中重度卵巢过度刺激综合征预测因子分析

Predictors of moderate to severe ovarian hyperstimulation syndrome

目的:探讨行辅助生殖技术治疗的患者发生中重度卵巢过度刺激综合征(OHSS)的预测指标。方法:选取2015年1月至2020年1月在首都医科大学附属北京妇产医院生殖医学科行IVF/ICSI治疗发生中重度OHSS的60例患者和同期未发生OHSS的313例患者。回顾性分析比较两组的一般情况、促排卵指标,进行逐步logistic回归分析筛选OHSS的危险因子,通过ROC曲线及曲线下面积(AUC)分析各指标的预测能力。结果:HCG日E2、AMH、AFC、获卵数及妊娠均为OHSS的独立危险因子(OR>1.000),bFSH为保护因素。AMH、AFC、HCG日E2水平及获卵数对OHSS的预测价值中等(0.7<AUC<0.9),其中HCG日E2预测价值最高,联合四项指标后预测价值高于单项指标(AUC=0.862)。预测中重度OHSS的最佳临界值分别是HCG日E2≥3896.73pg/ml,获卵数≥12.5个,AMH≥4.825ng/ml,AFC≥12.5个。结论:AMH、AFC、HCG日E2水平及获卵数均对OHSS的发生有较好的预测作用,联合四项指标预测价值最高。

Objective:To study the predictors of moderate to severe ovarian hyperstimulation syndrome(OHSS)in IVF.Methods:From January 2015 to January 2020,60 patients with moderate to severe OHSS who underwent IVF/ICSI were selected as the case group,and 313 patients after IVF without OHSS were selected as the control group.The basic conditions,treatment status were compared and stepwise logistic regression analysis was performed to screen the risk factors of OHSS.The predictive power of predictors was analyzed by receiver operating characteristic curve(ROC)and area under the curve(AUC).Results:E2 on the HCG day、AMH,AFC,the number of occytes collected,and pregnancy were independent risk factors for OHSS(OR>1.000),and bFSH was a protective factor.The predictive value of AMH,AFC,E2 on the HCG day and the number of occytes collected to OHSS was medium(0.7<AUC<0.9).Among them,the predictive value of E2 on HCG day was the highest.The combined predicted value of the four indicators was higher than the single indicator(AUC=0.862).The optimal thresholds for identifying OHSS were:E2 on HCG day≥3896.73pg/ml,number of occytes obtained≥12.5,AMH≥4.825ng/ml,AFC≥12.5.Conclusions:AMH、AFC、the numbers of oocytes retrieval and E2 on HCG day all have a good predictive effect on the occurrence of OHSS,and the combined predicted value was the highest.