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PCOS女性辅助生殖中BMI与炎症标志物的双向中介效应研究

Bidirectional Mediation Effects of Body Mass Index and Inflammatory Markers on Assisted Reproductive Outcomes in Women With Polycystic Ovary Syndrome
RSS 订阅 · BJOG · 2026-10-09

这是一项针对966名接受辅助生殖技术(ART)治疗的多囊卵巢综合征(PCOS)女性的历史队列研究。研究评估了体重指数(BMI)与炎症标志物(中性粒细胞/淋巴细胞比值NLR、系统免疫炎症指数SII、血小板/淋巴细胞比值PLR)对ART结局的双向中介作用，发现较高BMI和炎症指数与较少获卵数和优质胚胎数相关，BMI与NLR存在双向相关通路。

要点

  • 肥胖PCOS女性获卵数中位数为12.00个，显著低于体重不足者的14.50个(p<0.001)
  • NLR中介了9.2%(95%CI:2.3%-20.0%)的BMI对优质胚胎数的影响
  • BMI中介了26.6%(95%CI:13.3%-62.3%)的NLR对优质胚胎数的影响

核心结论

  • PCOS女性中，较高BMI和外周炎症指数与获卵数减少、优质胚胎数减少相关
  • BMI与NLR位于共同的双向相关通路上，其中BMI贡献的份额更大
  • 本研究为探索性和假设生成性质，非验证性研究

研究设计与样本

  • 历史队列研究，纳入966名接受ART治疗的PCOS女性
  • 按BMI分为体重不足组(n=38)、正常体重组(n=547)、超重组(n=282)和肥胖组(n=99)
  • 采用多变量回归、限制性立方样条和基于准贝叶斯方法的双向因果中介分析(1000次模拟)
  • 单中心研究，来自南京医科大学附属南京妇幼保健院生殖医学科

主要发现

  • 获卵数从体重不足组的14.50个(IQR 12.00-20.75)降至肥胖组的12.00个(IQR 9.00-16.00)(p<0.001)
  • 优质胚胎数从体重不足组的4.00个(IQR 0.25-6.00)降至肥胖组的1.00个(IQR 0.00-3.50)(p<0.001)
  • 所有炎症标志物与可用胚胎率均呈一致的负剂量-反应关系(均p<0.001)
  • SII和PLR显示的中介效应极小(<5%)

关键数值与推荐

  • NLR中介了BMI对优质胚胎数影响的9.2%(95%CI:2.3%-20.0%)
  • BMI中介了NLR对优质胚胎数影响的26.6%(95%CI:13.3%-62.3%)
  • BMI中介了NLR对可用胚胎影响的58.6%(95%CI:5.6%-528.4%)

临床怎么用

  • PCOS女性接受ART治疗前应重视BMI管理，肥胖可能降低获卵数和优质胚胎数
  • 外周血NLR可作为PCOS女性ART结局的潜在预测指标
  • BMI和炎症状态可能通过双向通路影响生殖结局，控制体重可能部分改善炎症相关的不良结局

局限性

  • 单中心历史队列研究，结论为探索性和假设生成性质
  • 未说明因果关系的确切方向，需进一步验证性研究

以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。

原文

ABSTRACT Objective To evaluate the bidirectional mediation effects of body mass index (BMI) and inflammatory markers (neutrophil-to-lymphocyte ratio [NLR], systemic immune-inflammation index [SII], platelet-to-lymphocyte ratio [PLR]) on assisted reproductive technology (ART) outcomes in women with polycystic ovary syndrome (PCOS). Design A historical cohort study. This analysis is exploratory and hypothesis-generating rather than confirmatory. Setting Department of Reproductive Medicine, Nanjing Women's Hospital of Nanjing Medical University, China. Population A total of 966 women with PCOS undergoing ART, categorized by BMI: underweight (n = 38), normal weight (n = 547), overweight (n = 282), and obesity (n = 99). Methods Multivariable regression, restricted cubic splines, and bidirectional causal mediation analysis using the Quasi-Bayesian approach with 1000 simulations were performed. Main Outcome Measures Number of oocytes retrieved, high-quality embryos, available embryo rate, and clinical pregnancy outcomes. Results Oocytes retrieved decreased from 14.50 (IQR 12.00–20.75) in underweight to 12.00 (IQR 9.00–16.00) in obese women (p < 0.001). High-quality embryos declined from 4.00 (IQR 0.25–6.00) to 1.00 (IQR 0.00–3.50) across BMI categories (p < 0.001). All inflammatory markers showed consistent negative dose–response relationships with available embryo rate (all p < 0.001). NLR mediated 9.2% (95% CI: 2.3%–20.0%) of BMI's effect on high-quality embryos. BMI mediated 26.6% (95% CI: 13.3%–62.3%) of NLR's effect on high-quality embryos and 58.6% (95% CI: 5.6%–528.4%) on available embryos. SII and PLR showed minimal mediation effects (< 5%). Conclusions These findings are exploratory and hypothesis-generating. In this single-centre cohort of women with PCOS, higher BMI and higher peripheral inflammatory indices were associated with fewer oocytes retrieved and fewer high-quality embryos, and BMI and NLR appeared to lie on shared, bidirectionally related pathways, with the larger share attributable to BMI.

来源：BJOG，查看原文。版权归原作者所有。

引用

  1. BJOG：Bidirectional Mediation Effects of Body Mass Index and Inflammatory Markers on Assisted Reproductive Outcomes in Women With Polycystic Ovary Syndrome
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供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。