摘要
目的探讨多囊卵巢综合征(PCOS)不孕症患者冻胚移植(FET)日血清孕酮(P)和雌二醇(E_(2))水平与FET妊娠结局的相关性。方法选取2019年5月至2024年5月山西医科大学附属运城市中心医院收治的150例PCOS不孕症患者为研究对象,均采用激素替代法准备子宫内膜并行FET。收集所有患者的临床资料并在移植当天检测血清P、E_(2)、25-羟基维生素D[25-(OH)D],并测定患者的子宫内膜厚度。根据移植35 d后的妊娠情况,分为临床妊娠组(89例)和非妊娠组(61例);87例临床妊娠患者完成随访,根据随访期内不良事件发生情况分为妊娠结局良好组(50例)和妊娠结局不良组(37例)。比较临床妊娠组和非妊娠组、妊娠结局良好组和妊娠结局不良组的一般临床资料、P、E_(2)、子宫内膜厚度的差异性。采用Logistic回归模型分析患者血清P、E_(2)与临床妊娠、妊娠结局的相关性,并采用受试者工作特征(ROC)曲线下面积(AUC)分析移植日血清P、E_(2)在预测PCOS不孕症患者FET临床妊娠、妊娠结局中的价值。结果150例PCOS不孕症患者均完成了FET,共有89例成功妊娠,临床妊娠率为59.33%。多因素Logistic回归分析结果显示,PCOS不孕症患者的年龄、身体质量指数、卵裂球完整胚胎数、25-(OH)D、P、E_(2)和子宫内膜厚度是FET临床妊娠的影响因素(OR=1.331,95%CI:1.239~1.418,P<0.001;OR=1.379,95%CI:1.262~1.506,P<0.001;OR=0.472,95%CI:0.350~0.637,P<0.001;OR=0.908,95%CI:0.836~0.985,P=0.002;OR=1.096,95%CI:1.008~1.193,P=0.003;OR=0.712,95%CI:0.606~0.839,P<0.001;OR=0.310,95%CI:0.232~0.411,P<0.001)。87例临床妊娠患者完成随访,其中不良妊娠结局37例(42.53%),妊娠良好结局50例(57.47%)。多因素Logistic回归分析结果显示,PCOS不孕症患者的年龄、E_(2)和子宫内膜厚度是FET妊娠结局的影响因素(OR=1.257,95%CI:1.149~1.376,P<0.001;OR=0.954,95%CI:0.930~0.979,P<0.001;OR=2.889,95%CI:2.003~4.168,P<0.001)。ROC曲线结果显示,P、E_(2)预测PCOS不孕症患者FET临床妊娠的AUC分别为0.805、0.723,E_(2)预测PCOS不孕症患者FET妊娠结局的AUC为0.770。结论PCOS不孕症患者移植日血清P、E_(2)水平与FET临床妊娠率相关,P、E_(2)水平升高对FET临床妊娠率有利,较高的E_(2)水平还与FET良好妊娠结局相关。移植日P、E_(2)水平对FET临床妊娠有一定的预测价值,且移植日E_(2)水平还可进一步预测FET妊娠结局。
Objective To investigate the correlation between serum progesterone(P)and estradiol(E_(2))levels on the day of frozen embryo transfer(FET)and the pregnancy outcome of FET in infertile patients with polycystic ovary syndrome(PCOS).Methods A total of 150 infertile patients with PCOS who underwent hormone replacement therapy for endometrial preparation and FET at Yuncheng Central Hospital affiliated to Shanxi Medical University between May 2019 and May 2024 were selected as the research subjects.Clinical data were collected for all patients.Serum levels of P,E_(2),and 25-hydroxyvitamin D[25-(OH)D],and endometrial thickness were measured on the transfer day.Based on pregnancy status 35 days after transfer,patients were divided into a clinical pregnancy group(89 cases)and a non-pregnancy group(61 cases).Eighty-seven clinically pregnant patients completed follow-up.According to the occurrence of adverse events during follow-up,they were divided into a good pregnancy outcome group(50 cases)and a poor pregnancy outcome group(37 cases).Differences in general clinical data,P,E_(2),and endometrial thickness were compared between the clinical pregnancy group and non-pregnancy group,and between the good pregnancy outcome group and poor pregnancy outcome group.Logistic regression analysis was used to assess the correlation between serum P,E_(2)levels and clinical pregnancy/pregnancy outcomes.The area under the receiver operating characteristic(ROC)curve(AUC)was used to evaluate the predictive value of serum P and E_(2)levels on transfer day for FET clinical pregnancy and pregnancy outcomes in PCOS infertility patients.Results All 150 infertile patients with PCOS completed FET,with 89 successful pregnancies,yielding a clinical pregnancy rate of 59.33%.Multivariate Logistic regression analysis showed that age,body mass index,number of intact blastocyst embryos,25-(OH)D,P,E_(2),and endometrial thickness were influencing factors for FET clinical pregnancy(OR=1.331,95%CI:1.239-1.418,P<0.001;OR=1.379,95%CI:1.262-1.506,P<0.001;OR=0.472,95%CI:0.350-0.637,P<0.001;OR=0.908,95%CI:0.836-0.985,P=0.002;OR=1.096,95%CI:1.008-1.193,P=0.003;OR=0.712,95%CI:0.606-0.839,P<0.001;OR=0.310,95%CI:0.232-0.411,P<0.001).Eighty-seven clinically pregnant patients completed follow-up,with 37 cases(42.53%)of adverse pregnancy outcomes and 50 cases(57.47%)of good pregnancy outcomes.Multivariate Logistic regression analysis showed that age,E_(2),and endometrial thickness were influencing factors for FET pregnancy outcomes(OR=1.257,95%CI:1.149-1.376,P<0.001;OR=0.954,95%CI:0.930-0.979,P<0.001;OR=2.889,95%CI:2.003-4.168,P<0.001).ROC curve analysis showed that the AUC for P and E_(2)in predicting FET clinical pregnancy in PCOS infertility patients were 0.805 and 0.723,respectively.The AUC for E_(2)in predicting FET pregnancy outcomes in PCOS infertility patients was 0.770.Conclusion Serum P and E_(2)levels on the transfer day in PCOS infertility patients are correlated with the FET clinical pregnancy rate.Elevated P and E_(2)levels are beneficial for the FET clinical pregnancy rate,and higher E_(2)levels are also associated with good FET pregnancy outcomes.Serum P and E_(2)levels on the transfer day have certain predictive value for FET clinical pregnancy,and the E_(2)level on the transfer day can further predict FET pregnancy outcomes.
作者
李晓红
景霞
王雪松
LI Xiaohong;JING Xia;WANG Xuesong(Department of Reproductive Medicine,Yuncheng Central Hospital Affiliated to Shanxi Medical University,Yuncheng,Shanxi 044000,China)
出处
《转化医学杂志》
2025年第6期91-96,共6页
Translational Medicine Journal
基金
山西医科大学附属运城市中心医院院级课题(YJ2023022)。
关键词
多囊卵巢综合征
不孕症
冻胚移植
孕酮
雌二醇
妊娠结局
相关性
Polycystic ovary syndrome
Infertile
Frozen embryo transfer
Progesterone
Estradiol
Pregnancy outcome
Correlation
作者简介
李晓红,硕士研究生,主治医师。主要从事生殖医学方向研究;通信作者:景霞,E-mail:m13403594609@163.com。
