拮抗剂方案IVF患者hCG注射日雌/孕激素比值对妊娠结局的预测价值  

Research on the Value of the Progesterone-to-estradiol Ratio on the Day of hCG Administration in Predicting IVF Outcome Undergoing GnRH Antagonist Cycles

作　　者：李娟[1] 曹云霞[1] 许孝凤[1] 杜雪[1] 刘云云[1] 

机构地区：[1]安徽医科大学第一附属医院,合肥230022

出　　处：《生殖与避孕》2014年第11期897-901,907,共6页Reproduction and Contraception

摘　　要：目的:探讨卵巢储备能力正常的不孕症患者在拮抗剂方案超促排卵周期中人绒毛膜促性腺激素(h CG)注射日血清孕酮/雌二醇(P/E2)比值对体外受精-胚胎移植(in vitro fertilization and embryo transfer,IVF-ET)妊娠结局的预测价值。方法:回顾性分析103例接受拮抗剂方案超促排卵且卵巢储备能力正常患者的临床资料,采用受试者工作特征曲线(receiver operating characteristic,ROC)筛选h CG注射日P/E2比值对妊娠结局预测的最佳阈值并根据该阈值进行分组,比较组间的临床参数,采用Logistic回归分析研究h CG注射日P/E2比值和临床妊娠之间的关系。结果:拮抗剂方案中h CG注射日P/E2比值最佳阈值为0.26,P/E2比值≤0.26组临床妊娠率明显高于P/E2比值>0.26组(57.69%vs 21.56%,P<0.001)。Logistic回归分析结果显示P/E2比值可以作为一个独立的临床妊娠结局的预测指标,该指标具有64.5%的敏感度和74.2%的特异度。结论:对卵巢储备能力正常且采用拮抗剂方案治疗的患者,虽然h CG注射日P/E2比值≤0.26者临床妊娠率明显增高,该比值对IVF妊娠结局具有一定的预测价值。Objective： To explore the predictive value of the progesterone-to-estradiol （P/E2） ratio on the day of hCG administration for IVF outcome in patients with normal ovarian reserve undergoing GnRH antagonist cycles. Methods： A retrospective analysis was performed on 103 women with normal ovarian reserve undergoing the GnRH antagonist protocol. Receiver operating characteristics （ROC） analysis was performed to determine cut-off values for the P/E2 ratio detrimental to IVF outcomes. The patients were divided into two groups separately according to the cut-off value found by the ROC curve. Logistic regression analysis was used to study the association between the IVF outcomes and the P/E2 ratio. Results： The optimal cut-off value for P/E2 ratio in GnRH antagonist cycles was 0.26; clinical pregnancy rates were found to be significantly higher in patients with P/E2 ratios ≤ 0.26 than those with 〉0.26 （57.69% vs 21.56%, P〈0.001）. In Logistic regression analysis, the P/ E2 ratio was found to be an independent predictor for pregnancy, the sensitivity was 64.5%, the specificity was 74.2%. Conclusion： Although a P/E2 ratio ≤ 0.26 on the day of hCG administration was associated with significantly higher clinical pregnancy, it has poor predictive value for IVF outcome in patients with normal ovarian reserve undergoing GnRH antagonist cycles.

关 键 词：孕酮/雌二醇(P/E2)比值 妊娠率 拮抗剂 体外受精-胚胎移植(IVF-ET) 

分 类 号：R714.8[医药卫生—妇产科学]