冻融单胚胎移植后早期血清β-HCG水平对活产结局的预测价值

Predictive value of early serumβ-HCG level for live birth outcome after frozen-thawed single embryo transfer

目的探讨冻融单胚胎移植后早期血清β-HCG水平对活产结局的预测价值。方法回顾性分析2020年1月至2022年12月于烟台市烟台山医院生殖医学中心行单卵裂期胚胎移植(SCT-D3)后第14天β-HCG(β-HCG14)值及单囊胚移植(SBT-D5/6)后第12天β-HCG(β-HCG12)值均阳性的322个解冻周期患者的临床资料,根据妊娠结局分为生化妊娠组(n=52)、早期流产组(n=47)、活产组(n=223)3组,并对女方年龄(<35岁、≥35岁)进行亚组分层。采用二元Logistic回归分析筛选活产相关预测因子,相关及偏相关分析血清β-HCG水平对活产的影响,绘制β-HCG预测活产的受试者工作特征(ROC)曲线并确定阈值。结果不同妊娠结局组的早期β-HCG水平差异有统计学意义(H=132.628,P<0.001),活产组显著高于其他2组(P<0.001)。二元Logistic回归分析结果显示,女方年龄[OR=0.460,95%CI(0.248,0.855),P=0.014]、移植胚胎质量[OR=2.034,95%CI(1.070,3.868),P=0.030]、早期β-HCG水平[OR=1.004,95%CI(1.003,1.005),P=0.000]是冻融单胚胎移植活产的独立预测因子。ROC曲线分析显示,早期β-HCG预测活产的曲线下面积(AUC)为0.867,敏感度0.937,特异性0.677,临界值为265.5 U/L,并且高龄组预测阈值(341.2 U/L)高于低龄组(240.9 U/L)。结论女方年龄、移植胚胎质量、早期β-HCG水平是冻融单胚胎移植活产的独立预测因子;早期β-HCG预测活产ROC曲线在女方不同年龄分层中存在一定差异,但总体预测价值较高,各中心可定义自身活产预测期望值。

Objective:To explore the predictive value of early serumβ-HCG level for live birth outcome after frozen-thawed single embryo transfer.Methods:A retrospective cohort study was conducted to analyze the clinical data of 322 thawing cycles of patients whoseβ-HCG values both on the 14th day(β-HCG 14)after single cleavage-stage embryo transfer(SCT-D3)and on the 12th day(β-HCG 12)after single blastocyst transfer(SBT-D5/6)were positive in the Reproductive Medicine Center of Yantaishan Hospital from January 2020 to December 2022.According to the pregnancy outcome,they were divided into three groups as biochemical pregnancy group(n=52),early abortion group(n=47)and live birth group(n=223),and further stratified as the elder group(≥35 years old)and the young group(<35 years old)according to the age of the woman.Binary logistic regression analysis was used to screen the related predictors of live births,and the influence of serumβ-HCG level on live births was analyzed by the correlation and partial correlation,and the receiver operating characteristic(ROC)curve ofβ-HCG for predicting live births was drawn and the threshold was determined.Results:The earlyβ-HCG levels in groups with different pregnancy outcomes were significantly different(H=132.628,P<0.001),and that of the live birth group was significantly higher than those of the other two groups(P<0.001).The results of binary logistic regression analysis showed that the age of the woman[OR=0.460,95%CI(0.248,0.855),P=0.014],the quality of the transferred embryo[OR=2.034,95%CI(1.070,3.868),P=0.030],the earlyβ-HCG level[OR=1.004,95%CI(1.003,1.005),P=0.000]were independent predictors of the live birth of frozen-thawed single embryo transfer.The ROC curve analysis showed that the area under the curve(AUC)of earlyβ-HCG for predicting live births was 0.867,the sensitivity was 0.937,the specificity was 0.677,and the critical value was 265.5 U/L,and the prediction threshold of the elder group(341.2 U/L)was higher than that of the young group(240.9 U/L).Conclusions:The age of the woman,the quality of the transferred embryo and the earlyβ-HCG level are independent predictors of the live birth of frozen-thawed single embryo transfer.The ROC curve of earlyβ-HCG prediction of live births has some differences in different age groups of women,but the overall prediction value is high,and each center can define its own expected value of live births.