恶性肿瘤治疗后患者辅助生殖助孕结局影响因素分析  

Analysis of the influencing factors on the outcome of assisted reproductive technology in patients after malignancy treatment

作　　者：李月红 方华 蒋冬冬 蔡雪芬 杨晓慧 郑备红[3,4] 孙艳 LI Yue-hong;FANG Hua;JIANG Dong-dong;CAI Xue-fen;YANG Xiao-hui;ZHENG Bei-hong;SUN Yan(College of Clinical Medicine for Obstetrics&Gynecology and Pediatrics,Fujian Medical University,Fuzhou 350001;School of Public Health,Fujian Medical University,Fuzhou 350001;Center of Reproductive Medicine,Fujian Maternity and Child Health Hospital,College of Clinical Medicine for Obstetrics&Gynecology and Pediatrics,Fujian Medical University,Fuzhou 350001;Fujian Key Laboratory of Prenatal Diagnosis and Birth Defect,Fuzhou 350001;Fujian Clinical Research Center for Maternal-Fetal Medicine,Fuzhou 350001)

机构地区：[1]福建医科大学妇儿临床医学院,福州350001 [2]福建医科大学公共卫生学院,福州350001 [3]福建省妇幼保健院生殖医学中心,福建医科大学妇儿临床医学院,福州350001 [4]福建省产前诊断与出生缺陷重点实验室,福州350001 [5]福建省母胎医学临床医学研究中心,福州350001

出　　处：《生殖医学杂志》2024年第2期139-147,共9页Journal of Reproductive Medicine

基　　金：福建省科技创新联合资金项目(2020Y9137);福建省卫生健康委员会中青年科研重大项目(2022ZQNZD010);福建省科技重大专项项目资助(2021YZ034011);福建省卫生健康重大科研专项(2021ZD01002)。

摘　　要：目的探讨恶性肿瘤治疗后不孕症女性采用辅助生殖技术(ART)助孕的结局及其影响因素。方法回顾性分析2003年1月至2021年10月在福建省妇幼保健院首次接受体外受精/卵胞浆内单精子注射(IVF/ICSI)助孕的62例恶性肿瘤治疗后的不孕症女性(病例组)的病例资料,并根据年龄及取卵时间采用1∶2匹配方式,匹配同期首次接受IVF/ICSI助孕的非恶性肿瘤患者124例(对照组)。比较两组患者的一般资料、促排卵情况、实验室指标及妊娠结局,采用Logistic回归分析临床妊娠的影响因素,运用受试者工作特征(ROC)曲线计算曲线下面积(AUC)评估影响因素的预测效力。结果与对照组相比,病例组基础窦卵泡计数和促性腺激素(Gn)使用总量显著减少(P<0.05),Gn刺激天数显著缩短(P<0.05);而两组患者在年龄、不孕年限、基础性激素水平、抗苗勒管激素(AMH)、体质量指数(BMI)、授精方式、获卵数、受精率、卵裂率、优质胚胎形成率、囊胚形成率、累积妊娠率、每移植周期临床妊娠率等方面,差异均无统计学意义(P>0.05)。多因素Logistic回归分析显示,恶性肿瘤病史[OR=1.683,95%CI(0.736,3.847),P=0.217]不是妊娠结局的影响因素,而获卵数[OR=1.150,95%CI(1.023,1.293),P=0.020]是恶性肿瘤患者治疗后ART妊娠结局的唯一的独立影响因素。年龄与获卵数联合预测临床妊娠效力高于单个指标预测(AUC=0.786,P<0.001),最佳诊断界值点为获卵数为8枚、年龄41岁,敏感度为0.814,特异度为0.737。结论恶性肿瘤治疗后不孕女性行ART助孕可获得良好的妊娠结局,恶性肿瘤病史不是ART妊娠结局的独立影响因素;获卵数与妊娠结局呈正相关,术后评估其获卵数的水平结合患者年龄可以有效预测妊娠结局。Objective:To investigate the outcomes and influencing factors of assisted reproductive technology(ART)in infertile women after the treatment of malignant tumor.Methods:A retrospective analysis was conducted on 62 infertile women with malignant tumors who underwent in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)for the first time in Fujian Maternal and Child Health Hospital from January 2003 to October 2021(the study group).According to the age and egg retrieval time,a matching method was used to recruit 124(1∶2)female patients with non-malignant tumors who received IVF/ICSI for the first time(the control group).The basic characteristics,ovulation induction methods,laboratory test results,and pregnancy outcomes of two groups were compared.The logistic regression was conducted to analyze the influencing factors of clinical pregnancy,and the receiver operating characteristic(ROC)curve was used to calculate the area under the curve(AUC)to evaluate the predictive power of the influencing factors.Results:Compared to the control group,the study group had lower basal antral follicle count(P<0.05),lower total gonadotropin(Gn)use(P<0.05),and shorter duration of Gn stimulation(P<0.05).However,there were no statistically significant differences between the two groups in terms of age,infertility duration,basal reproductive hormones,the concentration of anti-Müllerian hormone(AMH),body mass index(BMI),insemination type,the number of eggs obtained,fertilization rate,cleavage rate,high-quality embryo formation rate,blastocyst formation rate,cumulative pregnancy rate,and clinical pregnancy rate per transplantation cycle(P>0.05).Multivariate logistic regression analysis showed that the history of malignant tumors[OR=1.683,95%CI(0.736,3.847),P=0.217]was not a risk factor of pregnancy outcomes,while the number of eggs obtained[OR=1.150,95%CI(1.023,1.293),P=0.020]was the only independent influencing factor for malignant tumor patients.The combined prediction of age and the number of retrieved eggs had a higher cl

关 键 词：辅助生殖技术 恶性肿瘤 妊娠结局 获卵数 影响因素 

分 类 号：R711.6[医药卫生—妇产科学] R73[医药卫生—临床医学]