摘要
目的探究可能影响单一卵母细胞(获卵数为1)受精结局的血清激素及其浓度截断值。方法回顾性分析2015年1月至2019年12月于本生殖中心行常规IVF助孕且仅获得一个卵母细胞的433例患者临床资料,按照其卵母细胞受精结局的不同,将患者分为IVF-2PN组(n=326)和IVF-3PN组(n=107)。对比分析两组患者的基本资料、Gn总量、HCG总量、基础激素(FSH、LH、E_(2)、PRL)水平以及Gn日和HCG日血清激素水平之间的差异;通过Logistic回归模型分析单一卵母细胞发生多精子受精的危险因素,并利用ROC曲线计算影响单一卵母细胞受精结局的激素浓度截断值。根据浓度截断值进行亚分组分析,比较不同激素浓度组间的受精结局差异。结果两组患者年龄、不孕年限、BMI、基础FSH、基础LH、基础PRL水平、Gn日血清FSH水平、HCG总量及HCG日血清FSH及E_(2)水平均无显著性差异(P>0.05)。与IVF-2PN组相比,IVF-3PN组的血清基础E_(2)水平、Gn日血清LH及E_(2)水平、HCG日血清LH水平显著升高(P<0.05),Gn总量显著下降(P<0.05)。Logistic回归分析结果表明:血清基础E_(2)水平、Gn总量、Gn日血清LH及E_(2)水平、HCG日血清LH水平均与单一卵母细胞多精子受精存在显著相关性(P<0.05)。ROC曲线计算结果显示基础血清E_(2)浓度截断值为258.74 pmol/L[AUC=0.533,95%CI(0.482,0.583),P=0.200];Gn日血清LH浓度截断值为6.32 U/L[AUC=0.583,95%CI(0.534,0.632),P=0.001]、E_(2)浓度截断值为471.60 pmol/L[AUC=0.575,95%CI(0.526,0.624),P=0.003];HCG日血清LH浓度截断值为3.28 U/L[AUC=0.591,95%CI(0.542,0.639),P=0.000]。将不同时间点各激素浓度联合起来作为多因素进行ROC曲线分析,结果为[AUC=0.631,95%CI(0.569,0.693),P=0.000],AUC面积增加且P<0.05。亚组分析结果显示,当激素浓度高于对应的截断值时,IVF-2PN比例显著降低,而IVF-3PN比例显著增加(P<0.05)。结论血清激素水平对单一卵母细胞多精子受精的预测价值需要综合考虑LH和E_(2)两种激素浓度的动态变化。当血清基础E_(2)水平、Gn日血清LH和E_(2)水平、HCG日血清LH水平分别高于对应的浓度截断值时,可能会增加单一卵母细胞发生多精子受精的风险。
Objective:To explore the serum hormones and the corresponding cutoff values of concentration that may affect the fertilization outcome in IVF cycles with single oocyte retrieved.Methods:A retrospective analysis was made on 433 patients in conventional IVF cycles with single oocyte retrieved in our center from January 2015 to December 2019.The patients were divided into two groups according to different fertilization outcome of single oocyte:IVF-2PN group(n=326)and IVF-3PN group(n=107).The basic information of patients,Gn dosage,HCG dosage,basal hormone levels(FSH,LH,E_(2),PRL),the serum hormone levels(FSH、LH、E_(2))on Gn day and HCG day were compared between the two groups.Logistic regression model was used to analyze the risk factors for polyspermy in single oocyte.ROC curve was used to calculate the cutoff value of hormone concentration affecting the fertilization outcome of single oocyte.Subgroup analysis was conducted according to the cutoff value to compare the difference in fertilization outcome between different hormone concentration groups.Results:There were no significant differences in age,infertility years,body mass index(BMI),basal serum levels of FSH,LH and PRL,the serum FSH levels on Gn day,HCG dosage,and the serum levels of FSH and E_(2) on HCG day between the two groups(P>0.05).The basal E_(2) level,the serum levels of LH and E_(2) on Gn day,and the serum LH level on HCG day in IVF-3PN group were significantly higher,but the Gn dosage was significantly lower than those in IVF-2PN group(P<0.05).Logistic regression analysis showed that the basal E_(2) levels,Gn dosage,the serum levels of LH and E_(2) on Gn day,and the serum LH level on HCG day were significantly associated with polyspermy of single oocyte(P<0.05).ROC curve calculation results show that the cutoff values of basal E_(2) concentration,LH and E_(2) on Gn day and LH on HCG day were 258.74 pmol/L[AUC=0.533,95%CI(0.482,0.583),P=0.200],6.32 U/L[AUC=0.583,95%CI(0.534,0.632),P=0.001],471.60 pmol/L[AUC=0.575,95%CI(0.526,0.624),P=0.003]and 3.28 U/L[AUC=0.591,95%CI(0.542,0.639),P=0.000]respectively.The concentrations of hormones at different time points were combined as multiple factors for ROC curve analysis,and the result showed that AUC was increased[AUC=0.631,95%CI(0.569,0.693),P=0.000].Subgroup analysis showed that when the hormone concentration was higher than the corresponding cutoff value,the percentage of IVF-2PN decreased significantly,while the proportion of IVF-3PN increased significantly(P<0.05).Conclusions:The predictive value of serum hormone levels on polyspermy in single oocyte needs to consider the dynamic changes of LH and E_(2) concentrations.When the basal level of E_(2) the serum levels of LH&E_(2) on Gn day,and serum LH levels on HCG day were respectively higher than the corresponding cutoff values of concentration,the risk of polyspermy in single oocyte may be increased.
作者
赵海静
邱绮
欧阳能勇
朱玉琴
王文军
ZHAO Hai-jing;QIU Qi;OUYANG Neng-yong;ZHU Yu-qin;WANG Wen-jun(Reproductive Center,Sun Yat-Sen Memorial Hospital of Sun Yat-sen University,Guangzhou 510120)
出处
《生殖医学杂志》
CAS
2021年第10期1288-1294,共7页
Journal of Reproductive Medicine
基金
广东省自然科学基金-面上项目(2019A1515012005)。
作者简介
赵海静,女,黑龙江哈尔滨人,助理研究员,辅助生殖技术专业;通讯作者:王文军,Email:wenjungzcn@163.com。
