多囊卵巢综合征患者血清GnSAF,Irisin, Copeptin 表达水平及其与妊娠结局的相关性研究

目的 探讨多囊卵巢综合征(polycystic ovary syndrome，PCOS)患者血清促性腺激素峰抑制因子(gonadotropinpeak suppressor factor，GnSAF)、鸢尾素(Irisin)、和肽素(Copeptin)表达水平及其与妊娠结局的关系。方法 将2018 年10 月～ 2020 年10 月湖北省大冶市人民医院诊治的PCOS 患者106 例设为PCOS 组，另选择同期82 例健康体检女性为对照组。收集两组有关临床资料，检测比较两组血清GnSAF, Irisin 和Copeptin 水平，分析PCOS 患者血清GnSAF , Irisin , Copeptin 水平与临床指标的相关性，应用Logistic 回归分析探讨PCOS 发生的影响因素，并对PCOS 组行常规西医药物治疗，对比不同妊娠结局患者血清GnSAF，Irisin 和Copeptin 水平，应用受试者工作特征(ROC)曲线观察血清GnSAF，Irisin 和Copeptin 对患者妊娠结局的预测价值。结果 PCOS 组体质量指数(body mass index，BMI)25.28±3.76kg/m2、空腹血糖(fasting blood glucose，FPG) 5.47±0.58mmol/L， 空腹胰岛素(fasting insulin，FINS)15.61±2.75mIU/L，稳态模型胰岛素抵抗指数(homeostasis model insulin resistance index，HOMA-IR)3.79±0.83，三酰甘油(triglyceride，TG)1.87±0.58mmol/L，睾酮(testosterone，T)1.94±0.53nmol/L，促黄体生成素(luteinizinghormone，LH)12.86±2.28mU/ml 及血清GnSAF(22.00±1.93pg/ml), Irisin(3.09±0.69ng/L) ,Copeptin(12.61±3.27pmol/L) 水平均高于对照组(22.06±3.27kg/m2，5.14±0.43mmol/L ，9.04±2.49mIU/L，2.07±0.64，1.42±0.49mmol/L，1.21±0.34nmol/L，5.63±1.07mU/ml,19.82±2.26pg/ml，2.07±0.63ng/L ，8.62±1.94pmol/L)； 高密度脂蛋白胆固醇(high-density lipoprotein cholesterol，HDL-C)1.24±0.21mmol/L，雌二醇(estradiol，E2) 112.48±19.55pmol/L 水平均低于对照组(1.40±0.24mmol/L，134.06±24.16pmol/L)，差异具有统计学意义(t ＝ 4.315 ～ 26.532，均P ＝ 0.000)。Pearson 相关系数模型分析显示，血清GnSAF 水平与E2 呈负相关(r ＝ -0.308)，血清Irisin, Copeptin 水平与BMI ，FPG, FINS, HOMA-IR, TG 水平呈正相关(r ＝ 0.321 ～ 0.649)，与HDL-C 水平呈负相关(r ＝ -0.409)，且血清Irisin水平与T 水平呈正相关(r ＝ 0.321)，差异均有统计学意义(均P ＜ 0.05)。Logistic 回归分析发现，血清GnSAF,Irisin 和Copeptin 均为PCOS 发病的独立危险因素(Waldχ2 ＝ 10.246 ～ 15.464, OR ＝ 2.482 ～ 3.438, 均P ＜ 0.05)。妊娠成功PCOS 患者血清GnSAF(21.13±1.85pg/ml ), Irisin(2.77±0.64ng/L)和Copeptin(11.02±3.04pmol/L)水平均低于妊娠失败患者(22.24±2.04pg/ml ，3.18±0.72ng/L ，13.05±3.48pmol/L)，差异具有统计学意义(t ＝ 2.354，20472，2.540, 均P ＜ 0.05)。绘制ROC 曲线预测模型可知，血清GnSAF, Irisin 和Copeptin 三项指标均对患者妊娠失败有一定预测价值，采取联合时曲线下面积(AUC)最大，为0.948，敏感度和特异度分别为91.57% 和86.96%。结论 PCOS 患者血清GnSAF, Irisin 和Copeptin 水平呈异常高表达，且表达与临床指标有关，可为预后预测提供参考。

