早卵泡期长方案新鲜周期单胚胎移植活产的多因素分析及预测模型构建  

Multivariate analysis and prediction model construction for live birth in patients with long-acting follicular phase in fresh single embryo transfer cycle

作　　者：任炳楠 张晓柯 郑威 张俊韦 于晓娜[1] 管一春[1] Ren Bingnan;Zhang Xiaoke;Zheng Wei;Zhang Junwei;Yu Xiaona;Guan Yichuan(Reproductive Center of the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第三附属医院生殖医学科,郑州450052

出　　处：《中华生殖与避孕杂志》2023年第9期887-897,共11页Chinese Journal of Reproduction and Contraception

摘　　要：目的分析影响早卵泡期长方案新鲜周期单胚胎移植活产的影响因素,构建列线图预测模型,为临床决策和个体化治疗提供参考。方法本研究是一项基于辅助受孕人群的回顾性队列研究,分析2017年1月至2020年12月期间于郑州大学第三附属医院生殖医学科接受体外受精/卵胞质内单精子注射-胚胎移植(in vitro fertilization/intracytoplasmic sperm injection and embryo transfer,IVF/ICSI-ET)治疗、行早卵泡期长方案促排卵并进行新鲜周期单胚胎移植的2795例患者的临床资料。使用随机抽样法,按3∶1的比例将患者分为建模组(2100例)和验证组(695例),使用单因素和多因素logistic回归筛选与移植后新生儿活产相关的独立危险因素,构建列线图预测模型。使用受试者工作特征(receiver operator characteristic,ROC)曲线、校准曲线和决策曲线对列线图预测模型的区分度和校准度进行评价。结果多因素logistic回归分析显示,年龄、孕前多囊卵巢综合征(polycystic ovarian syndrome,PCOS)、人绒毛膜促性腺激素(human chorionic gonadotropin,hCG)注射日孕酮水平、优质胚胎率、移植胚胎类型是影响活产的独立相关因素。经过分层分析显示,年龄≥36岁且hCG注射日孕酮水平≥5.20 nmol/L,显著降低新生儿活产率,存在两因素的交互作用(P=0.043)。hCG注射日孕酮水平≥5.20 nmol/L且优质胚胎率<59.60%,显著降低新生儿活产率,交互作用有统计学意义(P=0.010)。通过列线图预测模型的构建,建模组和验证组的ROC曲线下面积(area under the curve,AUC)分别为0.637(95%CI:0.615~0.658)和0.617(95%CI:0.579~0.654),校准曲线显示列线图模型预测活产率与实际发生率具有较为良好的一致性。决策曲线显示预测活产率在24.05%~68.75%,本研究构建的列线图模型有着更好的净收益,表明对于临床决策有着良好的应用价值。结论年龄、孕前PCOS、hCG注射日孕酮水平、优质胚胎率、移植胚�Objective To explore risk factors associated with the live birth in patients with long-acting follicular phase in fresh single embryo transfer cycle and to construct nomogram prediction model for providing a reference for clinical decision-making and individualized treatment.Methods An assisted reproduction population-based retrospective cohort analysis of the clinical data of 2795 patients with long-acting follicular phase in fresh single embryo transfer cycle who underwent in vitro fertilization/intracytoplasmic sperm injection and embryo transfer(IVF/ICSI-ET)was performed in the Reproductive Center of the Third Affiliated Hospital of Zhengzhou University from January 2017 to December 2020.These patients were randomly divided into modeling group and validation group according to 3∶1.Univariate and multivariate logistic regression were used to screen potential risk factors for newborn live birth after fresh single embryo transfer.The nomogram model was established according to the regression coefficients.Besides,area under the receiver operator characteristic(ROC)curve,calibration curve and decision curve analysis were used to evaluate the discrimination and calibration of the model.Results Through multiple logistic regression analysis,female age,progestational polycystic ovary syndrome(PCOS),the level of progestrogen on the day of human chorionic gonadotropin(hCG)injection,high-quality embryo rate,type of embryos transferred were independent risk factors associated with live birth.Stratified analysis found age≥36 years together with the level of progestrogen≥5.20 nmol/L on the day of hCG injection could reduce the probability of live birth signally,and statistically significant interaction was found(P=0.043).The level of progestrogen≥5.20 nmol/L on the day of hCG injection together with high-quality embryo rate<59.60%could reduce the probability of live birth signally,and statistically significant interaction was found(P=0.010).The area under the curve(AUC)of modeling group and validation group was 0.63

关 键 词：单胚胎移植 列线图 活产率 早卵泡期长效长方案 预测模型 

分 类 号：R714.8[医药卫生—妇产科学]