体外受精鲜胚移植患者妊娠结局的预测因素研究

Predictors of Pregnancy Outcome in Patients Undergoing IVF-ET

目的探讨新鲜周期胚胎移植术后不同天数血清性激素水平对体外受精-胚胎移植(IVF-ET)患者妊娠结局的预测价值.方法回顾性分析在苏州大学第一附属医院生殖医学中心首次行体外受精/卵胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)治疗的277例患者的临床资料,采用t检验、Logistic回归分析和受试者工作曲线(ROC)分析基础性激素及移植后6 d和14 d的E_(2)、P、P/E_(2)、LH、FSH,β-hCG值等与妊娠结局的关系.结果活产周期的胚胎移植后6 d E_(2)、P,移植后14 d E_(2)、β-hCG水平分别高于非活产周期(P<0.05);而活产周期的移植后6 d及14 d P/E_(2)、基础P值、AMH明显低于非活产周期(P<0.05);Logistic回归分析发现移植后6 d和14 d E_(2)是影响活产周期的危险因素(P<0.05);移植后14 d E_(2)的ROC曲线下面积为0.938,远大于移植后6 d E_(2)的ROC曲线下面积0.615(P<0.05),当截点值为378.3 pg/mL时,其诊断活产的敏感性82.7%,特异性94.2%.结论胚胎移植后14 d血清E_(2)与IVF妊娠结局密切相关,可作为预测妊娠结局的潜在指标.

Objective To explore the predictive value of based serum hormone and serum hormone on different days after in vitro fertilization-embryo transplantation(IVF-ET)on pregnancy outcomes.Methods The clinical data of 277 patients received in vitro fertilization/intracytoplasmic sperm injection and embryo transfer(IVF/ICSI-ET)in Reproductive Medicine Center of the First Affiliated Hospital of Soochow University was collected.The correlation between pregnancy outcomes and based serum hormone and E_(2),P,P/E_(2),β-hCG on the 6th and 14th day after embryo transplantation was employed by T-test,Logistic regression and ROC analysis.Results The level of E_(2)and P on the 6th day after embryo transplantation and E_(2),β-hCG on the 14th day after embryo transplantation in live birth group were significantly higher than those in non-live birth group(P<0.05).However,the level of P/E_(2)on the 6th and 14th day after embryo transplantation,the base P and AMH of the live birth group were significantly lower than those in non-live birth group(P<0.05).E_(2)on the 6th and 14th day after embryo transplantation were significantly associated with live birth by Logistic regression analysis(P<0.01).E_(2)on the 14th day after embryo transplantation outperformed E_(2)on the 6th day after embryo transplantation in prediction of live birth in all patients(AUC=0.938,0.615,respectively).Using 378.3 pg/mL as a cutoff point,E_(2)on the 14th day after embryo transplantation discriminated live birth from non-live birth patients with 82.7%sensitivity and 94.2%specificity.Conclusion E_(2)on the 14th day after IVF-ET is correlated with pregnancy outcome.It has been also proved as a parameter in predicting pregnancy outcomes.