雌激素浓度与人工周期冻融胚胎移植患者妊娠结局的关系  

Relationship between estrogen concentration and pregnancy outcome in patients with artificial cycle freezing-thawing embryo transfer

作　　者：樊艳玲 樊月 丰程文 刘宝莲[1] FAN Yanling;FAN Yue;FENG Chengwen;LIU Baolian(Reproductive medicine center of Tangshan maternal and child health hospital,Hebei Tangshan 063000,China;North China University of technology,Hebei Tangshan 063000,China)

机构地区：[1]唐山市妇幼保健院生殖医学中心,河北唐山063000 [2]华北理工大学,河北唐山063000

出　　处：《中国妇幼健康研究》2023年第7期67-73,共7页Chinese Journal of Woman and Child Health Research

基　　金：2022年度河北省医学科学研究课题(20221767)。

摘　　要：目的分析雌激素浓度与人工周期冻融胚胎移植(FET)患者妊娠结局的关系。方法纳入2020年2月至2021年1月在唐山市妇幼保健院生殖医学中心接受FET助孕的800例不孕症患者为研究对象,所有患者均在内膜转化日常规检测卵泡刺激素(FSH)、黄体生成素(LH)、抗苗勒氏管激素(AMH)、孕酮(P)、雌二醇(E_(2)),并于移植前1天测量子宫内膜厚度。根据移植后第35d超声检查结果评估患者妊娠成功率,将患者分为临床妊娠组和未妊娠组;对临床妊娠组展开随访,以随访期间孕妇、胎儿及新生儿不良事件评估妊娠结局,将其分为不良结局和良好结局。构建Logistic回归模型,分析雌激素浓度与人工周期FET患者临床妊娠率及妊娠结局的关系。结果(1)800例不孕症患者均完成人工周期FET,在接受35d观察后,共有360例患者确认为临床妊娠,临床妊娠率为45.00%;未妊娠440例,占55.00%。(2)与未妊娠组相比,临床妊娠组患者年龄较小,内膜转化日血清P、E_(2)浓度较高,移植日内膜较厚,差异均有统计学意义(Z/t值分别为11.360、2.391、19.767、13.812,P<0.05)。Logistic回归分析显示,年龄、E2浓度、移植日内膜厚度与人工周期FET患者临床妊娠率有关,OR及其95%CI值分别为1.329(1.243~1.421)、0.959(0.952~0.965)、0.309(0.235~0.408),P<0.05。(3)348例临床妊娠患者完成随访,期间共186例有不良妊娠结局,占53.45%;162例妊娠结局良好,占46.55%。与良好妊娠结局患者相比,不良妊娠结局患者年龄普遍较大,内膜转化日血清E2浓度较低,移植日内膜厚度较小,差异均有统计学意义(Z/t值分别为5.513、9.086、7.211,P<0.05)。Logistic回归分析显示,年龄、E2浓度、移植日内膜厚度与人工周期FET患者妊娠结局有关,OR及其95%CI值分别为1.258(1.151~1.375)、0.969(0.961~0.978)、0.348(0.242~0.500),P<0.05。结论内膜转化日E2浓度与人工周期FET患者临床妊娠率及妊娠结局均有关,E2浓度降低可增�Objective To analyze the relationship between estrogen concentration and pregnancy outcome in patients with artificial cycle freeze-thawing embryo transfer(FET).Methods This was a prospective study,a total of 800 infertile patients who received FET assisted pregnancy in Reproductive Medicine Center,Tangshan Maternal and Child Health Hospital from February 2020 to January 2021 were selected as the study subjects.All patients were routinely drawn blood to detect follicle-stimulating hormone(FSH),luteinizing hormone(LH),antimhollerian hormone(AMH),progesterone(P),and estradiol(E_(2))on the day of endometrial transformation,and measured endometrial thickness 1 day before transplantation.The success rate of pregnancy was evaluated according to the results of ultrasound examination on the 35th day after transplantation,and the patients were divided into clinical pregnancy group and non-pregnancy group.The clinical pregnancy group was followed up,and the pregnancy outcome was evaluated by adverse events of pregnant women,fetuses and neonates during the follow-up,which were divided into adverse outcomes and good outcomes.Logistic regression model was established to analyze the relationship between estrogen concentration and clinical pregnancy rate and pregnancy outcome in patients with artificial cycle FET.Results Among the 800 infertility patients included,all completed artificial cycle FET.After 35d observation,a total of 360 patients were confirmed to be clinically pregnant,with clinical pregnancy rate of 45.00%and non-pregnancy rate of 440 patients,accounting for 55.00%.Compared with the non-pregnancy group,the clinical pregnancy group was generally younger,the serum P and E_(2) concentrations on the day of endometrial transformation were higher,and the endometrium on the day of transplantation was thicker,with a statistical significant difference(Z/t values were 11.360,2.391,19.767,13.812,P<0.05).Logistic regression model was constructed to show that age,E2 concentration and intimal thickness on the day of transplan

关 键 词：不孕症 人工周期 冻融胚胎移植 雌激素 妊娠结局 

分 类 号：R173[医药卫生—妇幼卫生保健]