超重/肥胖不孕症患者孕前体质量控制情况及影响因素分析

焦晓柯; 曹红霞; 王丹丹; 邢金芳

doi:10.16766/j.cnki.issn.1674-4152.002371

超重/肥胖不孕症患者孕前体质量控制情况及影响因素分析

doi: 10.16766/j.cnki.issn.1674-4152.002371

1.
河南中医药大学第三附属医院不孕与不育诊疗中心，河南郑州 450008
2.
郑州大学第三附属医院河南省妇幼保健院河南省妇女儿童医院生殖中心，河南郑州 450052

基金项目:

河南省医学科技攻关计划联合共建项目 LHGJ20190398

详细信息

通讯作者:
焦晓柯, E-mail: momagom@163.com

中图分类号: R711.6 R173
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- 文章访问数: 121
- HTML全文浏览量: 65
- PDF下载量: 11
- 被引次数: 0
出版历程
- 收稿日期: 2021-08-16
- 网络出版日期: 2022-08-13

Analysis of prepregnancy body quality control and its influencing factors in overweight/obese infertility patients

1.
Infertility and Infertility Diagnosis Treatment Center, the Third Affiliated Hospital of Henan University of Traditional Chinese medicine, Zhengzhou, Henan 450008, China

摘要

摘要: 目的了解超重/肥胖不孕症患者的孕前体质量控制状况，并分析其影响因素。方法选取2019年6月—2020年6月在河南中医药大学第三附属医院就诊的超重/肥胖不孕症患者116例为研究对象，收集患者的一般临床资料及体质量控制前后的相关数据，分析体质量控制效果的相关影响因素。结果患者体质量控制时间为8~24周，减重量为0~25(7.43±0.62)kg，减重量占原始体质量的0~26.83%，减重量/原始体质量≥10%的患者共45例，占总例数的38.79%；患者既往是否控制体质量、既往体质量控制方式、基础代谢、体质量控制时间、原始BMI、一般自我效能感评分对体质量控制效果有显著影响(均P＜0.05)；经多因素logistic回归分析，基础代谢、体质量控制时间、BMI、一般自我效能感评分是患者体质量控制效果的影响因素。结论超重/肥胖不孕症患者的体质量控制效果欠佳，仍有待进一步提高。基础代谢率降低、BMI降低、一般自我效能感评分降低是影响患者体质量控制效果的独立危险因素，体重控制时间长属于患者体质量控制效果的保护因素，临床应针对上述因素给予干预措施以提高患者体质量控制效果，改善妊娠结局。
- 不孕症 /
- 超重 /
- 肥胖 /
- 体质量控制 /
- 影响因素
Abstract: Objective To investigate the prepregnancy body quality control status of overweight/obese infertility patients and analysed the influencing factors. Methods A total of 116 cases of overweight/obese infertility patients who were treated in the Outpatient Department of the Reproductive Medicine Center of our hospital from June 2019 to June 2020 were selected as the research objects. General clinical data and relevant data before and after body weight control were collected, and relevant factors influencing the effect of body weight control were analysed. Results The time of body mass control was 8-24 weeks. The weight loss was 0-25 (7.43±0.62) kg on average, and the weight loss accounted for 0-26.83% of the original body weight. A total of 45 patients (38.79%) had weight loss/original body weight ≥10%. Whether the patients had controlled the body mass in the past, the way of body mass control in the past, basic metabolism, body mass control time, original BMI and general self-efficacy score had significant effects on the effect of body mass control (all P < 0.05). Multivariate logistic regression analysis showed that basic metabolism, body mass control time, BMI and general self-efficacy were the influential factors of body mass control effect. Conclusion The effect of body mass control in overweight/obese infertile patients is poor and needs to be further improved. Basal metabolic rate, lower BMI reduce, general self-efficacy scores are independent risk factors affecting the effects of patients' body quality control, weight control patients with longer belong to the protection of the body quality control effect factors, clinical should be aimed at the above factors intervention measures to improve the patients' body quality control effect, improve the pregnancy outcome.
- Infertility /
- Overweight /
- Obesity /
- Body mass control /
- Influencing factors

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表 1 超重/肥胖不孕症患者体质量控制效果比较(x±s)

Table 1. Comparison of weight control effect in overweight/obese infertile patients (x±s)

