体外受精-胚胎移植术后先兆流产的危险因素及预后模型的建立

Prognostic value of different factors to predict threatened abortion of in vitro fertilization embryo transfer

目的探讨影响体外受精-胚胎移植(in vitro fertilization and embryo transfer, IVF-ET)术后患者先兆流产的危险因素,建立其预后预测模型。方法回顾性分析2016年6月—2018年6月兰州大学第一医院生殖医学中心收治的因输卵管因素行IVF-ET治疗的患者(年龄<35岁)的临床资料,共856例,其中出现先兆流产的患者102例(先兆流产组),无先兆流产患者754例(对照组)。采用多因素logistic回归分析,得出相应的独立危险因素,建立预后预测模型。结果体质指数(body mass index, BMI)增高、移植后第14天人绒毛膜促性腺激素(human chorionic gonadotrophin,β-hCG)和孕酮的降低是影响IVF-ET术后先兆流产患者预后的危险因素(P <0.05)。多因素分析联合各项危险因素,以BMI、移植后第14天β-hCG和孕酮建立IVFET后先兆流产患者预后预测模型,受试者操作特征曲线下面积为0.815,敏感度为79.3%,特异度为80.2%。结论 BMI增高、移植后第14天β-hCG和孕酮降低是影响IVF-ET术后先兆流产预后的独立危险因素。以BMI、移植后第14天β-hCG和孕酮建立的预后模型在一定程度上能够较为准确地预测IVF-ET先兆流产的发生,指导临床预处理。

Objective To explore and evaluate factors that predict threatened abortion in vitro fertilization embryo transfer and established an effective predictive model. Methods This retrospective study includes 102 threatened abortion patients and 754 normal patients of tubal factor infertility in Reproductive Medicine Center of the First Hospital of Lanzhou University from Jun, 2016 to Jun, 2018. Multivariate logistic regression analyses were used to identify predictors of threatened abortion and established predictive model. Results Body mass index(BMI), β-hCG and progestin on 14 th day of transformation were related to threatened abortion(P < 0.05). The area under receiver operator characteristic curve were 0.815, with 79.3% sensitivity and 80.2% specificity. Conclusions Increased BMI and decreased β-HCG and progesterone on 14 th day of transformation were independent risk factors for the prognosis of threatened abortion after IVF-ET. The predictive model which comprises by BMI, β-hCG, and progestin on 14 th day of transformation for threatened abortion in IVF-ET is desired.