ROC曲线分析DFI对IVF-ET结局的预测价值

Predictive Value of DFI for IVF-ET Outcomes with ROC Curve

目的通过运用ROC曲线方法分析精子DNA碎片指数(DFI)对体外受精-胚胎移植(IVF-ET)结局的影响及预测价值。方法运用回顾性分析方法,选取在2018年1月-2020年12月期间于我院接受IVF-ET治疗的100例不孕不育患者的临床资料,根据患者的DFI值的高低将其分为高指数组(DFI≥25%)和低指数组(DFI<25%),其中高指数组纳入患者人数60例,低指数组纳入患者人数40例。比较两组患者经IVF-ET治疗后胚胎发育情况,以及不同妊娠结局患者的DFI水平以及各组受精率、优质胚胎率、卵裂率、临床妊娠率等指标情况,进而分析DFI在IVF-ET结局中的预测价值。结果高指数组受精率、优质胚胎率均显著低于低指数组,且两组差异有统计学意义(P<0.05);而高指数组与低指数组相比,卵裂率无明显差异,结果无统计学意义(P>0.05);高指数组临床妊娠率显著低于低指数组,结果有统计学意义(P<0.05);IVF-ET结局为临床妊娠的患者DFI水平显著低于妊娠失败者,差异有统计学意义(P<0.05);经过ROC曲线分析,DFI水平预测IVF-ET结局为临床妊娠的曲线下面积(AUC)为0.889,截断值为20.20%,约登指数为0.795,特异度为0.851,灵敏度为0.943,95%CI为0.874~0.978,P值<0.05。结论精子DFI水平越低,越有助于提高IVF-ET中受精率、优质胚胎率以及临床妊娠率。

Objective To analyze the influence and predictive value of sperm DNA fragmentation index(DFI)on the outcome of in vitro fertilization-embryo transfer(IVF-ET)by ROC curve method.Methods Retrospective analysis was used to select the clinical data of 100 infertility patients who received IVF-ET treatment in our hospital from January 2018 to December 2020.According to the DFI value of patients,they were divided into high index group(DFI≥25%)and low index group(DFI<25%).There were 60 patients in the high index group and 40 patients in the low index group.The embryo development after IVF-ET treatment was compared between the two groups,as well as the DFI levels of patients with different pregnancy outcomes,as well as the fertilization rate,high-quality embryo rate,cleavage rate,clinical pregnancy rate and other indicators in each group,and then the predictive value of DFI in IVF-ET outcome was analyzed.Results The fertilization rate and embryo quality rate in high index group were significantly lower than those in low index group,and the differences between the two groups were statistically significant(P<0.05).There was no significant difference in cleavage rate between high index group and low index group(P>0.05).The clinical pregnancy rate of high index group was significantly lower than that of low index group,with statistical significance(P<0.05).The DFI level of ivF-ET patients with clinical pregnancy was significantly lower than that of pregnancy failure,the difference was statistically significant(P<0.05).According to ROC curve analysis,the area under curve(AUC),cut-off value,Yoden index,specificity and sensitivity of DFI level for predicting ivF-ET outcome to clinical pregnancy was 0.889,20.20%,0.795,0.851,0.943,95%CI of 0.874~0.978,P<0.05.Conclusion The lower the sperm DFI level is,the higher the fertilization rate,high quality embryo rate and clinical pregnancy rate in IVF-ET.