单发肌壁间肌瘤患者IVF/ICSI生殖结局影响因素分析  

Analysis of influencing factors of reproductive outcomes in IVF/ICSI patients with single interparietal myoma

作　　者：张丽霞[1,2,3] 孙萍 张萍[4] 于倩[1,2] 颜磊[1,2] Zhang Lixia;Sun Ping;Zhang Ping(Center for Reproductive Medicine,Cheeloo College of Medicine,Shandong University,Jinan 250001;Advanced Medical Research Institute of Shandong University,Jinan 250001;Maternal and Child Health and Family Planning Service Center of Yanggu County,Liaocheng 252300;The second hospital of Shandong University,Jinan 250001)

机构地区：[1]山东大学生殖医学研究中心,济南250001 [2]山东大学附属生殖医院,济南250001 [3]阳谷县妇幼保健计划生育服务中心,聊城252300 [4]山东大学第二医院,济南250001

出　　处：《现代妇产科进展》2024年第2期120-125,共6页Progress in Obstetrics and Gynecology

基　　金：国家重点研发计划(No:2022YFC2704100)。

摘　　要：目的:探究单发肌壁间肌瘤患者体外受精-胚胎移植/卵胞质内单精子显微注射(IVF-ET/ICSI)生殖结局的可能相关影响因素。方法:纳入2014年1月至2019年12月于山东大学附属生殖医院接受IVF/ICSI治疗的单发肌壁间肌瘤不孕症患者1348例,根据患者妊娠结局分为活产组(403例)与未活产组(945例)、妊娠组(634例)与未妊娠组(714例)。采用倾向性匹配评分(PSM)对活产组与未活产组患者进行1∶1条件匹配控制混杂因素,共386对患者匹配成功。两组间有统计学差异的协变量采用二元logistic回归分析。采用ROC曲线分析肌壁间肌瘤与生殖结局的关系,并评价其预测价值。通过计算约登指数找到截断值。结果:PSM匹配后,未获得活产组的宫腔操作史、子宫内膜压迫患者比例明显高于活产组,肌壁间肌瘤大小明显大于活产组,差异均有统计学意义(P<0.05);未妊娠组患者的子宫肌瘤直径显著大于妊娠组患者,差异均有统计学意义(P<0.05)。经二元logistic回归分析校正混杂因素后,宫腔操作史、子宫内膜受压及单发肌壁间肌瘤的直径对患者活产率存在显著影响(P<0.05);单发肌壁间肌瘤直径大小对患者妊娠存在显著影响(P=0.004)。通过ROC曲线分析得出单发肌壁间肌瘤直径在预测活产率方面的截断值为2.35cm。结论:在单发肌壁间肌瘤患者中,成功活产与未活产患者相比,在宫腔操作史、子宫内膜受压以及子宫肌瘤直径方面存在显著差异,且三者均为导致活产率下降的独立影响因素,当肌瘤直径≥2.35cm对活产率的影响更为显著。Objective:To explore the relevant factors that may affect single muscle intramural myoma patients in vitro fertilization and embryo transplantation/egg cytoplasm single sperm injection.Methods:This study included 1348 infertility patients with single intermuscular myoma who received IVF/ICSI treatment in the Affiliated Reproductive Hospital of Shandong University from January,2014 to December,2019.According to the pregnancy outcome of the patients,they were divided into live birth group and non-live birth group,pregnancy group and non-pregnancy group,of which 945 patients did not receive live birth.A total of 403 patients received live births.PSM(Propensity Score Matching)was used to control confounding factors by matching live birth patients with non-live birth patients 1∶1,and 386 patients were successfully matched.The covariables with statistical difference between the two groups were analyzed by binary logistic regression.ROC curve was used to analyze the relationship between interwall fibroids and reproductive outcomes,and to evaluate its predictive value.The truncation value was found by calculating the Jorden index.Results:After PSM matching,the comparison between the live birth group and the non-live birth group showed that the number of patients with no history of uterine operation and endometrial compression in the live birth group was significantly higher than that in the live birth group,and the size of intermuscular fibroids in this group was significantly larger than that in the live birth group,and there was a statistical difference.The diameter of uterine fibroids in the non-pregnant group was significantly larger than that in the pregnant group.After binary logistic regression analysis,the history of uterine operation,endometrial compression and the diameter of single interwall myoma had significant effects on the live birth rate(P<0.05).The diameter of single intramural myoma had significant effect on pregnancy(P=0.004).ROC curve analysis showed that the cut off value of single interwall myoma

关 键 词：单发肌壁间肌瘤 体外受精 卵胞质内单精子显微注射 妊娠结局 

分 类 号：R71[医药卫生—妇产科学]