项目	类别	例数	减重量(kg)	统计量	P值
年龄(岁)	20~30	76	7.37±1.18	-0.593^a	0.554
	31~38	40	7.51±1.26
文化程度	初中及以下	52	7.41±1.22	-0.295^a	0.769
	高中及以上	64	7.48±1.31
居住地	农村乡镇	45	7.29±1.16	-0.786^a	0.433
	城市	71	7.46±1.12
工作状况	无业	38	7.28±1.32	-0.747^a	0.457
	在职	78	7.47±1.27
不孕病因	输卵管因素	52	7.59±1.15	0.868^b	0.423
	排卵因素	38	7.28±1.17
	子宫内膜异位	26	7.35±1.18
BMI	24~ < 28	67	6.87±1.35	-3.113^a	0.002
	≥28	49	7.68±1.43
既往控制体质量	是	82	6.89±1.15	-3.596^a	＜0.001
	否	34	7.76±1.27
自我效能感评分(分)	≤45	68	6.71±1.29	-4.724^a	＜0.001
	＞45	48	7.87±1.32
既往控制体质量方式	饮食调节	65	7.16±1.63	3.746^b	0.027
	锻炼	28	7.95±1.72
	药物、减肥产品	23	6.72±1.68
基础代谢(kcal)	＜1 200	43	6.87±1.35	-3.007^a	0.003
	≥1 200	73	7.68±1.43
体质量控制时间(周)	8~12	28	6.68±1.19	11.883^b	＜0.001
	13~18	56	7.12±1.25
	19~24	32	8.17±1.28
注：^a为t值，^b为F值。

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表 2 变量赋值情况

Table 2. Variable assignment method

项目	赋值方法
既往是否控制体质量	是=1，否=0
既往体质量控制方式	饮食调节=1，锻炼=2，药物或减肥产品=3
基础代谢(kcal)	＜1 200=1，≥1 200=2
体重量控制时间(周)	8~12=1，13~18=2，19~24=3
BMI	24~28=1，≥28=2
自我效能感评分(分)	≤45=1，＞45=2
减重量(kg)	连续型变量

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表 3 影响患者孕前体质量控制效果的多因素logistic回归分析

Table 3. Multivariate logistic regression analysis on the effect of pre-pregnancy weight control

项目	B	SE	Wald χ²	P值	OR值	95% CI
既往是否控制体质量	0.296	0.176	3.475	0.062	1.344	0.952~1.898
既往体质量控制方式	0.186	0.169	2.627	0.105	1.204	0.865~1.677
基础代谢(kcal)	0.779	0.327	5.729	0.017	2.179	1.148~4.136
体重量控制时间(周)	-0.465	0.127	8.956	0.003	0.628	0.490~0.806
BMI	0.976	0.585	6.475	0.011	2.654	1.843~8.351
一般自我效能感(分)	1.198	0.796	12.468	< 0.001	3.313	1.498~7.327

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参考文献(16)

