扳机日血清孕酮/获卵数比值对卵巢储备功能低下患者IVF-ET妊娠结局的预测价值  

Trigger day serum progesterone/oocyte number ratio as a predictor of pregnancy outcomes in patients with diminished ovarian reserve undergoing IVF-ET

作　　者：金宁娟 何清 方海琴 潘苏荣 巢时斌 吴晓璇 康嘉慧 Jin Ningjuan;He Qing;Fang Haiqin;Pan Surong;Chao Shibin;Wu Xiaoxuan;Kang Jiahui(Reproductive Medicine Center,Yancheng Maternity and Child Health Hospital Affiliated to Yangzhou University Medical College/Yancheng Maternity and Child Health Hospital,Yancheng Jiangsu 224000,China;School of Clinical Medicine,Fuzhou Medical College of Nanchang University,Fuzhou Jiangxi 344000,China)

机构地区：[1]扬州大学医学院附属盐城妇幼保健院/盐城市妇幼保健院生殖医学中心,江苏盐城224000 [2]南昌大学抚州医学院临床学院,江西抚州344000

出　　处：《保健医学研究与实践》2024年第8期65-70,共6页Health Medicine Research and Practice

基　　金：江西省教育厅科学技术研究项目(GJJ2203402)。

摘　　要：目的 探讨扳机日血清孕酮/获卵数比值(POI)对卵巢储备功能低下(DOR)患者体外受精-胚胎移植(IVF-ET)妊娠结局的预测价值,以期为临床决策的制定提供参考。方法 选取2021年1月-2023年12月在扬州大学医学院附属盐城妇幼保健院接受IVF-ET治疗的135例DOR患者作为研究对象。根据患者IVF-ET妊娠结局分为妊娠组(n=74)与未妊娠组(n=61)。收集2组患者临床资料并比较所有患者POI值。采用受试者工作特征(ROC)曲线评估扳机日血清孕酮、获卵数及POI对DOR患者IVF-ET妊娠结局的预测价值,采用多因素logistic逐步回归分析探讨IVF-ET妊娠结局的影响因素。结果 未妊娠组患者扳机日血清孕酮、POI均高于妊娠组,获卵数低于妊娠组,差异有统计学意义(P<0.05)。扳机日血清孕酮、获卵数及POI预测DOR患者IVF-ET妊娠结局的曲线下面积(AUC)分别为0.792(0.742~0.837)、0.833(0.788~0.878)、0.921(0.876~0.966)。2组患者比较,妊娠组患者抗苗勒管激素(AMH)、血清雌二醇(E2)水平和卵泡个数≥5个、优质胚胎个数≥3个的人数比例高于未妊娠组,差异有统计学意义(P<0.05)。多因素logistic回归分析,结果显示,AMH降低(OR=2.465,95%CI:1.224~4.962),E2降低(OR=2.335,95%CI:1.104~4.937),扳机日血清孕酮≥0.87 ng/m L(OR=1.917,95%CI:1.136~3.236),获卵数≤4.37个(OR=2.787,95%CI:1.426~5.448),POI≥0.25(OR=3.943,95%CI:1.951~7.970)是DOR患者IVF-ET妊娠结局的危险因素(P<0.05)。结论 POI对DOR患者IVF-ET妊娠结局具有较高的预测价值,其预测能力优于单独的扳机日血清孕酮或获卵数。POI≥0.25是影响DOR患者IVF-ET妊娠结局的重要因素,此外,AMH、E2水平也是影响妊娠结局的独立因素。Objective To investigate the predictive value of the ratio of serum progesterone on the trigger day to the number of oocytes retrieved index(POI)for the pregnancy outcomes of patients with diminished ovarian reserve(DOR)undergoing in vitro fertilization-embryo transfer(IVF-ET),aiming to provide support for clinical decision-making.Methods A total of 135 DOR patients who underwent IVF-ET treatment at Yancheng Maternal and child Health Care Hospital Afficiated to Yangzhou University from January 2021 to December 2023 were selected as the study participants.Patients were assigned to a pregnancy group(n=74)and a non-pregnancy group(n=61)based on their IVF-ET pregnancy outcomes.Clinical data of the two groups were collected and POI values of all patients were compared.The predictive value of serum progesterone on the trigger day,the number of oocytes retrieved,and POI for the pregnancy outcomes of DOR patients undergoing IVF-ET were assessed using the receiver operating characteristic(ROC)curve.A multivariate logistic regression analysis was used to explore the influencing factors of IVF-ET pregnancy outcomes.Results Serum progesterone on the trigger day and POI in the non-pregnancy group were higher than those in the pregnancy group,while the number of oocytes retrieved was lower in the non-pregnancy group,with statistical significance(P<0.05).The areas under the curve(AUC)for predicting the pregnancy outcomes of DOR patients undergoing IVF-ET for serum progesterone on the trigger day,the number of oocytes retrieved,and POI were 0.792(0.742-0.837),0.833(0.788-0.878),and 0.921(0.876-0.966),respectively.When comparing the two groups,the pregnancy group had higher levels of anti-Müllerian hormone(AMH)and estradiol(E2),and a higher proportion of patients with≥5 follicles and≥3 good-quality embryos,with statistically significant differences(P<0.05).Multivariate logistic regression analysis showed that reduced AMH(OR=2.465,95%CI:1.224-4.962),reduced E2(OR=2.335,95%CI:1.104-4.937),serum progesterone on the trigger day�

关 键 词：体外受精-胚胎移植 卵巢储备功能低下 妊娠结局 孕酮 孕酮/获卵数比值 

分 类 号：R711.75[医药卫生—妇产科学]