Changes of Serum GnSAF,Irisin and Copeptin Levels in Patients with Polycystic Ovary Syndrome and Their Relationship with Pregnancy Outcomes

Objective To investigate the expression levels of serum gonadotropin peak suppressor factor (GnSAF), Irisin and Copeptinin patients with polycystic ovary syndrome (PCOS) and their relationship with pregnancy outcomes. Methods A total of 106 PCOS patients diagnosed and treated in the People’s Hospital of Daye City, Hubei Province from October 2018 to October 2020 were selected as the PCOS group, and 82 healthy women who underwent physical examination during the same period were selected as the control group. The relevant clinical data of the two groups were collected, and the serum levels of GnSAF, Irisin and Copeptin were detected and compared between the two groups.The correlation between serum GnSAF, Irisin and Copeptin levels and clinical indicators in PCOS patients was analyzed, and the influencing factors of PCOS were analyzed by logistic regression analysis. The PCOS group was treated with conventional western medicine, the serum levels of GnSAF, Irisin and Copeptin were compared in patients with different pregnancy outcomes, and the receiver operating characteristic (ROC) curve was used to observe the predictive value of serum GnSAF, Irisin and Copeptin on the pregnancy outcome of patients. Results PCOS group body mass index(BMI，25.28±3.76kg/m2), fasting blood glucose (FPG， 5.47±0.58mmol/L), fasting insulin (FINS，15.61±2.75mIU/L), homeostasis model insulin resistance index (HOMA-IR，3.79±0.83), triglyceride (TG ， 1.87±0.58mmol/L), testosterone(T，1.94±0.53nmol/L), luteinizing hormone (LH，12.86±2.28mU/ml) and serum GnSAF(22.00±1.93pg/ml ), Irisin(3.09±0.69ng/L), Copeptin(12.61±3.27pmol/L) levels were higher than those in the control group(22.06±3.27kg/m2，5.14±0.43mmol/L，9.04±2.49mIU/L，2.07±0.64，1.42±0.49mmol/L，1.21±0.34nmol/ L，5.63±1.07mU/ml, 19.82±2.26pg/ml，2.07±0.63ng/L，8.62±1.94pmol/L), the levels of high-density lipoprotein cholesterol (HDL-C，1.24±0.21mmol/L )and estradiol (E2，112.48±19.55pmol/L ) levels were lower than those of the control group(1.40±0.24mmol/L，134.06±24.16pmol/L), and the differences were statistically significan(t t＝4.315～26.532， all P ＝ 0.000). Pearson correlation coefficient model analysis showed that serum GnSAF levels were negatively correlated with E2(r ＝ -0.308). Serum Irisin, Copeptin levels were positively correlated with BMI, FPG, FINS, HOMA-IR, TG levels(r ＝ 0.321 ～ 0.649), and negative correlation with HDL-C levels(r ＝ -0.409). Serum Irisin level was positively correlated with T level(r ＝ 0.321)，the differences were statistically significant (all P ＜ 0.05).Logistic regression analysis found that serum GnSAF, Irisin and Copeptin were independent risk factors for PCOS (Waldχ2 ＝ 10.246 ～ 15.464,OR ＝ 2.482 ～ 3.438,all P ＜ 0.05).The serum levels of GnSAF(21.13±1.85pg/ml), Irisin(2.77±0.64ng/L) and Copeptin(11.02±3.04pmol/L) in PCOS patients with successful pregnancy were lower than those in patients with pregnancy failure(22.24±2.04pg/ml， 3.18±0.72ng/L ，13.05±3.48pmol/L),the differences were statistically significant (t=2.354, 2.472, 2.540, all P ＜ 0.05). According to the prediction model of ROC curve, the three indexes of serum GnSAF, Irisin and Copeptin had a certain predictive value for pregnancy failure. When combined, the area under the curve(AUC)was the largest(0.948), with a sensitivity of 91.57% and a specificity of 86.96%，respectively .Conclusion The serum levels of GnSAF, Irisin and Copeptinin PCOS patients are abnormally high, and the expressions are related to clinical indicators, which can provide a reference for prognosis prediction.