解冻单囊胚形态评分与早期血清β-人绒毛膜促性腺激素浓度和活产的相关性  

Correlation Between Blastocyst Morphology Score,Early Serumβ-hCG Concentrations and Live Birth After Thawed Single Blastocyst Transfer

作　　者：蔡小华 欧建平[1] 李涛[1] CAI Xiao-hua;OU Jian-ping;LI Tao(Fertility Center,The Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China)

机构地区：[1]中山大学附属第三医院生殖医学中心,广东广州510630

出　　处：《中山大学学报（医学科学版）》2023年第3期497-503,共7页Journal of Sun Yat-Sen University:Medical Sciences

摘　　要：【目的】在解冻单囊胚移植后HCG阳性患者中,评估囊胚形态评分对第12天血清β-人绒毛膜促性腺激素(β-hCG)水平和活产结局的影响;分析血清β-hCG水平对活产的预测价值。【方法】回顾本院2016年1月至2020年5月的519个单囊胚激素替代治疗-冻融胚胎移植(HRT-FET)周期HCG阳性患者的数据。先根据Gardner囊胚分级分为4组(AA、AB、BA和BB);再根据囊腔扩张程度分期分为4组(3期、4期、5期、6期,Gardner评分)。比较不同分级和分期的囊胚移植后第12天的血清β-hCG浓度和活产率;通过相关性检验确定囊胚Gardner分级或分期与血清β-hCG水平之间的关系,绘制ROC曲线确定预测活产的血清β-hCG临界值。【结果】①移植后第12天血清β-hCG浓度AA组和AB组均显著高于BB组(P<0.001,P<0.001),移植不同分级的囊胚活产率差异无统计学意义(P=0.120)。移植不同分期的囊胚后第12天血清β-hCG浓度和活产率差异均无统计学意义(P=0.091,P=0.557)。②囊胚分级与第12天血清β-hCG浓度之间存在显著的弱相关性(rs=-0.221,P<0.001),在控制了混杂因素后仍存在显著的弱相关性(rs=-0.228,P<0.001);囊胚分期与第12天血清β-hCG浓度之间不存在显著的相关性(rs=-0.052,P=0.240),在控制了混杂因素后相关性仍然不显著(rs=-0.029,P=0.508)。③ROC曲线分析得出,第12天血清β-hCG预测活产的临界值为657.5 mU/mL(P<0.001)。【结论】囊胚的分级和分期不影响活产率,不同分级的囊胚产生的血清β-hCG差异有统计学意义;可通过早期血清β-hCG值预测活产。【Objectives】To assess the correlation between blastocyst morphology score,serum human chorionic gonadotropinβsubunit(β-hCG)levels on day 12 after transfer and live birth outcomes among cycles tested HCG-positive after thawed single blastocyst transfer;to analyze the predictive value of serumβ-hCG levels on live birth.【Methods】We reviewed the data of 519 frozen-thawed single blastocyst transfer cycles(FET)that had been tested HCG-positive from January 2016 to May 2020 at our IVF center.These FET cycles were firstly divided into 4 groups(AA,AB,BA,and BB)according to Gardner′s grading system of inner cell mass(ICM)and trophectoderm cell(TE),and then 4 groups(stages 3,4,5 and 6)according to the degree of blastocyst expansion.Serumβ-hCG concentrations on day 12 after transfer and live birth rates were compared among groups transferred with different blastocysts grading and expansion stage.The relationship between Gardner’s grading or expansion stage of blastocysts and serumβ-hCG levels was determined by correlation test,and ROC curves were plotted to determine the threshold values of serumβ-hCG for predicting live birth.【Results】(1)The serumβ-hCG concentration in the AA group and AB group on the 12 th day after the transfer was significantly higher than that in the BB group(P<0.001,P<0.001).However,there was no significant difference in the live birth rate when different ICM/TE-graded blastocysts were transferred(P=0.120).There were no significant differences in serumβ-hCG con-centration on day 12 after transfer and live birth rate among blastocysts with different expansion stages(P=0.091,P=0.557).(2)There was a significant weak correlation between blastocyst ICM/TE grading and serumβ-hCG concentration on day 12(r s=-0.221,P<0.001),and even after controlling for confounding factors(r s=-0.228,P<0.001);There was no significant correlation between blastocyst’s expansion stage and serumβ-hCG concentration on day 12 after the transfer(r s=-0.052,P=0.240),and the association remained insignifica

关 键 词：囊胚形态 血清β-人绒毛膜促性腺激素 活产率 体外受精-胚胎移植 

分 类 号：R714.8[医药卫生—妇产科学]