胚胎移植后血β-HCG值预示孕早期妊娠结局的价值

Relationship betweenβ-H CG value after embryo transfer and early pregnancy outcome

目的探讨卵母细胞受精后17d(D3胚胎移植后14d或D5胚胎移植后12d)血β-HCG值与早期妊娠结局的相关性。方法分析我院2012年1月至2015年1月通过IVF/ICSI/FET助孕方式成功受孕并按时返院复查的患者共523例,按照血β-HCG值分组,分析各组早孕期不同妊娠结局的发生率;用ROC曲线分析血β-HCG值预测早孕期各种妊娠结局的意义以及界值。结果随着卵母细胞受精后17d血β-HCG值增加,患者的生化妊娠率由60.0%降至0,多胎率由0增加至13.3%,胚胎停育率由55.6%下降至0,宫外孕率由22.2%下降至0;血β-HCG值预测生化/临床妊娠的界值为213.15U/L,ROC曲线下面积(AUC)为0.917,敏感度0.848,特异度0.906;预测单胎/胎妊娠的界值为986.65U/L,AUC为0.906,敏感度0.828,特异度0.713;预测双胎/三胎的界值为2 206.5U/L,AUC为0.611,敏感度0.333,特异度0.069;预测单胎停育/持续妊娠的界值为270.57U/L,AUC为0.631,敏感度0.889,特异度0.406。结论卵母细胞受精后17d血β-HCG值可以较好预测生化/临床妊娠以及单胎/多胎妊娠;而对于双胎/三胎、单胎停育/持续妊娠的预测价值不大。

Objective： To explore the relationship between β- HCG value at 14 clays after Day 3 embryo transfer or 12 days after Day 5 embryos transfer and the outcome of early pregnancy. Methods： The data of 523 pregnant women with IVF/ICSI/FET in our hospital from January 2012 to January 2015 were analyzed. The women were divided into 9 groups according to β-HCG value, and the clinical pregnancy outcome of each group was analyzed. The significance of predicting the outcome of pregnancy was evaluated by the area under ROC curve （AUC） and β-HCG value. Results： Along with the increase of β-HCG value at 17 days after fertilization, the biochemical pregnancy rate was decreased from 60. 0%to 0, and the multiple births rate was increased from 0 to 13.3%,as well as the embryo arrest rate （55.6% to 0） and ectopic pregnancy rate （22.2% to 0） were decreased. The cutoff value of β- HCG for predicting biochemical pregnancy was 213.15 U/L, and AUC was 0. 917, sensitivity 0. 848, specificity 0. 906. The cutoff value of β-HCG for predicting singleton or multiple births was 986.65 U/L,and AUC was 0.90G,sensitivity 0. 828 ,specificity 0. 713. The cutoff value for twins or triplets was2 206. 5 U/L,andAUCwas0.611,sensitivity0.333,specificity0.069. The cutoff value for singleton miscarriage or ongoing pregnancy was 270.57, and AUC was 0. G31, sensitivity 0. 889, specificity 0. 406. Conclusions： The β- HCG value at 17 days after fertilization can predict the biochemical or clinical pregnancy,singleton or multiple births, but the predictive value is not significant for predicting twins/ triplets or singleton miscarriage/ongoing pregnancy.