卵泡期长效长方案促排卵患者发生卵巢过度刺激综合征危险因素分析及其发病 风险的预测  

Analysis of risk factors and prediction for ovarian hyperstimulation syndrome in patients with long-acting follicular phase in in vitro fertilization/intracytoplasm sperm injection

作　　者：胡琳莉[1] 谢瑞 孙莹璞[1] Hu Linli;Xie Rui;Sun Yingpu(Center for Reproductive Medicine,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院生殖中心,450052

出　　处：《中华生殖与避孕杂志》2019年第11期874-879,共6页Chinese Journal of Reproduction and Contraception

摘　　要：目的探索行体外受精/卵胞质内单精子注射(IVF/ICSI)卵泡期长效长方案促排卵助孕治疗后患者发生卵巢过度刺激综合征(ovarian hyperstimulation syndrome,OHSS)的相关危险因素,并建立OHSS的诺曼(Nomogram,列线图)预测模型。方法回顾性分析2016年1月1日至2017年9月30日期间于郑州大学第一附属医院生殖中心行IVF/ICSI治疗的6288例患者的临床资料,按照4:1随机分为建模组(5044例)和验证组(1244例)。通过logistic回归筛选影响OHSS发生的独立危险因素,即为模型入组变量,并依据模型中的回归系数建立诺曼预测模型。通过受试者工作特征(ROC)曲线下面积(AUC)评估诺曼模型的预测准确度。结果在建模组中多因素logistic回归分析显示年龄、不孕类型、体质量指数(BMI)、抗苗勒管激素(AMH)、窦卵泡数(AFC)、人绒毛膜促性腺激素(hCG)注射日雌二醇水平及直径>10 m m卵泡数是影响OHSS发生的独立危险因素。根据上述因素构建OHSS发生风险的预测模型,建模组的AUC是0.842(95%CI=0.829~0.856),验证组的AUC是0.798(95%CI=0.767-0.830)。结论筛选出行IVF/ICSI治疗患者发生OHSS的风险因素,成功建立的诺曼模型能够有效、简便和直观清晰地预测OHSS的发生。Objective To explore the risk factors associated with ovarian hyperstimulation syndrome(OHSS)in patients with long-acting long-term follicular phase in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI),and to establish Nomogram prediction model of OHSS.Methods A retrospective analysis of the clinical data of 6288 patients who underwent IVF/ICSI treatment in the Reproductive Center of the First Affiliated Hospital of Zhengzhou University from January 1,2016 to September 30,2017 was performed and these patients were randomly divided into two groups according to 4;1,including 5044 cases in modeling group and 1244 cases in validation group.Logistic regression was used to screen out the independent risk factors affecting the occurrence of OHSS,which was the model enrollment variable,and the nomogram model was established according to the regression coefficient of the relevant variables.The prediction accuracy of the OHSS nomogram model was evaluated by calculating the area under the receiver operating characteristic(ROC)standard curve(AUC).Results Multivariate logistic regression analysis of the model group showed age,infertility type,body mass index(BMI),anti-Miillerian hormone(AMH),antral follicle number(AFC),and estrogen levels on human chronic gonadotropin hormone(hCG)injection day and the number of follicles>10 mm in diameter were independent risk factors affecting the occurrence of OHSS.Based on the above factors,a predictive model for the risk of OHSS was constructed.The AUC of the model group was 0.842(95%CI=0.829-0.856),and the AUC of the validation group was 0.798(95%CI=0.767-0.830).Conclusion To screen out the risk factors of OHSS in patients with IVF/ICSI treatment,the successful establishment of nomogram model can effectively and easily predict the occurrence of OHSS.This study has certain clinical guiding significance for early prevention and treatment of OHSS.

关 键 词：受精 体外 卵胞质内单精子注射 卵泡期长效长方案 卵巢过度刺激综合征 

分 类 号：R71[医药卫生—妇产科学]