宫腔粘连分离术对冻融胚胎移植后产科结局的影响因素分析  

Analysis of influencing factors of intrauterine adhesion separation on obstetric outcomes after frozen-thawed embryo transfer

作　　者：丁凯[1] 李欣[1] 沈晶晶 凌秀凤[1] 赵纯[1] Ding Kai;Li Xin;Shen Jingjing;Ling Xiufeng;Zhao Chun(Center of Reproductive Medicine,Women's Hospital of Nanjing Medical University,Nanjing Women and Children's Healthcare Hospital,Nanjing 21004,China)

机构地区：[1]南京医科大学附属妇产医院(南京市妇幼保健院)生殖医学中心,南京210004

出　　处：《中华生殖与避孕杂志》2024年第5期497-504,共8页Chinese Journal of Reproduction and Contraception

基　　金：国家自然科学基金面上项目(81971386)。

摘　　要：目的分析宫腔粘连分离术(transcervical resection of adhesion,TCRA)对冻融胚胎移植(frozen-thawed embryo transfer,FET)后患者产科并发症的影响及其相关因素。方法采用回顾性队列研究,收集2015年4月至2022年5月期间在南京医科大学附属妇产医院生殖医学中心行自体卵母细胞FET治疗并至少活产1名新生儿患者的临床资料。根据宫腔情况分为3组,对照组:正常宫腔形态(712例);宫腔粘连(intrauterine adhesion,IUA)组:IUA患者未行TCRA治疗(45例);TCRA组:IUA患者行TCRA治疗(51例)。通过倾向性评分匹配(propensity score matching,PSM)探讨3组患者宫腔情况与产科并发症的关系,并通过多因素logistic回归方法分析与TCRA相关的产科并发症的危险因素,采用校准曲线、受试者工作特征(receiver operating characteristic,ROC)曲线对构建的多因素logistic回归模型的效能进行评估。结果①在PSM前,3组间子宫内膜厚度、有无瘢痕子宫、妊娠次数、分娩次数、流产次数、人工流产次数和移植胚胎数的差异均有统计学意义(均P<0.05);在PSM后,基线特征在各组间达到平衡,TCRA组和IUA组的胎盘植入性疾病(placenta accreta spectrum disorders,PAS)发生率[48.8%(20/41);45.2%(19/42)]显著高于相应的对照组[24.7%(18/73),P=0.016;22.8%(18/79),P=0.019]。②多因素logistic回归分析显示子宫内膜厚度(OR=0.79,95%CI:0.69~0.90,P<0.001)、妊娠次数(2次,OR=2.25,95%CI:1.33~3.82,P=0.003)、子宫内膜准备方案(促性腺激素释放激素激动降调节联合激素替代疗法,OR=2.29,95%CI:1.16~4.52,P=0.017)、瘢痕子宫(OR=2.19,95%CI:1.39~3.45,P<0.001)和宫腔情况(IUA和TCRA,OR=2.11,95%CI:1.07~4.17,P=0.031;OR=2.70,95%CI:1.37~5.31,P=0.004)是PAS发生的独立预测因子。③预测PAS发生的多因素logistic回归模型的ROC曲线下面积为0.732(95%CI:0.686~0.778),并且校准曲线的结果经过内部验证表明预测风险和实际结果之间具有良好一致性(P=0.540),表现出良好的区分�Objective To analyze the impact of transcervical resection of adhesion(TCRA)on obstetric complications in patients after frozen-thawed embryo transfer(FET)and its associated factors.Methods A retrospective cohort study was conducted by collecting clinical data from patients who underwent autologous oocyte FET treatment and gave birth to at least one live newborn at the Reproductive Medicine Center of Nanjing Women and Children's Healthcare Hospital from April 2015 to May 2022.Based on the uterine condition,patients were divided into three groups:control group with normal uterine morphology(712 cases);the intrauterine adhesion(IUA)group consisting of IUA patients who did not undergo TCRA surgery(45 cases);the TCRA group,which included IUA patients who received TCRA treatment(51 cases).The relationship between uterine conditions and obstetric complications among the three groups was investigated using propensity score matching(PSM).Multivariate logistic regression analysis was applied to identify risk factors associated with obstetric complications related to TCRA.The performance of the constructed multivariate logistic regression model was evaluated using calibration curves and receiver operating characteristic(ROC)curves.Results1)Before PSM,statistically significant differences were observed among the three groups regarding endometrial thickness,the presence of a scarred uterus,numbers of pregnancies,deliveries,miscarriages,induced abortions,and transferred embryos(all P<0.05).After PSM,baseline characteristics were balanced across the groups.The rates of placenta accreta spectrum disorders(PAS)in the TCRA group[48.8%(20/41)]and the IUA group[45.2%(19/42)]were significantly higher than those in control group[24.7%(18/73),P=0.016;22.8%(18/79),P=0.019].2)Multivariable logistic regression analysis revealed that endometrial thickness(OR=0.79,95%CI:0.69-0.90,P<0.001],number of pregnancies(2 times,OR=2.25,95%CI:1.33-3.82,P=0.003),endometrial preparation protocol(gonadotropin-releasing hormone agonist plus hormone repla

关 键 词：宫腔粘连 宫腔粘连分离术 冻融胚胎移植 产科并发症 胎盘植入 

分 类 号：R714.8[医药卫生—妇产科学]