卵泡输出率对不孕患者卵巢反应性及妊娠结局的预测价值  

Value of follicular output rate in predicting ovarian response and pregnancy outcome of infertile patients

作　　者：马玲[1] 陈雅 洪志丹[1] 周春[1] Ma Ling;Chen Ya;Hong Zhidan;Zhou Chun(Reproductive Medicine Center of Obstetrics and Gynecology Department,Zhongnan Hospital of Wuhan University,Wuhan 430071,Hubei Province,China;Wuhan University School of Health Science,Wuhan 430071,Hubei Province,China)

机构地区：[1]武汉大学中南医院妇产科生殖医学中心,430071 [2]武汉大学健康学院,430071

出　　处：《中华妇幼临床医学杂志（电子版）》2018年第6期704-710,共7页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基　　金：湖北省卫生计生委科研一般项目(JX6B74)~~

摘　　要：目的探讨在体外受精-胚胎移植(IVF-ET)中,卵泡输出率(FORT)对不孕患者卵巢反应性及临床妊娠率的预测价值。方法选择2010年1月1日至2014年12月31日,在武汉大学中南医院生殖医学中心进行IVF-ET治疗的768例不孕患者为研究对象。本研究中,FORT为注射人绒毛膜促性腺激素(hCG)当日,直径为14～22mm排卵前卵泡数(PFC)与直径为3～8mm窦卵泡计数(AFC)的比值。根据其FORT值,将其分为低FORT值组(n=255,FORT值小于所有受试者FORT值的第33位百分位数,即FORT值<0.36),中FORT值组(n=277,FORT值处于所有受试者FORT值的第33～67位百分位数,即FORT值为0.36～0.67),高FORT值组(n=236,FORT值大于所有受试者FORT值的第67位百分位数,即FORT值>0.67)。采用回顾性分析方法,采集3组患者的一般临床资料及控制性促排卵相关指标。采用单因素方差分析,对于3组患者的年龄、人体质量指数(BMI)、基础卵泡刺激素(FSH)、AFC、促性腺激素(Gn)总量、Gn使用时间、注射hCG当日雌二醇水平、PFC、获卵数、MⅡ卵子数、移植胚胎数等进行比较。采用最小显著差异法(LSD)法,对3组患者AFC进一步进行两两比较。采用Kruskal-Wallis H秩和检验,对3组患者不孕年限、基础促黄体激素(LH)、基础雌二醇水平等进行比较。采用χ~2检验,对3组患者不孕原因构成比、优质胚胎率、胚胎种植率、临床妊娠率、活产率等进行比较。采用Pearson相关性分析,对不孕患者FORT与其获卵数、可利用胚胎数、优质胚胎数、年龄、基础FSH水平、基础雌二醇水平的相关性进行分析。对于不孕患者临床妊娠率的影响因素,进行多因素非条件logistic回归分析。本研究遵循的程序符合武汉大学中南医院伦理委员会所制定的伦理学标准,得到该委员会批准(审批文号:2017109)。结果 (1)3组患者的年龄、BMI、不孕年限、不孕原因构成比等一般临床资料比较,差异均无统计学意义(P>0.05)Objective To investigate clinical values of follicular output rate(FORT)in predicting ovarian response and pregnancy outcome of infertile patients with in vitro fertilization and embryo transfer(IVF-ET).Methods From January 1,2010 to December 31,2014,a total of 768 infertile patients who were treated with IVF-ET in Reproductive Medicine Center of Zhongnan Hospital of Wuhan University were collected as research subjects.In this study,FORT was the ratio of the number of preovulatory follicles(PFC)with a diameter of 3 to 8 mm and the antral follicle count(AFC)of 14 to 22 mm on the day of human chorionic gonadotropin(hCG)injection.According to FORT value,they were divided into 3 groups,low FORT value group(n=255,FORT value was lower than the 33rd percentile of the FORT value of all subjects,i.e.FORT value<0.36),middle FORT value group(n=277,FORT value was in the 33th to 67th percentile of the FORT value of all subjects,i.e.FORT value was 0.36 to 0.67),and high FORT value group(n=236,FORT value was higher than the 67th percentile of the FORT value of all subjects,i.e.FORT value>0.67).The general clinical data and related indicators of controlled ovulation hyperstimulation of 3 groups were collected by retrospective analysis.The age,body mass index(BMI),basal follicle stimulating hormone(FSH),AFC,total amount of gonadotropin(Gn),Gn use days,estradiol level on the day of hCG injection,PFC,number of ovums obtained,number of MⅡovums and number of embryos transferred were analyzed by one-way ANOVA analysis.The least significant difference(LSD)method was used to analyze AFC among three groups in further pairwise comparison.The duration of infertility,basic luteinizing hormone(LH)and basal estradiol levels were analyzed by Kruskal-Wallis H rank sum test.Chi-square test was used to analyze the ratio of different causes of infertility,high-quality embryos rate,embryo implantation rate,clinical pregnancy rate and live birth rate.Pearson correlation analysis was used to analyze the correlation between FORT and number of ovums

关 键 词：受精 体外 胚胎移植 卵泡输出率 卵巢反应性 控制性超促排卵 妊娠结局 窦卵泡计数 取卵前卵泡 不育 女(雌)性 

分 类 号：R711.6[医药卫生—妇产科学]