子宫内膜异位症生育指数与r-AFS分期在IVF中的预测价值

Predictive Value of Endometriosis Fertility Index and r-AFS Classification in IVF Treatment Cycles

【目的】探讨子宫内膜异位症生育指数(EFI)与r-AFS分期对体外受精-胚胎移植(IVF-ET)的累积妊娠结局的预测价值。【方法】回顾性分析2008年1月至2011年12月109例143个周期行腹腔镜手术治疗后到本生殖中心行IVF-ET的子宫内膜异位症(EMs)因素不孕患者的病史、手术资料及妊娠结局。按照r-AFS的分期标准对EMs患者进分期,按照EFI的评分标准计算EFI,利用ROC曲线与多水平模型分别比较EFI评分和r-AFS分期对IVF累积妊娠结局的影响。【结果】(1)EFI评分预测IVF累积妊娠结局的ROC曲线下面积为0.644,大于机会参考线下面积(P<0.05);诊断界值点为6分,特异性为0.62,敏感性为0.61;AFS分期预测IVF累积妊娠结局的ROC曲线下面积为0.415(P>0.05),不具有诊断意义。(2)根据ROC曲线诊断界值点为6分,将患者以6分为界,分别比较4分与5分、≤5分与≥6分、6分与≥7分的累积妊娠率的差异。EFI评分为4分(n=6)、5分(n=28)的患者,累积妊娠率为40.0%,44.5%,差异无统计学意义(P>0.05);EFI评分为≤5分(n=71),≥6分(n=72)的患者,总累积妊娠率有统计学差异(38.2%vs.60.6%,P=0.005);EFI评分6分(n=36),≥7分(n=37)的患者,累积妊娠率为61.8%,59.5%,差异无统计学意义(P>0.05);<3分的患者,有17个IVF周期,累积妊娠率为25.0%。r-AFS分期为Ⅰ期(n=28)、Ⅱ期(n=12)、Ⅲ期(n=39)、IV期(n=64)的患者,累积妊娠率无统计学差异(P=0.163)。【结论】子宫内膜异位症生育指数(EFI)可以有效的预测EMs患者腹腔镜术后IVF累积妊娠结局,≥6分的患者累积妊娠率有明显升高,为EMs患者腹腔术后IVF临床诊疗提供了重要的参考依据。未发现r-AFS分期对EMs患者IVF-ET后的妊娠结局有预测价值。

[Objective] To determine the predictive value of the endometriosis fertility index and r-AFS classification for the outcome of cumulative pregnancy in IVF cycles. [Method] Totally 109 infertile women with 143 IVF cycles were retrospectively analyzed from January 2008 to December 2011. Before IVF cycle, these women were diagnosed as endometriosis and treated by laparoscopy in our hospital. Medical history, surgery materials, and pregnancy outcome were collected. Staged patients according to the revised American Fertility Society System; calculated EFI score basing on the endometriosis fertility index system; the ROC curve and the multilevel statistical models were used to assess the differences in cumulative pregnancy rates between different EFI scores and r-AFS stages. [Result] （1） The areas under ROC curve （AUC） of EFI and r-AFS were 0.644 （P 〈 0.05） and 0.415 （P 〉 0.05）, respectively. The best point for diagnosis by EFI was 6, so we use EFI scores of 6 as the point. The accumulative pregnancy rates of aEFI scores of 4 （n = 26） and 5 （n = 28） were 40.0% and 44.5%, respectively, there were no significant differences （P〉 0.05）. The total cumulative pregnancy rates among patients with EFI scores of ≥6 were significantly higher than that of EFI score of ≤5 （38.2% vs 60.6% ,P = 0.005）. The accumulative pregnancy rates among the EFI scores of 6 （n = 36） and ≥7（n = 37） were comparable （61.8% vs 59.5%, P 〉 0.05）. But the EFI scores of 〈3, have only 17 IVF cycles, the cumulative pregnancy rate was 25.0%. 28, 12, 39, 64 IVF cycles were assigned to stage Ⅰ , Ⅱ , Ⅲ, and Ⅳ according to the revised American Fertility Society System, statistical significance was not achieved in accumulative pregnancy rates among all stages （ Ⅰ -Ⅳ, P = 0.163）. [Conclusion] EFI can be used as a good effective tool to predict pregnancy outcome in the patients attempted to IVF after laparoscopic surgery, the cumulative pregnancy rates among EFI scores of ≥ 6 were obviously increased, which provides an important basis for IVF treatment. The predictive value of r-AFS classification for the pregnancy outcome in IVF cycles were not found.