卵巢敏感指数、卵泡输出率及卵泡敏感指数对卵巢过度刺激综合征的预测价值

Predictive value of ovarian sensitivity index,follicle output rate and follicle sensitivity index for ovarian hyperstimulation syndrome

目的探讨卵巢敏感指数(OSI)、卵泡输出率(FORT)、卵泡敏感指数(FSI)对行体外受精/卵胞浆内单精子显微注射(IVF/ICSI)患者发生卵巢过度刺激综合征(OHSS)的预测价值。方法回顾性分析2012年3月至2021年12月于联勤保障部队第九四○医院生殖医学中心选择长效长方案/拮抗剂方案行控制性促排卵(COH)治疗共664例患者的临床资料。根据患者是否出现OHSS分为OHSS组(n=88)和对照组(n=576),分析两组患者的基本信息和临床资料,通过受试者工作特征(ROC)曲线及曲线下面积(AUC)分析OSI、FORT、FSI和OSI+FORT+FSI联合对OHSS的预测能力。结果OHSS组的年龄、不孕年限、HCG总量和优质胚胎率显著低于对照组,而窦卵泡数(AFC)、长效长方案占比、扳机日雌二醇(E_(2))、扳机日孕酮、停针日卵泡数(PFC)、获卵数、OSI、FORT和FSI显著高于对照组(P<0.05);两组间体质量指数(BMI)、不孕因素、促性腺激素(Gn)启动量、Gn总量、Gn总天数、扳机日LH和受精率比较均无显著差异(P>0.05)。在对OHSS的预测中,OSI+FORT+FSI联合ROC曲线AUC最大为0.746;对轻度OHSS的预测中,OSI的ROC曲线AUC最大为0.725;对中、重度OHSS的预测中,OSI+FORT+FSI联合ROC曲线AUC最大,分别为0.786和0.839。结论OSI、FORT、FSI及联合应用对不同程度的OHSS都有一定的预测作用,其中联合应用效果最好。

Objective:To investigate the predictive value of ovarian sensitivity index(OSI),follicle output rate(FORT)and follicle sensitivity index(FSI)for ovarian hyperstimulation syndrome(OHSS)in the patients with IVF/ICSI treatment.Methods:The clinical data of 664 patients who underwent the long-acting long protocol/antagonist protocol for controlled ovarian hyperstimulation(COH)at the Reproductive Medicine Center of the 940 th Hospital of the People’s Liberation Army from March 2012 to December 2021 were retrospectively analyzed.The patients were divided into two groups according to whether they experienced OHSS:the OHSS group(n=88)and the control group(n=576).The basic condition and clinical data of the two groups were analyzed,and the receiver operating characteristic(ROC)curve and the area under the curve(AUC)were used to analyze the predictive value of OSI,FORT,FSI and OSI+FORT+FSI for OHSS.Results:The age,duration of infertility,total HCG dose used and high-quality embryo rate in the OHSS group were significantly lower than those in the control group(P<0.05),while antral follicle count(AFC),proportion of long-acting long protocol,the levels of E_(2) and progesterone on trigger day,follicle count on pause injection day(PFC),number of oocytes retrieved,OSI,FORT and FSI were significantly higher than those in the control group(P<0.05).There were no significant differences in body mass index(BMI),infertility factors,starting dose of gonadotropin(Gn),total dose of Gn,total days of Gn,LH level on trigger day and fertilization rate between the two groups(P>0.05).For the prediction of OHSS,the AUC of ROC curve of combined OSI+FORT+FSI index was the largest(0.746).For the prediction of mild OHSS,the AUC of ROC curve of OSI was 0.725.For the prediction of moderate and severe OHSS,the AUC of ROC curve of combined OSI+FORT+FSI index was the largest,with 0.786 and 0.839 respectively.Conclusions:OSI,FORT,FSI and their combined application have certain predictive value on different degrees of OHSS,and the combined application has the best value.