[1]	姜璎钊, 刘均娥, 韩静. 女性不孕症患者病耻感水平及影响因素的调查研究[J]. 中华护理杂志, 2018, 53(6): 698-703. doi: 10.3761/j.issn.0254-1769.2018.06.011 JIANG Y Z, LIU Y E, HAN J. The investigation on the status and relevant factors of stigma in female patients with infertility[J]. Chinese Journal of Nursing, 2018, 53(6): 698-703. doi: 10.3761/j.issn.0254-1769.2018.06.011
[2]	BEST D, AVENELL A, BHATTACHARYA S. How effective are weight-loss interventions for improving fertility in women and men who are overweight or obese?A systematic review and meta-analysis of the evidence[J]. Hum Reprod Update, 2017, 23(6): 681-705. doi: 10.1093/humupd/dmx027
[3]	马清光, 李慧敏, 程晓, 等. 妊娠超重孕妇肥胖抑制素与孕前体指数、胰岛素抵抗的相关性研究[J]. 实验与检验医学, 2019, 37(5): 865-867. doi: 10.3969/j.issn.1674-1129.2019.05.029 MA Q G, LI H M, CHENG X, et al. Correlation of adiposin with prepregnancy body index and insulin resistance in overweight pregnant women[J]. Experimental and Laboratory Medicine, 2019, 37(5): 865-867. doi: 10.3969/j.issn.1674-1129.2019.05.029
[4]	刘丽, 郝苗苗, 张燕, 等. 不孕症女性体重指数对IVF/ICSI-ET妊娠结局的影响[J]. 宁夏医学杂志, 2019, 41(9): 807-809. https://www.cnki.com.cn/Article/CJFDTOTAL-NXYX201909018.htm LIU L, HAO M M, ZHANG Y, et al. Effect of body mass index on pregnancy outcome of IVF/ICSI-ET in infertile women[J]. Ningxia Medical Journal, 2019, 41(9): 807-809. https://www.cnki.com.cn/Article/CJFDTOTAL-NXYX201909018.htm
[5]	RYAN D H, YOCKEY S R. Weight loss and improvement in comorbidity: Differences at 5%, 10%, 15%, and Over[J]. Curr Obes Rep, 2017, 6(2): 187-194.
[6]	张宝玲. 牙周病患者口腔保健自我效能感水平及影响因素[J]. 航空航天医学杂志, 2021, 32(7): 874-875. doi: 10.3969/j.issn.2095-1434.2021.07.066 ZHANG B L. Level and influencing factors of oral health care self-efficacy in patients with periodontal disease[J]. Journal of Aerospace Medicine, 2021, 32(7): 874-875. doi: 10.3969/j.issn.2095-1434.2021.07.066
[7]	陈艳, 张智峰, 张亚杰, 等. 肥胖对女性生殖功能的影响及其防治[J]. 中国计划生育学杂志, 2018, 26(8): 759-761. https://www.cnki.com.cn/Article/CJFDTOTAL-JHSY201808036.htm CHEN Y, ZHANG Z F, ZHANG Y J, et al. ffects of obesity on female reproductive function and its prevention and treatment[J]. Chinese Journal of Family Planning, 2018, 26(8): 759-761. https://www.cnki.com.cn/Article/CJFDTOTAL-JHSY201808036.htm
[8]	牛金蕾. 减重对超重及肥胖不孕患者辅助生殖结局及围产期结局的影响[D]. 济南: 山东大学, 2019. NIU J L. Effect of weight loss on assisted reproductive outcomes and perinatal outcomes in overweight and obese infertile patients[D]. Jinan: Shandong University, 2019.
[9]	邵洁, 郭静波, 廖娟, 等. 不孕症超重/肥胖患者孕前体质量控制情况及影响因素研究[J]. 国际生殖健康/计划生育杂志, 2020, 39(6): 460-464. https://www.cnki.com.cn/Article/CJFDTOTAL-GWJS202006006.htm SHAO J, GUO J B, LIAO B, et al. Study on pre-pregnancy BMI control and influencing factors in infertile women with overweight / obesity[J]. Journal of International Reproductive Health/Family Planning, 2020, 39(6): 460-464. https://www.cnki.com.cn/Article/CJFDTOTAL-GWJS202006006.htm
[10]	张佳月, 田征文, 谭红专. 人类基础代谢率测量方法的研究进展[J]. 中南大学学报(医学版), 2018, 43(7): 805-810. https://www.cnki.com.cn/Article/CJFDTOTAL-HNYD201807020.htm ZHANG J Y, TIAN Z W, TAN H Z. Research progress in measurement of human basal metabolic rate[J]. Journal of Central South University (Medical Science), 2018, 43(7): 805-810. https://www.cnki.com.cn/Article/CJFDTOTAL-HNYD201807020.htm
[11]	简妙如. 电针结合有氧运动对单纯性肥胖基础代谢率的影响[D]. 南京: 南京中医药大学, 2017. JIAN M R. Effect of electroacupuncture combined with aerobic exercise on basal metabolic rate in simple obesity[D]. Nanjing: Nanjing University of Traditional Chinese Medicine, 2017.
[12]	张莹, 吴景欢, 洪平, 等. 北京市超重和肥胖成人基础代谢率的研究[J]. 卫生研究, 2016, 45(5): 739-742, 748. https://www.cnki.com.cn/Article/CJFDTOTAL-WSYJ201605036.htm ZHANG Y, WU J H, HONG P, et al. Basal metabolic rate of overweight and obese adults in Beijing[J]. Journal of Hygiene Research, 2016, 45(5): 739-742, 748. https://www.cnki.com.cn/Article/CJFDTOTAL-WSYJ201605036.htm
[13]	RASHAD N M, SAYED S E, SHERIF M H, et al. Effect of a 24 -week weight management program on serum leptin level in correlation to anthropometric measures in obese female: A randomized controlled clinical trial[J]. Diabetes Metab Syndr, 2019, 13(3): 2230-2235.
[14]	叶娅琼, 蒋瑶枝, 陈君霞, 等. 子宫内膜预处理对多囊卵巢综合征不孕患者的促排卵疗效[J]. 中华全科医学, 2020, 18(9): 1530-1533. doi: 10.16766/j.cnki.issn.1674-4152.001552 YE Y Q, JIANG Y Z, CHEN J X, et al. Effect of endometrial pretreatment on ovulation induction in infertile patients with polycystic ovary syndrome[J]. Chinese Journal of General Practice, 2020, 18(9): 1530-1533. doi: 10.16766/j.cnki.issn.1674-4152.001552
[15]	杨石慧, 王玮. 归芍地黄汤联合人绒毛膜促性腺激素治疗黄体功能不全性不孕症疗效观察[J]. 中华全科医学, 2020, 18(7): 1204-1206. doi: 10.16766/j.cnki.issn.1674-4152.001465 YANG S H, WANG W. The clinical efficacy of Yellow soup of paeoniae combined with human chorionic gonadotropin in the treatment of female infertility caused by luteal phase defect[J]. Chinese Journal of General Practice, 2020, 18(7): 1204-1206. doi: 10.16766/j.cnki.issn.1674-4152.001465
[16]	SACHA C R, PAGE C M, GOLDMAN R H, et al. Are women with obesity and infertility willing to attempt weight loss prior to fertility treatment?[J]. Obes Res Clin Pract, 2018, 12(1): 125-128. doi: 10.1016/j.orcp.2017.11.004