摘要
目的探讨影响多囊卵巢综合征(PCOS)患者体外受精-胚胎移植(IVF-ET)妊娠结局的相关因素及预测价值。方法选取2015年5月至2017年12月PCOS进行IVF-ET并有妊娠结局的104例患者作为研究对象。根据移植后第28天超声结果分为临床妊娠成功组(41例)和临床妊娠失败组(63例)。比较两组患者的年龄、妊娠前体质指数(BMI)、抗苗勒管激素(AMH)、基础卵泡刺激素(FSH)、黄体生成素(LH)、LH/FSH值和雌二醇(E2),并进行多因素分析,建立临床妊娠的全变量风险预测模型。结果单因素分析显示,临床妊娠成功组的年龄(P=0.004)、LH/FSH值(P=0.009)、Gn用量(P=0.013)小于临床妊娠失败组,而临床妊娠成功组的FSH水平(P=0.013)、获卵总数(P=0.018)、hCG日子宫内膜厚度(P=0.005)、正常受精率(P=0.004)高于临床妊娠失败组;logistic多因素分析显示,年龄(OR=0.638,95%CI:0.480~0.847,P=0.002)、LH/FSH(OR=0.106,95%CI:0.026~0.423,P=0.002)、Gn用量(OR=0.961,95%CI:0.927~0.995)是影响IVF-ET治疗PCOS患者妊娠结局的独立危险因素,FSH(OR=1.276,95%CI:1.199~1.359)、正常受精率(OR=1.146,95%CI:1.025~1.118)是独立保护因素。以临床妊娠是否成功为因变量,年龄、FSH、LH/FSH值为自变量,采用逐步回归法,临床妊娠结局预测模型:P=1/(1+e-(-3.136-0.450×年龄-0.244×FSH-2.248×(LH/FSH)-0.040×Gn用量+1.146×受精率))。此方程与患者临床妊娠结局做ROC曲线,曲线下面积为0.971,95%CI:0.918~0.987。结论年龄、FSH、LH/FSH值是影响IVF-ET治疗PCOS患者不孕妊娠结局的独立影响因素,三者联合有望用于临床妊娠结局的预测。
Objective To investigate the factors and predictive value of in vitro fertilization-embryo transform(IVF-ET)pregnancy outcomes in patients with polycystic ovary syndrome(PCOS).Methods A total of 104 patients who were diagnosed of PCOS and received IVF-ET from May 2014 to December 2017 were enrolled.Patients were divided into 2 groups:successful clinical pregnancy group(n=41)and unsuccessful clinical pregnancy group(n=63).Ages,BMI,AMH,FSH,LH,LH/FSH and E2 were compared and a multivariate analysis was performed to investigate the risk factors and establish a model for pregnancy outcome prediction by logistic regression.Results Single factor analysis showed that the ages(P=0.004),LH/FSH(P=0.009)and Gn dosage(P=0.013)of patients in the successful clinical pregnancy group were lower than those in the unsuccessful group,while the FSH level(P=0.013),total number of oocytes(P=0.018),endometrial thickness at the day of administration of hCG(P=0.005),fertilization rate(P=0.004)were higher in successful clinical pregnancy group.Logistic multivariate analysis showed that age(OR=0.638,95%CI:0.480~0.847,P=0.002),LH/FSH(OR=0.106,95%CI:0.026~0.423,P=0.002)and Gn dosage(OR=0.961,95%CI:0.927-0.995)were independent risk factors,FSH(OR=1.276,95%CI:1.199~1.359,P=0.006)and fertilization rate(OR=1.146,95%CI:1.025~1.118)were independent protective factors.The prediction model(P)acquired by the stepwise method for clinical pregnancy probability was:P=1/(1+e-(-3.136-0.450×ages-0.244×FSH-2.248×(LH/FSH)-0.040×Gn dosage+1.146×fertilization rate)).The area under ROC curve was 0.971(95%CI:0.918~0.987).Conclusion Age,LH/FSH and FSH were the independent factors affecting the pregnancy outcome of IVF-ET in patients with PCOS,and the combination of the three is expected to be used to predict the outcome of clinical pregnancy.
作者
周晓燕
汤美玲
马娟
王葳
沈澍
ZHOU Xiaoyan;TANG Meiling;MA Juan;WANG Wei;CHEN Shu(Department of Reproductive Medicine,Wanbei Coal Electricity Group Company General Hospital,Suizhou,Anhui 243000,China)
出处
《中国妇产科临床杂志》
CSCD
北大核心
2020年第4期370-373,共4页
Chinese Journal of Clinical Obstetrics and Gynecology
关键词
多囊卵巢综合征
辅助生殖技术
妊娠结局
预测模型
影响因素
polycystic ovary syndrome
assisted reproductive technique
pregnancy outcome
prediction model
impact factor
