基于阴道多普勒超声检查与临床资料构建不明原因不孕患者胚胎反复种植失败的预测模型

Construction of a Predictive Model for Recurrent Embryo Implantation Failure in Patients with Unexplained Infertility Based on Vaginal Doppler Ultrasound and Clinical Data

目的:观察不孕患者阴道多普勒超声检查结果与临床资料,构建预测模型分析其不明原因胚胎反复种植失败的影响因素。方法:选取2020年6月至2022年12月于本院不明原因胚胎反复种植失败的198例不孕患者为研究组,另取同期于本院胚胎种植成功的100例不孕患者为对照组,所有患者均接受阴道多普勒超声检查,对比两组阴道超声检查结果及临床资料,绘制受试者工作特征曲线(ROC)分析多因素预测不孕患者胚胎种植结果的价值,建立Logistic回归模型,识别不孕患者胚胎反复种植失败的影响因素,并进行模型验证。结果:研究组年龄大于对照组,AMH水平、自身免疫抗体异常率高于对照组,人工流产次数多于对照组(P<0.05);研究组移植日内膜厚度低于对照组,子宫动脉搏动指数高于对照组(P<0.05);绘制ROC曲线,结果显示,年龄、AMH、人工流产次数、自身免疫抗体、移植日内膜厚度、子宫动脉搏动指数对不孕患者胚胎种植结果具有一定预测价值(AUC=0.706、0.720、0.611、0.649、0.719、0.771);建立Logistic回归模型,结果显示,年龄大、人工流产次数多、自身免疫抗体异常、子宫动脉搏动指数高是不孕患者胚胎反复种植失败的危险因素(OR>1,P<0.05);AMH水平高、移植日内膜厚度高是不孕患者胚胎种植结果的保护因素(OR<1,P<0.05);根据Logistic回归模型得到回归方程,绘制ROC曲线发现,该模型预测不孕患者胚胎反复种植失败的AUC=0.928,P<0.05,模型可靠、稳定。结论:不孕患者胚胎反复种植失败可能与患者年龄、AMH水平、人工流产次数、自身免疫抗体、移植日内膜厚度、子宫动脉搏动指数等有关,临床可在胚胎种植前对患者进行阴道多普勒超声检查,结合临床资料综合评估患者胚胎种植结果,并采取针对性干预措施,以获得良好妊娠结局。

Objective:To construct a predictive model for recurrent embryo implantation failure in unexplained infertility patients based on vaginal Doppler ultrasound examination results and clinical data,and to analyze the influencing factors.Methods:The study group consisted of 198 unexplained infertility patients with recurrent embryo implantation failure from June 2020 to December 2022 at our hospital.The control group included 100 infertility patients with successful embryo implantation during the same period.All patients underwent vaginal Doppler ultrasound examinations.The results of the ultrasound examinations and clinical data were compared between the two groups.Receiver Operating Characteristic(ROC)curve analysis was used to evaluate the predictive value of multiple factors on embryo implantation outcomes.A Logistic regression model was established to identify the influencing factors of recurrent embryo implantation failure and to validate the model.Results:The study group had a higher age,higher AMH levels,higher rate of abnormal autoantibodies,and more induced abortions compared to the control group(P<0.05).The study group had a thinner endometrial thickness on the day of transfer and a higher uterine artery pulsatility index compared to the control group(P<0.05).ROC curve analysis showed that age,AMH,number of induced abortions,autoantibodies,endometrial thickness on the day of transfer,and uterine artery pulsatility index had predictive value for embryo implantation outcomes in infertility patients(AUC=0.706,0.720,0.611,0.649,0.719,0.771).The Logistic regression model showed that advanced age,a higher number of induced abortions,abnormal autoantibodies,and a higher uterine artery pulsatility index were risk factors for recurrent implantation failure in infertility patients(OR>1,P<0.05);higher AMH levels and greater endometrial thickness on the day of transfer were protective factors for embryo implantation outcomes(OR<1,P<0.05).The ROC curve drawn based on the Logistic regression model showed that the model's predictive value for recurrent implantation failure in infertility patients was AUC=0.928,P<0.05,indicating that the model was reliable and stable.Conclusion:Recurrent implantation failure in infertility patients may be related to factors such as age,AMH levels,number of induced abortions,autoantibodies,endometrial thickness on the day of transfer,and uterine artery pulsatility index.Clinicians can use transvaginal Doppler ultrasound examination before embryo implantation,combined with clinical data,to comprehensively evaluate the patient's embryo implantation outcomes and take targeted interventions to achieve a favorable pregnancy outcome.