子宫内膜厚度和体积对体外受精-胚胎移植临床结局的预测作用

Endometrial thickness and volume in the prediction of pregnancy outcome after in vitrofertilization and embryo transfer

目的探讨超声检查子宫内膜厚度和体积,对体外受精-胚胎移植(IVF-ET)临床结局预测的准确性。方法选择2012年12月至2013年5月在南京大学医学院附属鼓楼医院生殖医学中心接受IVFET治疗的254例不孕患者为研究对象。回顾性分析其临床病历及相关数据资料,根据患者在该治疗周期中是否成功妊娠,将254例患者分为妊娠组(n=160)和未妊娠组(n=94)。每例患者均在注射人绒毛膜促性腺素(hCG)当日上午进行超声二维扫查及三维成像,分别获取患者子宫内膜厚度和内膜体积数据。采用受试者工作特征(ROC)曲线评估上述2项指标,预测患者IVF-ET临床结局的准确性。两组患者年龄、不孕年限、取卵数等一般临床资料比较,差异无统计学意义(P>0.05)。结果本研究254例患者中,妊娠率为63.0%(160/254)。妊娠组患者内膜厚度及内膜体积,均显著厚于或大于未妊娠组,且差异均有统计学意义[(11.0±1.8)mmvs(10.2±1.9)mm,t=3.114,P=0.002;(5.5±1.9)mL vs(4.3±1.9)mL,t=4.831,P<0.001]。ROC曲线分析结果显示,内膜厚度与内膜体积的曲线下面积(AUC)比较,差异无统计学意义(0.63 vs 0.69,Z=0.19,P>0.05)。内膜体积预测临床结局,在其最佳临界值为4.1mL时的灵敏度和特异度分别为76.9%和55.3%。结论内膜厚度和内膜体积对预测IVF-ET患者临床结局的准确性均较低。

Objective To evaluate the accuracy of endometrial thickness and volume in the prediction of clinical outcome after in vitro fertilization and embryo transfer （IVF-ET）. Methods A total of 254 cases of infertile women who were underwent IVF-ET therapy in the Reproduction Center of Affiliated Drum Tower Hospital of Medical College of Nanjing University from December 2012 to May 2013 were enrolled in the study. Analyze case history and data retrospectively. According to clinical pregnancy result, they were divided into pregnancy group （n = 160） and non-pregnancy group （n = 94）. Transvaginal ultrasound scan and 3D reconstruction were applied accordingly for every patient on the day when human chorionic gonadotrophin（hCG） was injected, and got data of endometrial thickness and volume. Use receiver operating characteristic（ROC） curve to evaluate the accuracy of endometrial thickness and volume for predicting IVF- ET clinical outcome. There were no significant differences between two groups in general clinical characteristics including age, years of infertility and follicles aspirated, etc.. Results Within the 254 recruited patients, the pregnancy rate was 63.0 % （160/254）. Endometrial thickness and endometrial volume of pregnant group were thicker or bigger than those of non-pregnant group, and the differences were statistically significant[（11. 0±1.8） mm vs （10.2±1. 9） mm,t=3.114,P=0. 002;（5. 5±1.9） mL vs （4.3±1.9） mL, t=4. 831,P〈0. 001）]. ROC curve analysis revealed that there were no significant differences between area under curve（AUC） of endometrial thickness and volume（0.63 vs 0. 69 ,Z= 0. 19, P〈0.05）. In the prediction of clinical outcome, the sensitivity and specificity of endometrial volume were 76.9% and 55.3% at the optimal critical value of 4. 1 mL. Conclusions Both endometrial thickness and volume could offer only moderate accuracy in the prediction of clinical outcome in patients undergo IVF-ET therapy.