超重/肥胖型PCOS患者IVF/ICSI-ET妊娠失败危险因素分析及预测列线图构建

Analysis of risk factors for IVF/ICSI-ET pregnancy failure in overweight/obese PCOS patients and construction of a predictive nomogram

目的总结超重/肥胖型多囊卵巢综合征(PCOS)患者体外受精/卵胞质内单精子注射—胚胎移植(IVF/ICSI-ET)妊娠失败的危险因素,基于危险因素构建预测超重/肥胖型PCOS患者IVF/ICSI-ET妊娠失败风险列线图(列线图模型)。方法131例拟行IVF/ICSI-ET的超重/肥胖型PCOS患者,均完成胚胎移植周期,收集其体成分特征变量、实验室检查特征变量及临床病例资料变量等。将131例患者分为训练集91例和验证集40例,采用LASSO回归分析法分析超重/肥胖型PCOS患者IVF/ICSI-ET妊娠失败的独立危险因素。基于独立危险因素,构建列线图模型,分别采用受试者工作特征曲线(ROC)、校准曲线、Hosmer-Lemeshow拟合优度检验评价列线图模型的预测能力、校准度、拟合度,采用临床决策曲线评价列线图模型的临床应用价值。结果超重/肥胖型PCOS患者IVF/ICSIET妊娠失败的独立危险因素有年龄、身体质量指数、水合率和胰岛素抵抗(λ分别为-0.186、-0.947、-0.064、-0.290)。列线图模型的曲线下面积为0.934,校准曲线及拟合曲线预测列线图模型的校准度、拟合度均较好。妊娠失败的阈值为50%~80%时,列线图模型的临床获益38%~62%。结论年龄、身体质量指数、水合率和胰岛素抵抗是超重/肥胖型PCOS患者IVF/ICSI-ET临床妊娠失败的独立危险因素。基于独立危险因素成功构建了列线图模型,该列线图模型可有效预测超重/肥胖型PCOS患者IVF/ICSI-ET临床妊娠失败,拟合度好、校对度高,临床应用价值较高。

Objective To summarize the risk factors for pregnancy failure of in vitro fertilization/intracytoplasmic sperm injection-embryo transfer(IVF/ICSI-ET)in overweight/obese patients with polycystic ovary syndrome(PCOS),and to build a nomogram(nomogram model)to predict the risk of pregnancy failure of IVF/ICSI-ET in overweight/obese patients with PCOS based on the risk factors.Methods Totally 131 overweight/obese PCOS patients who planned to un⁃dergo IVF/ICSI-ET completed the embryo transfer cycle,and their body composition characteristic variables,laboratory examination characteristic variables,and clinical case data variables were collected.Patients were divided into a training set of 91 cases and a validation set of 40 cases.LASSO regression analysis was used to analyze the independent risk factors for IVF/ISCI-ET pregnancy failure in overweight/obese PCOS patients.Based on independent risk factors,a nomo⁃gram model was constructed,and the predictive ability,and calibration of the nomogram model were evaluated using the receiver operating characteristic(ROC)curve,calibration curve,and Hosmer-Lemeshow goodness-of-fit test.We evaluat⁃ed the clinical application value through the clinical decision curve.Results The independent risk factors of IVF/ICSIET pregnancy failure in overweight/obese PCOS patients were age,body mass index,hydration rate and insulin resistance(λ:-0.186,-0.947,-0.064,and-0.290).The area under the ROC curve of the nomogram model was 0.934,and the calibration curve and fitted curve showed that both the calibration and fitting of the nomogram model were good.When the threshold probability was between 50%and 80%,the clinical application value of the nomogram model was good(the bene⁃fit was about 38%to 62%).Conclusions Age,body mass index,hydration rate and insulin resistance are independent risk factors for IVF/ICSI-ET clinical pregnancy failure in overweight/obese PCOS patients.A nomograph model is success⁃fully constructed based on independent risk factors.The nomograph model has good degree of fitting,high calibration,and high clinical application value.