中重度卵巢过度刺激综合征最佳预测因素的初步探讨

Preliminary study on the best predictive factor of moderate-severe ovarian hyperstimulation syndrome

目的探讨中、重度OHSS发生的最佳预测指标,以期更好地指导临床工作,降低中、重度OHSS的发生。方法回顾性分析2014年1月至2018年7月于本中心接受IVF/ICSI-ET治疗的5 225个周期的临床资料。选择发生中、重度OHSS进行住院治疗的45例患者作为OHSS组;选择同期接受IVF治疗、但未发生OHSS的53例患者作为非OHSS组。比较两组之间促排卵过程中的临床数据和实验室数据,并对筛选出的危险因素做回归分析,利用ROC曲线确定诊断界值。结果 (1)中、重度OHSS的发生率为0.86%,发生时间为取卵后(13.9±5.3)d;进行新鲜移植的患者为37例,均成功妊娠。(2)OHSS组的PCOS患者比例和窦卵泡数均显著高于非OHSS组(P<0.05);OHSS组的Gn用量、HCG日的E_2值和直径大于11mm的卵泡数均显著高于非OHSS组(P<0.05)。(3)窦卵泡数与OHSS发生有关,且为独立危险因素(P<0.05)。(4)ROC曲线显示AFC的诊断界值为≥16.5个,敏感性为70.5%,特异性为66%;HCG日直径大于11mm的卵泡数的诊断界值为≥13.5个,敏感性为79.5%,特异性为56.6%;HCG日E_2水平的诊断界值为≥13 347.79pmol/L。结论窦卵泡数≥16.5时能够更好地预测中、重度OHSS的发生,其次是HCG日直径在11mm以上的卵泡数≥13.5时能够较好的预测中、重度OHSS的发生。

Objective:To explore the best predictive factor of the moderate-severe ovarian hyperstimulation syndrome(OHSS).Methods:The data of 5225 patients undergone IVF/ICSI cycles in our productive center from January 2014 to July 2018 were retrospectively analyzed.Forty five patients who had moderate-severe OHSS were selected as OHSS group,and 53 patients without OHSS were selected as control group during the same period.Clinical and laboratory data were analyzed and compared between the two groups,and the risk factors were screened by regression analysis.The cutoff value was determined by ROC curve.Results:The incidence of moderate-severe OHSS was 0.86%in our center.OHSS often happened in(13.9±5.3)days after oocyte retrieval.Thirty seven patients with fresh embryo transfer were pregnancy successfully among the OHSS patients.The percentage of PCOS and the antral follicles count(AFC)in OHSS group were significantly higher than those in the control group(P<0.05).The total Gn dose,E2 level and the number of follicles>11mm on the HCG day were significantly higher than those in control group(P<0.05).The antral follicles count was related with OHSS and was the independent risk factor.The ROC curve showed that the cutoff value of AFC was≥16.5(70.5%sensitivity and 66%specificity).The cutoff value of the number of follicles>11 mm on the HCG day was≥13.5(79.5%sensitivity and 56.6%specificity).The cutoff value of E2 on the HCG day was≥13 347.79 pmol/L.Conclusions:Antral follicle count≥16.5 is the best predictive factor of occurrence of moderate-severe OHSS.Secondly,the number of follicles with diameter>11 mm on HCG day≥13.5 can also predict the occurrence of moderate and severe OHSS.