预测复苏周期单囊胚移植临床妊娠的列线图模型的开发和验证  

Development and validation of a nomogram for predicting pregnancy outcomes of single blastocyst transfer in frozen-thawed cycles

作　　者：沈彦军[1] 邓晓惠[1] 于红玲[1] 杨阳[1] 蒋利刚[1] 程来洋 刘亚飞 郭潇 晁岚[1] Shen Yanjun;Deng Xiaohui;Yu Hongling;et al(Infertility Center,Qilu Hospital of Shandong University,Jinan 250012)

机构地区：[1]山东大学齐鲁医院不孕不育诊疗中心

出　　处：《现代妇产科进展》2020年第3期194-198,共5页Progress in Obstetrics and Gynecology

基　　金：山东大学齐鲁医院科研基金资助项目(No:2016QLQN29)

摘　　要：目的:开发和验证复苏周期单囊胚移植临床妊娠的列线图预测模型,以根据预测临床妊娠的概率,更好地开展IVF-ET咨询,进行临床决策和患者选择。方法选取2015年1月到2018年12月首次行冷冻复苏单囊胚移植的1378例患者作为开发组,2019年1月到2019年5月首次行冷冻复苏单囊胚移植的292例患者为验证组。采用单因素和多因素logistic回归分析筛选与临床妊娠相关的独立影响因素,根据回归系数绘制相应的列线图预测模型,分别通过受试者工作特征曲线(ROC)及曲线下面积(AUC)和Hosmer-Lemeshow检测对模型的区分度和校准度进行评价。结果通过多因素Logistic回归分析,最终预测模型共纳入女方年龄、不孕类型、主要不孕因素、不孕年限、移植日子宫内膜厚度和囊胚扩张状态6个影响因素。开发组和验证组ROC曲线下面积分别为0.640(95%CI 0.610~0.669)和0.629(95%CI 0.564~0.693)。拟合优度检验Hosmer-Lemeshow χ^2=12.701,P>0.05,提示模型预测概率与实际观测概率之间差异无统计学意义,预测模型有较好的校准度。结论复苏周期单囊胚移植临床妊娠结局列线图预测模型有助于更好地开展单囊胚移植,具有一定的临床应用价值。Objective:To develop and validate a nomogram for clinical pregnancy outcomes of single blastocyst transfer in the Frozen-thawed cycles,so as to better carry out IVF-ET counselling for clinical decision-making and patient selection according to the predicted probability of successful pregnancy.Methods:A total of 1378 cases of frozen-thawed single blastocyst transfer for the first time from Jan.2015 to Dec.2018 were selected as the development group,and 292 cases of frozen-thawed single blastocyst transfer for the first time from Jan.2019 to May 2019 were selected as the verification group.Univariate and multivariate logistic regression analysis was used to screen independent influencing factors related to clinical pregnancy.The corresponding nomogram prediction model was drawn according to the regression coefficients.The area under the receiver operating characteristic curve and the goodness-of-fit were used to estimate the discrimination and calibration of the prediction model,respectively.Results:Through multivariate logistic regression analysis,the final prediction model included six factors:age,type of infertility,main factors of infertility,duration of infertility,endometrial thickness and blastocyst morphology on transplantation day.The area under the receiver operating characteristic curve of development group and verification group was 0.640(95%CI 0.610~0.669)vs 0.629(0.564~0.693),respectively.The goodness of fit test showed that Hosmer-Lemeshow χ^2=12.701,P>0.05,which indicated that there was no statistical difference between the predicted probabilities and the actual observed probabilities,and the predicted model had better calibration.Conclusions:The predictive model of clinical pregnancy outcomes of frozen-thawed single blastocyst transfer cycle is helpful to better carry out single blastocyst transfer,and has certain clinical application value.

关 键 词：复苏周期 单囊胚移植 LOGISTIC回归分析 列线图模型 

分 类 号：R711.6[医药卫生—妇产科学]