冻融单胚胎移植后早期血清β-HCG水平对活产结局的预测价值  

Predictive value of early serumβ-HCG level for live birth outcome after frozen-thawed single embryo transfer

作　　者：张爱玉 王冬梅[1] 王惠[1] 栾翠玉 ZHANG Ai-yu;WANG Dong-mei;WANG Hui;LUAN Cui-yu(Reproductive Medicine Center,Yantaishan Hospital,Yantai 264001;Out-patient Department of Yantai Yeda Hospital,Yantai 264004)

机构地区：[1]烟台市烟台山医院生殖医学中心,烟台264001 [2]烟台业达医院门诊部,烟台264004

出　　处：《生殖医学杂志》2024年第11期1415-1422,共8页Journal of Reproductive Medicine

基　　金：山东省医药卫生科技发展计划项目(202005030403);烟台市科技创新发展计划项目(2022YT064)。

摘　　要：目的探讨冻融单胚胎移植后早期血清β-HCG水平对活产结局的预测价值。方法回顾性分析2020年1月至2022年12月于烟台市烟台山医院生殖医学中心行单卵裂期胚胎移植(SCT-D3)后第14天β-HCG(β-HCG14)值及单囊胚移植(SBT-D5/6)后第12天β-HCG(β-HCG12)值均阳性的322个解冻周期患者的临床资料,根据妊娠结局分为生化妊娠组(n=52)、早期流产组(n=47)、活产组(n=223)3组,并对女方年龄(<35岁、≥35岁)进行亚组分层。采用二元Logistic回归分析筛选活产相关预测因子,相关及偏相关分析血清β-HCG水平对活产的影响,绘制β-HCG预测活产的受试者工作特征(ROC)曲线并确定阈值。结果不同妊娠结局组的早期β-HCG水平差异有统计学意义(H=132.628,P<0.001),活产组显著高于其他2组(P<0.001)。二元Logistic回归分析结果显示,女方年龄[OR=0.460,95%CI(0.248,0.855),P=0.014]、移植胚胎质量[OR=2.034,95%CI(1.070,3.868),P=0.030]、早期β-HCG水平[OR=1.004,95%CI(1.003,1.005),P=0.000]是冻融单胚胎移植活产的独立预测因子。ROC曲线分析显示,早期β-HCG预测活产的曲线下面积(AUC)为0.867,敏感度0.937,特异性0.677,临界值为265.5 U/L,并且高龄组预测阈值(341.2 U/L)高于低龄组(240.9 U/L)。结论女方年龄、移植胚胎质量、早期β-HCG水平是冻融单胚胎移植活产的独立预测因子;早期β-HCG预测活产ROC曲线在女方不同年龄分层中存在一定差异,但总体预测价值较高,各中心可定义自身活产预测期望值。Objective:To explore the predictive value of early serumβ-HCG level for live birth outcome after frozen-thawed single embryo transfer.Methods:A retrospective cohort study was conducted to analyze the clinical data of 322 thawing cycles of patients whoseβ-HCG values both on the 14th day(β-HCG 14)after single cleavage-stage embryo transfer(SCT-D3)and on the 12th day(β-HCG 12)after single blastocyst transfer(SBT-D5/6)were positive in the Reproductive Medicine Center of Yantaishan Hospital from January 2020 to December 2022.According to the pregnancy outcome,they were divided into three groups as biochemical pregnancy group(n=52),early abortion group(n=47)and live birth group(n=223),and further stratified as the elder group(≥35 years old)and the young group(<35 years old)according to the age of the woman.Binary logistic regression analysis was used to screen the related predictors of live births,and the influence of serumβ-HCG level on live births was analyzed by the correlation and partial correlation,and the receiver operating characteristic(ROC)curve ofβ-HCG for predicting live births was drawn and the threshold was determined.Results:The earlyβ-HCG levels in groups with different pregnancy outcomes were significantly different(H=132.628,P<0.001),and that of the live birth group was significantly higher than those of the other two groups(P<0.001).The results of binary logistic regression analysis showed that the age of the woman[OR=0.460,95%CI(0.248,0.855),P=0.014],the quality of the transferred embryo[OR=2.034,95%CI(1.070,3.868),P=0.030],the earlyβ-HCG level[OR=1.004,95%CI(1.003,1.005),P=0.000]were independent predictors of the live birth of frozen-thawed single embryo transfer.The ROC curve analysis showed that the area under the curve(AUC)of earlyβ-HCG for predicting live births was 0.867,the sensitivity was 0.937,the specificity was 0.677,and the critical value was 265.5 U/L,and the prediction threshold of the elder group(341.2 U/L)was higher than that of the young group(240.9 U/L).Conclusions:The a

关 键 词：冻融单胚胎移植 Β-人绒毛膜促性腺激素 妊娠结局 活产 预测价值 

分 类 号：R711.6[医药卫生—妇产科学]