非活动性结核对不孕患者IVF/ICSI-ET助孕结局的影响

Effect of inactive tuberculosis on pregnancy outcome of IVF/ICSI-ET in infertile patients

目的探讨非活动性结核对不孕患者首次行体外受精(in vitro fertilization,IVF)/卵胞质内单精子注射(intracytoplasmic sperm injection,ICSI)-胚胎移植(embryo transfer,ET)助孕结局的影响。方法通过回顾性队列研究分析2011年1月至2021年12月期间于郑州大学第一附属医院生殖与遗传专科医院首次进行新鲜周期胚胎移植不孕患者(15412例)的病例资料,应用倾向性评分匹配法(propensity score matching,PSM)按照1∶2配比分为非活动结核组(635例)和对照组(1270例),其中非活动结核组按部位分为肺结核亚组(A组,378例)、盆腔结核亚组(B组,214例)及其他结核亚组(C组,43例),按是否经过治疗分为治疗亚组(377例)及非治疗亚组(258例),对其助孕结局进行比较,并分析影响因素。结果经过PSM后非活动结核组和对照组基线资料差异均无统计学意义(均P>0.05)。非活动结核组患者的受精率[65.2%(5207/7991)]显著高于对照组[63.7%(9889/15524),P=0.027],但着床率[41.9%(483/1152)]、临床妊娠率[58.4%(371/635)]、活产率[46.5%(295/635)]均显著低于对照组[48.8%(1112/2279),P<0.001;67.2%(853/1270),P<0.001;57.9%(735/1270),P<0.001],流产率[20.5%(76/371)]显著高于对照组[13.8%(118/853),P=0.003],且内膜厚度[(11.8±2.6)mm]小于对照组[(12.5±3.9)mm,P<0.001]。亚组分析B组优质胚胎率[62.3%(1111/1784)]显著低于A组[66.5%(2027/3048),P=0.007]及对照组[65.9%(6516/9889),P=0.007],差异均有统计学意义。治疗亚组的着床率[46.6%(318/682)]、临床妊娠率[64.5%(243/377)]及活产率[51.7%(195/377)]均高于非治疗亚组[35.1%(165/470),P<0.001;49.6%(128/258),P<0.001;38.8%(100/258),P=0.001]。此外,logistic回归分析显示非活动性结核是影响临床妊娠、活产和流产(OR=0.71,95%CI:0.58~0.87,P=0.002;OR=0.65,95%CI:0.54~0.80,P<0.001;OR=1.58,95%CI:1.15~2.19,P=0.045)的独立危险因素。结论非活动性结核是不良助孕结局的独立危险因素,非活动性结核不孕患者与非结核不孕患者相比首次接受IVF/ICSI-ET的助孕结局较差,其中既往盆腔结核的患者更显著,而结核患者行规律抗痨治疗有助于改善助孕结局。

Objective To explore the effect of inactive tuberculosis on the assisted reproductive outcome of the first in vitro fertilization(IVF)/intracytoplasmic sperm injection(ICSI)and embryo transfer(ET)in infertile patients.Methods A retrospective cohort study was conducted to analyze the data of 15412 infertile patients who underwent the first fresh-cycle embryo transfer in the Reproductive and Genetics Hospital of the First Affiliated Hospital of Zhengzhou University from January 2011 to December 2021.They were divided into inactive tuberculosis group(635 cases)and control group(1270 cases)according to the ratio of 1∶2 by propensity score matching(PSM).The inactive tuberculosis group was divided into three subgroups:tuberculosis(group A,378 cases),pelvic tuberculosis(group B,214 cases)and other tuberculosis(group C,43 cases)according to the location.The inactive tuberculosis group was also divided into the treatment subgroup(377 cases)and the non-treatment subgroup(258 cases)according to whether they had undergone treatment.The assisted reproductive outcomes were compared and the influencing factors were analyzed.Results After PSM,the difference of the baseline data between the inactive tuberculosis group and control group was not statistically significant(all P>0.05).The fertilization rate[65.2%(5207/7991)]of patients in the inactive tuberculosis group was significantly higher than that of control group[63.7%(9889/15524),P=0.027],but the implantation rate[41.9%(483/1152)],the clinical pregnancy rate[58.4%(371/635)]and the live birth rate[46.5%(295/635)]were significantly lower than those of control group[48.8%(1112/2279),P<0.001;67.2%(853/1270),P<0.001;57.9%(735/1270),P<0.001],and the miscarriage rate[20.5%(76/371)]was significantly higher than that of control group[13.8%(118/853),P=0.003],and the endometrium thickness[(11.8±2.6)mm]was thinner than that of control group[(12.5±3.9)mm,P<0.001].For subgroup analysis,the high-quality embryo rate in group B[62.3%(1111/1784)]was significantly lower than that in group A[66.5%(2027/3048),P=0.007]and control group[65.9%(6516/9889),P=0.007],and the difference was statistically significant.The implantation rate[46.6%(318/682)],the clinical pregnancy rate[64.5%(243/377)]and the live birth rate[51.7%(195/377)]in the treatment group were higher than those in the non-treatment group[35.1%(165/470),P<0.001;49.6%(128/258),P<0.001;38.8%(100/258),P=0.001].In addition,logistic regression showed that inactive tuberculosis was an independent risk factor for clinical pregnancy,live birth,and miscarriage(OR=0.71,95%CI:0.58-0.87,P=0.002;OR=0.65,95%CI:0.54-0.80,P<0.001;OR=1.58,95%CI:1.15-2.19,P=0.045).Conclusion Inactive tuberculosis is an independent risk factor for adverse assisted reproductive outcomes.Compared with non-tuberculosis infertile patients,the pregnancy outcomes of inactive tuberculosis infertile patients who received IVF/ICSI-ET for the first time are poorer,especially the patients with pelvic tuberculosis in the past.Regular anti-tuberculosis treatment for tuberculosis patients can help to improve pregnancy outcomes.