HCG日孕酮升高对妊娠结局的影响及其早期预测因素的探讨  

The Impact of Elevated Progesterone on the Day of HCG Administration on Pregnancy Outcomes and its Early Prognostic Factors

作　　者：刁俊荣 张云山[2] 杜爱军[2] 袁丽娜[1] 

机构地区：[1]天津医科大学研究生院,天津300070 [2]天津市中心妇产科医院,天津300100

出　　处：《实用妇产科杂志》2016年第1期33-37,共5页Journal of Practical Obstetrics and Gynecology

摘　　要：目的：探讨注射人绒促性素（HCG）日孕酮（P）升高对妊娠结局的影响及基础P水平对HCG日P升高的早期预测情况。方法：对本中心行体外受精-胚胎移植（IVF-ET）患者有基础P水平检测结果的734个周期进行回顾性分析。将HCG日P为4.77 nmol/L设为临界值分为P升高组（204个周期）和P未升高组（530个周期）,比较两组各项临床参数指标。釆用Logistic回归分析探讨影响注射HCG日P升高的相关因素,并对其相关指标进行预测HCG日P升高的最佳判断点的统计,根据最佳判断点探讨其与妊娠结局的关系。结果：两组间正常受精率、优质胚胎率比较,差异无统计学意义（P〉0.05）,但与P未升高组比较,P升高组的胚胎着床率和临床妊娠率较低（P〈0.05）,流产率较高（P〈0.05）。基础P水平与HCG日P升高多元回归分析显示有相关性（OR=20.5,95%CI 4.73~89.01,P=0.000）。基础P预测HCG日P升高的最佳判断点为2.38 nmol/L,对应的敏感度为46.1%,特异度为79.2%。但以此为界值将P升高组细分为两组,其与妊娠结局有关的各项指标间比较,差异均无统计学意义（P〉0.05）。结论：HCG日P升高对妊娠结局不利,但不影响卵母细胞及胚胎质量。基础P水平可作为HCG日P升高的早期预测因素,但不是直接影响妊娠结局的独立决定性因子。Objective： To investigate the relationship between progesterone（ P） elevation on the day of HCG administration and pregnancy outcomes and assess basal progesterone level as a early predictor of progesterone elevation at HCG. Methods： 734 cycles with basal P measurement in IVF-ET were analyzed retrospectively in our Reproductive Medicine Center. The threshold of P level on the day of HCG administration was set at 4. 77 nmol / L and according to this threshold,patients were assigned to P elevation group（ 204 cycles） and no elevation group（ 530 cycles）. The clinical parameters were compared between the two groups. Logistic regression analysis was performed to explore the influence factors of elevated P on HCG injection day and the cut-off value of elevated P was found. Relationship between elevated P and pregnancy outcomes was investigated according to the cut-off value. Results： The rates of normal fertilization and high quality embryos between two groups did not show significant differences（ P0. 05）. But the implantation and clinical pregnancy rates of the P elevation group were lower and abortion rate was higher（ P0. 05）. Basal P level showed a strong relationship with elevated P on the day of HCG injection（ OR = 20. 5,95% CI 4. 73-89. 01,P = 0. 000）. The cut-off value of basal P for prediction of elevated P on the day of HCG injection was 2. 38 nmol / L,the sensitivity and specificity were 46. 1% and 79. 2% respectively. Furthermore,the P elevation group was subdivided into 2 subgroups according to the cut-off value. However,there was no statistical significant difference between two subgroups（ P 0. 05）. Conclusions： Elevated P level on HCG injection day negatively influences pregnancy outcomes. However,it does not seem to affect oocyte and embryo quality. Basal P is shown to be the early predictive factor for P elevation on the day of HCG.

关 键 词：孕酮 体外受精-胚胎移植 妊娠结局 预测 

分 类 号：R715.9[医药卫生—妇产科学]