2025 年第 5 期 第 20 卷

外周血辅助性T淋巴细胞1/辅助性T淋巴细胞2预测多囊卵巢综合征不孕症患者体外受精-胚胎移植后不良妊娠结局的临床分析

Clinical analysis of peripheral blood helper T lymphocyte 1/helper T lymphocyte 2 in predicting adverse pregnancy outcomes in infertile women with polycystic ovary syndrome after in vitro fertilization-embryo transfer

作者：张喜梅马国芳王丽萍穆兰芳熊正方

英文作者：Zhang Ximei Ma Guofang Wang Liping Mu Lanfang Xiong Zhengfang

单位：青海省妇女儿童医院妇产科，西宁810007

英文单位：Department of Obstetrics and Gynecology Qinghai Province Women and Children′s Hospital Xining 810007 China

关键词：多囊卵巢综合征；不孕症；妊娠结局；体外受精-胚胎移植；辅助性T淋巴细胞

英文关键词：Polycysticovarysyndrome;Infertility;Pregnancyoutcome;Invitrofertilization-embryotransfer;HelperTlymphocytes

• 摘要：

• 目的 探讨外周血辅助性T淋巴细胞（Th）1/Th2对多囊卵巢综合征（PCOS）不孕症患者体外受精-胚胎移植（IVF-ET）后不良妊娠结局的预测价值。方法 纳入2023年1月至2024年1月青海省妇女儿童医院103例接受IVF-ET治疗的PCOS不孕症患者的临床资料进行回顾性分析，根据妊娠结局情况分为不良妊娠组（53例）与正常妊娠组（50例）。比较2组基线资料、外周血Th1/Th2细胞因子水平。采用多因素Logistic回归方法分析PCOS不孕症患者IVF-ET后不良妊娠结局与外周血Th1/Th2细胞因子水平的关系。绘制列线图模型分析外周血Th1/Th2细胞因子对PCOS不孕症患者IVF-ET后不良妊娠结局的预测价值。结果 2组年龄、PCOS病程等一般资料比较差异均无统计学意义（均P＞0.05）。不良妊娠组Th1型细胞因子肿瘤坏死因子α（TNF-α）、γ干扰素、白细胞介素2（IL-2）水平均高于正常妊娠组，而Th2型细胞因子IL-4、IL-6、IL-10水平均低于正常妊娠组，差异均有统计学意义（均P＜0.05）。多因素Logistic回归分析结果显示PCOS不孕症患者IVF-ET后不良妊娠结局与TNF-α、IL-2、IL-4、IL-10有关（均P＜0.05），与γ干扰素、IL-6无关（均P＞0.05）。列线图模型分析结果显示TNF-α、IL-2较高和IL-4、IL-10较低的PCOS不孕症患者，IVF-ET后不良妊娠结局的风险较高。标准曲线显示预测风险能力指数为0.898，决策曲线显示净收益率最大值为0.515，预测模型准确度、区分度、临床实用性良好。结论 PCOS不孕症患者外周血Th1/Th2细胞因子异常可能提示IVF-ET后不良妊娠结局风险，基于各细胞因子构建的列线图模型可准确预测不良妊娠结局风险。

• Objective To investigate the predictive value of peripheral blood helper T lymphocyte (Th) 1/Th2 on adverse pregnancy outcomes in infertile women with polycystic ovary syndrome (PCOS) after in vitro fertilization-embryo transfer (IVF-ET). Methods The clinical data of 103 PCOS infertility patients who underwent IVF-ET treatment in Qinghai Province Women and Children′s Hospital from January 2023 to January 2024 were retrospectively analyzed. According to the pregnancy outcomes, they were divided into adverse pregnancy group (53 cases) and normal pregnancy group (50 cases). The baseline data and levels of Th1/Th2 cytokines in peripheral blood were compared between the two groups. Multivariate Logistic regression method was used to analyze the relationship between adverse pregnancy outcomes and peripheral blood Th1/Th2 cytokines levels in PCOS infertile patients after IVF-ET. A nomogram model was drawn to analyze the predictive value of Th1/Th2 cytokines in peripheral blood for adverse pregnancy outcomes in PCOS infertile patients after IVF-ET. Results There were no statistically significant differences in general data such as age, PCOS course, etc between the two groups (all P>0.05). The levels of Th1 cytokines tumor necrosis factor α (TNF-α), γ-interferon and interleukin 2 (IL-2) in the adverse pregnancy group were higher than those in the normal pregnancy group, while the levels of Th2 cytokines IL-4, IL-6 and IL-10 in the adverse pregnancy group were lower than those in the normal pregnancy group (all P<0.05). Multivariate Logistic regression analysis showed that the adverse pregnancy outcomes of PCOS infertility patients after IVF-ET were related to TNF-α, IL-2, IL-4 and IL-10 (all P<0.05), but not to γ-interferon and IL-6 (all P>0.05). The nomogram model analysis showed that PCOS infertility patients with higher levels of TNF-α and IL-2 and lower levels of IL-4 and IL-10 had a higher risk of adverse pregnancy outcomes after IVF-ET. The standard curve showed that the ability index to predict risk was 0.898, and the decision curve showed that the maximum net earning rate was 0.515. The accuracy, discrimination and clinical practicability of the prediction model were good. Conclusion Abnormal Th1/Th2 cytokines in peripheral blood of PCOS infertility patients may indicate the risk of adverse pregnancy outcomes after IVF-ET, and the nomogram model based on each cytokine can accurately predict the risk of adverse pregnancy outcomes.