人绒毛膜促性腺激素注射日孕酮/成熟卵子数比值对高龄患者新鲜胚胎移植后活产率的预测价值  

Predictive value of progesterone to number of mature oocytes index for live birth rate on human chorionic gonadotropin injection day after fresh embryo transfer in advanced age women

作　　者：张敏[1,2] 姜宏 倪丰[1] 刘迎春 李贝贝[1] Zhang Min;Jiang Hong;Ni Feng;Liu Yingchun;Li Beibei(Reproductive Medicine Center,the 901th Hospital of the Joint Logistic Support Force of People's Liberation Army,Hefei 230031,China;Sinopharm Dongfeng General Hospital,Shiyan 442001,China)

机构地区：[1]中国人民解放军联勤保障部队第901医院生殖医学中心,合肥230031 [2]国药东风总医院,十堰442001

出　　处：《中华生殖与避孕杂志》2020年第12期994-999,共6页Chinese Journal of Reproduction and Contraception

摘　　要：目的探究体外受精-胚胎移植(IVF-ET)周期人绒毛膜促性腺激素(hCG)注射日孕酮/成熟卵子数比值(PMOI)对高龄患者新鲜胚胎移植后活产率的预测价值。方法回顾性分析2015年1月1日至2018年6月30日期间在中国人民解放军联勤保障部队第901医院生殖医学中心行IVF-ET助孕高龄患者的临床资料,共277个移植周期。按hCG注射日PMOI水平分为≤0.075μg/L组(A组)、0.075~0.190μg/L组(B组)及≥0.190μg/L组(C组),比较3组患者临床资料和妊娠结局,并采用单因素和多因素logistic回归分析及受试者工作特征(ROC)曲线探讨hCG注射日PMOI对高龄患者活产率的预测价值。结果C组患者的卵泡刺激素(FSH)水平[(10.27±3.24)IU/L]显著高于A组[(8.20±1.93)IU/L,P<0.001]和B组[(8.87±2.54)IU/L,P=0.002],抗苗勒管激素(AMH)[(1.97±1.27)μg/L]及窦卵泡计数(AFC)(6.22±4.08)显著低于A组[(3.37±1.94)μg/L,P<0.001;12.19±6.29,P<0.001]和B组[(2.46±1.63)μg/L,P=0.029;9.74±4.83,P<0.001],晚期流产率(25.00%)显著高于A组(0%,P=0.020),活产率(8.70%)显著低于A组(24.29%,P=0.013)。logistic回归分析显示患者年龄(OR=0.750,P=0.029)和hCG注射日PMOI(OR=0.006,P=0.044)是影响活产率的危险因素。ROC曲线显示,hCG注射日PMOI对高龄患者活产率有预测价值,敏感度为43.5%,特异度为80.0%,截断值为0.144μg/L。结论高水平的hCG注射日PMOI是影响高龄患者新鲜周期活产率的危险因素,对高龄患者助孕结局有一定的预测价值。Objective To explore the predictive value of progesterone to number of mature oocytes index(PMOI)for live birth rate on human chorionic gonadotropin(hCG)injection day after fresh embryo transfer of advanced age women during in vitro fertilization-embryo transfer(IVF-ET)cycles.Methods The clinical data of 277 IVF-ET cycles with advanced age women in Reproductive Medicine Center,the 901th Hospital of the Joint Logistic Support Force of People's Liberation Army from January 1,2015 to June 30,2018 were analyzed retrospectively.According to the hCG injection day PMOI level,the patients were divided into three groups:group A(≤0.075μg/L),group B(0.075-0.190μg/L)and group C(≥0.190μg/L).The clinical data and pregnancy outcomes of the three groups were compared.Afterwards,univariate and multivariate logistic regression and receiver operating charac-teristic(ROC)curve were applied to explore the predictive value of PMOI on hCG injection day for live birth rate of advanced age women.Results The follicular-stimulating hormone(FSH)level[(10.27±3.24)IU/L]in group C was significantly higher,the anti-Müllerian hormone(AMH)[(1.97±1.27)μg/L]and antral follicle count(AFC)(6.22±4.08)were significantly lower than those in group A[(8.20±1.93)IU/L;(3.37±1.94)μg/L;12.19±6.29,P<0.001]and group B[(8.87±2.54)IU/L,P=0.002;(2.46±1.63)μg/L,P=0.029;9.74±4.83,P<0.001],the late abortion rate(25.00%)was significantly higher than that in group A(0%,P=0.020),the live birth rate(8.70%)was significantly lower than that in group A(24.29%,P=0.013).The logistic regression model demonstrated that age(OR=0.750,P=0.029)and hCG injection day PMOI(OR=0.006,P=0.044)were risk factors to live birth rate.The ROC curve showed that hCG injection day PMOI may be a promising candidate for prediction of live birth rate of advanced age women,and the sensitivity and specificity were 43.5%and 80.0%respectively,the cut-off value was 0.144μg/L.Conclusion Elevated hCG injection day PMOI level may be a risk factor for live birth rate and a promising cand

关 键 词：人绒毛膜促性腺激素 受精 体外 胚胎移植 活产率 高龄 孕酮/成熟卵子数比值 截断值 

分 类 号：R714.8[医药卫生—妇产科学]