically significant difference in the effect between overweight and obesity on spontaneous abortion in PCOS patients undergoing ART (OR = 1.34, 95% [0.97, 1.85]).
High BMI and insulin resistance are two risk factors for an increased risk of spontaneous abortion in PCOS patients undergoing ART, and losing weight and mitigating insulin resistance may decrease the spontaneous abortion rate in these patients undergoing ART.