IVF/ICSI-ET后阴道出血患者妊娠结局的影响因素分析及其列线图预测模型构建

Influencing factors and nomogram prediction model of pregnancy outcome of patients with vaginal bleeding after IVF/ICSI-ET

目的旨在探讨影响体外受精/卵胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)后阴道出血患者并发症发生的危险因素及列线图预测模型的构建。方法回顾性分析IVF/ICSI-ET术后先兆流产患者272例,依据妊娠最终结局将上述患者分为活产组和流产组。使用χ^(2)检验、独立样本t检验或Wilcoxon秩和检验评价患者特征。使用多变量Logistic回归系数创建了预测接受IVF/ICSI后先兆流产孕妇妊娠结局的列线图。结果活产组和流产组在基础资料、冷冻胚胎占比、治疗方案、移植胚胎数、优质胚胎率和胚胎种植率差异无统计学意义(P>0.05)。两组体质指数、胚胎移植后开始出现阴道出血时间、第14天血清hCG水平、第14天血清孕酮水平和孕囊数目差异有统计学意义(P<0.05)。经过多因素Logistic回归分析显示胚胎移植后开始出现阴道出血时间、移植后第14天血清hCG水平有统计学意义(P<0.05)。根据上述指标建立列线图,列线图的曲线下面积为0.710。列线图的ROC曲线下面积优于单一预测因素的ROC曲线下面积(胚胎移植后阴道开始出血时间的AUC为0.644,血清hCG14的AUC为0.625)。结论基于胚胎移植后开始出现阴道出血时间和胚胎移植后第14天血清hCG值建立的列线图模型能较好地预测IVF/ICSI-ET术后先兆流产患者的妊娠结局。

Objective To investigate the risk factors affecting the occurrence of complications in patients with vaginal bleeding after in vitro fertilization/intracytoplasmic sperm injection embryo transfer(IVF/ICSI-ET) and the construction of nomogram prediction model. Methods A total of 272 patients with threatened abortion after IVF/ICSI-ET were retrospectively analyzed in this study. They were divided into the live birth group and abortion group according to the final outcome of pregnancy. Patient characteristics were evaluated using the chi-square test, independent-samples Student’s t-test or Wilcoxon rank sum test. A nomogram was created to predict the pregnancy outcome of women with threatened abortion who received IVF/ICSI using multivariate logistic regression coefficients. Results There was no significant difference in the basic data, percentage of frozen embryos, treatment method, number of embryos transferred, high-quality embryo rate, and embryo implantation rate of the live birth group and abortion group(P>0.05). There were significant differences in body mass index, the onset of vaginal bleeding time after transplantation, serum levels of hCG and progesterone on 14 th day after embryo-transfer, and the number of gestational sacs between the two groups(P<0.05). After multivariate logistic regression analysis, the onset of vaginal bleeding time after transplantation and serum hCG levels on 14 th day after transfer were statistically significant(P<0.05). The nomogram was established based on the above indicators, with an area under the curve of 0.710 for the nomogram. The area under the ROC curve of our nomogram was better than the area under the ROC curve of a single risk factor(AUC of bleeding time after embryo-transfer: 0.644, AUC of serum hCG14:0.625). Conclusion The nomogram model established based on the onset of vaginal bleeding time after embryo-transfer and serum hCG value on 14 th day after embryo-transfer can better predict pregnancy outcome of patients with threatened abortion after IVF/ICSI-ET.