子宫腺肌病IVF-ET助孕病人血清PIBF、RBP-4水平及其对妊娠结局的预测价值

Serum PIBF and RBP-4 levels in adenomyosis patients undergoing IVF-ET assisted pregnancy and their predictive value for pregnancy outcome

目的:探讨子宫腺肌病体外受精-胚胎移植(IVF-ET)助孕病人血清孕激素诱导阻断因子(PIBF)、视黄醇结合蛋白-4(RBP-4)的表达及其对妊娠结局的预测价值。方法:选取行IVF-ET助孕的子宫腺肌病病人96例为研究对象,根据临床妊娠情况将研究对象分为临床妊娠组(56例)和未妊娠组(40例)。比较2组病人基本特征及治疗数据、血清PIBF、RBP-4水平。Pearson法分析血清PIBF、RBP-4与基础卵泡刺激素(FSH)、抗缪勒管激素(AMH)、基础促黄体生成素(LH)的相关性。多因素logistic回归分析影响子宫腺肌病IVF-ET助孕病人临床妊娠结局的影响因素。受试者工作特征(ROC)曲线分析血清PIBF、RBP-4水平对子宫腺肌病IVF-ET助孕病人妊娠结局的预测价值。结果:临床妊娠组FSH、AMH、促性腺激素(Gn)用量明显高于未妊娠组(P<0.05~P<0.01)。未妊娠组血清PIBF水平明显低于临床妊娠组(P<0.01),RBP-4水平明显高于临床妊娠组(P<0.01)。相关性分析显示,子宫腺肌病病人血清PIBF与基础FSH、AMH呈正相关(r=0.517、0.669,P<0.01),血清RBP-4与基础FSH、AMH呈负相关(r=-0.558、-0.634,P<0.01)。多因素logistic回归分析显示,基础FSH低水平、AMH低水平、PIBF低水平、RBP-4高水平是影响子宫腺肌病IVF-ET助孕病人临床妊娠结局的危险因素(P<0.05~P<0.01)。血清PIBF、RBP-4联合预测子宫腺肌病IVF-ET助孕病人妊娠结局的ROC曲线下面积(AUC)显著大于PIBF、RBP-4单独预测的AUC(P<0.05)。结论:血清PIBF、RBP-4与子宫腺肌病IVF-ET助孕病人妊娠结局相关,两者联合对子宫腺肌病IVF-ET助孕病人妊娠结局具有一定的预测价值。

Objective:To investigate the expression of serum progesterone-inducible blocking factor(PIBF)and retinol-binding protein-4(RBP-4)in patients with adenomyosis undergoing in vitro fertilization-embryo transfer(IVF-ET)assisted pregnancy and their predictive value for pregnancy outcomes.Methods:A total of 96 patients with adenomyosis who underwent IVF-ET assisted pregnancy were included as the study subjects,according to clinical pregnancy,the subjects were divided into clinical pregnancy group(56 cases)and non-pregnancy group(40 cases).The basic characteristics and treatment data,levels of serum PIBF and RBP-4 in the two groups were compared.The correlations of serum PIBF and RBP-4 with basal follicle stimulating hormone(FSH),anti-Mulerian hormone(AMH)and basal luteinizing hormone(LH)were analyzed by Pearson method.Multivariate logistic regression was applied to analyze the risk factors influencing the clinical pregnancy outcome of patients with adenomyosis by IVF-ET assisted pregnancy.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of serum PIBF and RBP-4 levels for pregnancy outcome in IVF-ET assisted pregnancy with adenomyosis.Results:The basal FSH,AMH and dose of gonadotropin(Gn)in the clinical pregnancy group were greatly higher than those in the non-pregnant group(P<0.05 to P<0.01).The level of serum PIBF in the non-pregnancy group was greatly lower than that in the clinical pregnancy group(P<0.01),and the level of RBP-4 was greatly higher than that in the clinical pregnancy group(P<0.01).Correlation analysis showed that serum PIBF was positively correlated with basal FSH and AMH in adenomyosis patients(r=0.517,0.669,P<0.01),and serum RBP-4 was negatively correlated with basal FSH and AMH in adenomyosis patients(r=-0.558,-0.634,P<0.01).Multivariate logistic analysis showed that low level of basal FSH,low level of AMH,low level of PIBF,and high level of RBP-4 were risk factors for clinical pregnancy outcomes of IVF-ET assisted pregnancy patients with adenomyosis(P<0.05 to P<0.01).The area under ROC curve(AUC)of the combined prediction of PIBF and RBP-4 for pregnancy outcomes in IVF-ET assisted pregnancy patients with adenomyosis was significantly greater than that of the AUC predicted by PIBF and RBP-4 alone(P<0.05).Conclusions:The low level of serum PIBF and high level of RBP-4 were the risk factors affecting the pregnancy outcome of IVF-ET assisted pregnancy patients with adenomyosis,and the combination of the two has a certain predictive value for the pregnancy outcome of IVF-ET assisted pregnancy patients with adenomyosis.