子宫内膜异位症性不孕患者血清APRIL和CXCL14水平与体外受精-胚胎移植后不良妊娠的关系

Relation of serum APRIL and CXCL14 levels with adverse pregnancy afteRin vitro fertilization and embryo transfeRin patients with endometriosis infertility

目的探讨子宫内膜异位症性不孕患者血清增殖诱导配体(APRIL)、C-X-C基序趋化因子配体14(CXCL14)水平与体外受精-胚胎移植(IVF-ET)后不良妊娠的关系。方法184例子宫内膜异位症性不孕患者均行IVF-ET助孕且成功妊娠,采用ELISA检测患者移植前的血清APRIL、CXCL14水平,并随访记录患者的妊娠情况。比较不同妊娠情况患者的一般资料、基础激素水平、IVF-ET相关参数、血清APRIL和CXCL14水平。采用多因素Logistic回归模型分析影响子宫内膜异位症性不孕患者行IVF-ET后出现不良妊娠的危险因素。采用受试者工作特征(ROC)曲线分析血清APRIL、CXCL14水平对子宫内膜异位症性不孕患者行IVF-ET后出现不良妊娠的预测价值。结果184例患者中,正常妊娠141例(正常妊娠组),不良妊娠43例(不良妊娠组)。不良妊娠组血清APRIL水平及基础促卵泡激素、雌二醇、黄体生成素水平均高于正常妊娠组,血清CXCL14水平、获卵数、受精率、可移植胚胎数均低于或少于正常妊娠组(均P<0.05)。多因素Logistic回归分析结果显示,血清APRIL和CXCL14水平,以及基础促卵泡激素和雌二醇水平、可移植胚胎数均是影响子宫内膜异位症性不孕患者IVF-ET后出现不良妊娠的独立危险因素(均P<0.05)。ROC曲线结果显示,血清ARPIL、CXCL14水平及二者联合预测子宫内膜异位症性不孕患者IVF-ET后出现不良妊娠的曲线下面积分别为0.795、0.765、0.860,敏感度分别为65.1%、60.5%、72.1%,特异度分别为83.7%、82.3%、84.4%。结论IVF-ET前血清ARPIL水平升高、CXCL14水平降低的子宫内膜异位症性不孕患者行IVF-ET后出现不良妊娠的风险增加。动态监测这两个指标有助于评估子宫内膜异位症性不孕患者行IVF-ET后出现不良妊娠的情况。

Objective To investigate the relation of serum proliferation-inducing ligand(APRIL)and C-X-C motif chemokine ligand 14(CXCL14)levels with adverse pregnancy afteRin vitro fertilization and embryo transfeR(IVF-ET)in patients with endometriosis infertility.Methods A total of 184 patients with endometriosis infertility underwent IVF-ET assisted pregnancy and obtained successful pregnancy,and theiRlevels of serum APRIL and CXCL14 before transfeRwere detected by the ELISA,and patients′pregnancy was followed up and recorded.The general data,basic hormone levels,parameters related to IVF-ET,and levels of serum APRIL and CXCL14 were compared between the patients with different pregnancy conditions.The risk factors affecting the occurrence of adverse pregnancy in patients with endometriosis infertility afteRundergoing IVF-ET were analyzed by the multivariate Logistic regression model.The predictive value of serum APRIL and CXCL14 levels on the occurrence of adverse pregnancy in patients with endometriosis infertility afteRundergoing IVF-ET was analyzed by the receiveRoperating characteristic(ROC)curve.Results Among 184 patients,there were 141 patients with normal pregnancy(the normal pregnancy group)and 43 patients with adverse pregnancy(the adverse pregnancy group).The adverse pregnancy group exhibited higheRserum APRIL level,and higheRlevels of basic follicle-stimulating hormone,estradiol,and luteinizing hormone,whereas loweRserum CXCL14 level,and less numbeRof retrieved oocytes,fertilization rate and transplantable embryos as compared with the normal pregnancy group(all P<0.05).The results of multivariate Logistic regression analysis revealed that serum APRIL and CXCL14 levels,basic follicle stimulating hormone and estradiol levels,and the numbeRof transplantable embryos were the independent risk factors affecting the occurrence of adverse pregnancy in patients with endometriosis infertility afteRIVF-ET(all P<0.05).The results of ROC curve implied that the areas undeRthe curve of serum APRIL and CXCL14 levels and the combination of the two levels foRpredicting the occurrence of adverse pregnancy in patients with endometriosis infertility afteRIVF-ET were 0.795,0.765,and 0.860,respectively,the sensitivities were 65.1%,60.5%,and 72.1%,respectively,and the specificities were 83.7%,82.3%,and 84.4%,respectively.Conclusion The patients with endometriosis infertility who had an elevation of serum APRIL level and decline of serum CXCL14 level before IVF-ET are at a increased risk of adverse pregnancy afteRIVF-ET.Dynamic monitoring of these two indicators is helpful to evaluate the occurrence of adverse pregnancy in patients with endometriosis infertility afteRundergoing IVF-ET.