不孕症患者IVF-ET后不明原因反复种植失败的预测因素分析

Analysis of predictive factors of unexplained repeated implantation failure after in vitro fertilization and embryo transfer in infertile patients

目的分析不孕症患者体外受精-胚胎移植(IVF-ET)后不明原因反复种植失败(RIF)的预测因素。方法前瞻性纳入2020年6月至2022年6月无锡市妇幼保健院接诊的82例IVF-ET的不孕症患者作为研究对象,根据RIF发生原因将患者分为RIF组与不明原因RIF组。比较两组患者的基线资料、实验室指标,分析IVF-ET后不明原因RIF的影响因素;分析各项影响因素对不孕症患者IVF-ET后不明原因RIF的预测价值。结果82例患者中不明原因RIF 22例,占比为26.83%。Logistic回归分析结果显示,高水平CD4^(+)/CD8^(+)、纤维蛋白原(FIB)是不孕症患者IVF-ET后不明原因RIF的独立危险因素(OR>1,P<0.05),高水平抗米勒管激素(AMH)、血管内皮生长因子(VEGF)、粒细胞集落刺激因子(G-CSF)是其保护因素(OR<1,P<0.05)。绘制受试者工作特征(ROC)曲线结果显示,AMH、CD4^(+)/CD8^(+)、FIB、VEGF、G-CSF预测不孕症患者IVF-ET后不明原因RIF的曲线下面积(AUC)>0.70,均具有一定预测价值。结论AMH、CD4^(+)/CD8^(+)、FIB、VEGF、G-CSF对不孕症患者IVF-ET后不明原因RIF有一定预测价值。

Objective To investigate the predictive factors of unexplained repeated implantation failure(RIF)after in vitro fertilization and embryo transfer(IVF-ET)in infertile patients.Methods A total of 82 infertile patients who received IVF-ET in Wuxi Maternal and Child Health Hospital from June 2020 to June 2022 were prospectively included as study subjects.The patients were divided into RIF group and unexplained RIF group according to the causes of RIF.The baseline data and laboratory parameters of the two groups were compared.The influencing factors of unexplained RIF after IVF-ET in infertile patients were analyzed.The predictive value of various influencing factors on unexplained RIF after IVF-ET in infertile patients was analyzed.Results Of the 82 patients,22 had unexplained RIF,accounting for 26.83%.The results of Logistic regression analysis showed that high levels of CD4^(+)/CD8^(+)and fibrinogen(FIB)were independent risk factors for unexplained RIF after IVF-ET in infertile patients(OR>1,P<0.05),while high levels of anti-Müllerian hormone(AMH),vascular endothelial growth factor(VEGF),and granulocyte colony-stimulating factor(G-CSF)were protective factors(OR<1,P<0.05).Receiver operating characteristic(ROC)curves was drawn,and the results showed that area under the ROC curve(AUC)of AMH,CD4^(+)/CD8^(+),FIB,VEGF,and G-CSF predicted unexplained RIF after IVF-ET in infertile patients is>0.70,all of which had certain predictive value.Conclusions AMH,CD4^(+)/CD8^(+),FIB,VEGF,G-CSF have certain predictive value for unexplained RIF after IVF-ET in infertile patients.