甲状腺功能对体外受精-胚胎移植治疗结局的影响

Effect of thyroid function on outcomes of IVF-embryo transfer

目的探究甲状腺功能对体外受精-胚胎移植(in vitro fertilization and embryo transfer,IVF-ET)治疗结局的影响。方法收集我院2016年3月—2017年3月进行IVF-ET治疗的249例输卵管不通所致不孕症患者的临床资料,其中成功101例,失败148例。比较两组患者临床资料,回归分析析明确IVF-ET与治疗结局的相关因素,采用受试者工作特征(receiver operating characteristic,ROC)曲线分析评价各因素对IVF-ET治疗的诊断效能。结果失败组中年龄、TSH、TBTL、DBIL、ALT、UREA、UA、CREA、RBC、HB各值均高于成功组,失败组中FT4、TC、TG、WBC、SBP、DBP、HR各值均低于成功组,差异有统计学意义(P<0. 05); TPOAB阳性率在两组间比较无统计学差异(P=0. 095); logistic二元回归分析得出年龄(OR:0. 765,95%CI:0. 593～0. 986)、TSH (OR:0. 353,95%CI:0. 209～0. 595)、DBIL(OR:0. 765,95%CI:0. 593～0. 986)、UA(OR:0. 765,95%CI:0. 593～0. 986)、CREA (OR:0. 887,95%CI:0. 830～0. 948)是IVF-ET治疗成功的危险因素; FT4(OR:1. 617,95%CI:1. 187～2. 203)则是其保护因素; ROC曲线表明TSH最佳诊断切点为1. 28; TSH的灵敏度最高为84. 46%。结论 TSH水平与IVF-ET治疗结局相关。

Objective To examine the effect of thyroid function on the outcomes of in vitro fertilization and embryo transfer（IVF-ET）.Methods The clinical data of 249 women receiving IVF-ET in our hospital from March 2016 to March 2017 were retrospectively reviewed. Among them, 101 cases were successful and 148 cases failed. The serological indexes were compared between two groups and the factors related to IVF-ET outcomes were analyzed. The value of related factors for predicting IVF-ET outcomes was analyzed by receiver-operating characteristics （ROC） curve.Results The age, TSH, TBTL, DBIL, ALT, UREA, UA, CREA, RBC and HB levels of failure group were significantly higher, and FT4, TC, TG, WBC, SBP, DBP, HR levels were significantly lower than those of success group （all P 〈0.05）. There was no statistical difference in TPOAB positive rate between the two groups（ P =0.095）. Binary logistic regression analysis showed that age（OR=0.765, 95%CI： 0.593 0.986）, TSH（ OR= 0.353, 95%CI： 0.209 0.595）, DBIL（OR=0.765, 95%CI： 0.593 0.986）, UA（OR=0.765, 95%CI： 0.593 0.986）, CREA（OR=0.887, 95%CI： 0.830 0.948） were risk factors for IVF-ET outcome, while FT4（OR=1.617, 95%CI： 1.187 2.203） was a protection factor for IVF-ET outcome. The ROC curve indicated that with 1.28 μmol/L as cut-off value, the sensitivity of TSH in predicting outcome of IVF-ET was 84.46%.Conclusion The level of TSH is associated with IVF-ET outcomes.