| Background & Aims: Polycystic ovary syndrome(PCOS)is a common reproductive endocrine disease that affects the health of women in childbearing age seriously.The disease is characterized by high androgenemia,chronic no ovulation,infertility,and often accompanied by metabolic disorders.PCOS patients are often associated with overweight/obesity.Overweight/obesity can deteriorate the patient’s reproductive function and affect the patient’s chance of pregnancy.Several current guidelines indicate that pre-pregnancy weight loss for overweight/obese PCOS patients can partially restore the patient’s reproductive capacity and improve the pregnancy rate after assisted reproductive therapy.The guidelines recommend lifestyle interventions centered on dietary calorie control.In addition,metformin can also be used in patients with low ovulation due to metabolic disorders.However,so far there were no risk prediction model has been established for successful pregnancy in overweight/obese PCOS patients receiving comprehensive medical treatment.In this study,Logistic regression analysis based on principal component analysis was used to establish a risk prediction model for comprehensive evaluation of overweight/obese PCOS patients in different stages of pregnancy under comprehensive medical treatment,providing theoretical basis for clinicians to adopt individualized treatment for patients with different risk factors.Methods: This study included a total of 464 overweight/obese PCOS infertility patients who met the admission criteria for lifestyle intervention + metformin treatment at the department of endocrinology and weight management center of nanjing gulou hospital from February 2016 to December 2018,and collected their clinical data.The diagnosis of PCOS is based on Rotterdam criteria,that is,two or more of the following three diagnostic conditions are met :(1)low ovulation or no ovulation;(2)the clinical manifestations of hyperandrogen and/or hyperandrogen;(3)polycystic changes in the ovaries(unilateral or bilateral ovaries with ≥12 follicles between 2 and 9mm in diameter,and/or increased ovarian volume ≥ 10cm3).The diagnosis of overweight and obesity is based on the world health organization(who)standard centered on Body mass index(BMI): BMI < 18.5kg/m2 is considered to be underweight;18.5 ≤ BMI ≤ 24.9kg/m2 is normal weight;25 ≤ BMI ≤ 29.9kg/m2 is overweight;Obesity is defined as 30kg/m2 ≤ BMI.Patients were divided into pregnancy,pregnancy within 6 months,pregnancy after 6 months and non-pregnancy groups according to pregnancy results.The independent sample T test was used to screen the risk factors,and the selected risk factors were analyzed by Logistic regression based on principal component analysis.The prediction model was established,the area under the ROC curve was calculated,and the prediction efficiency was evaluated.Results: In this study,464 overweight/obese PCOS infertility patients who underwent lifestyle intervention and metformin treatment in the department of endocrinology and weight management center of Nanjing Drum Tower Hospital from February 2016 to December 2018 were included and their clinical data were collected.The diagnosis of PCOS adopts Rotterdam standard,that is,two or more of the following three diagnostic conditions are met :(1)sparse ovulation or anovulation;(2)the clinical manifestations of hyperandrogenemia and/or hyperandrogenemia(such as androgenic alopecia,acne,hairy,etc.);(3)polycystic changes in the ovary(unilateral or bilateral ovaries with ≥12 follicles in diameter between 2 and 9mm,and/or increased ovarian volume ≥10cm3).The diagnosis of overweight and obesity is based on the World Health Organization(WHO)standard with Body mass index(BMI)as the center:BMI < 18.5kg/m2 is considered underweight;18.5≤BMI≤24.9kg/m2 is considered normal weight;25≤BMI≤29.9kg/m2 is considered overweight;Obesity is defined as 30kg/m2≤BMI.According to the results of pregnancy,the patients were divided into pregnancy,pregnancy within 6 months,pregnancy after 6 months and non-pregnancy groups.The independent sample T test was used to screen the risk factors,and the selected risk factors were analyzed by Logistic regression based on principal component analysis.The prediction model was established,the area under the ROC curve was calculated,and the prediction efficiency was evaluated.Conclusions: 1.The effects of obesity,insulin resistance and hyperinsulinemia on successful pregnancy after medical treatment in overweight/obese PCOS patients were prolonged and could not be eliminated by medical treatment for 6 months.The effect of LH on successful pregnancy in overweight/obese PCOS patients after medical treatment can be eliminated by 6 months of medical treatment.2.Body fat percentage and visceral fat area significantly affected the time needed for successful pregnancy in overweight/obese PCOS patients after medical treatment.3.The risk assessment model developed by the institute can assess the risk of successful pregnancy in the target population to some extent. |
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