不育男性睾丸精子行ICSI的临床结局预测模型构建与验证  

Construction and validation of the predictive model for clinical outcomes in infertile males with testicular spermatozoa undergoing ICSI

作　　者：胡杨杨[1] 刘晓明 宋博天 陈奥蕾 曹顺顺[2] Hu Yangyang;Liu Xiaoming;Song Botian;Chen Aolei;Cao Shunshun(Reproductive Medical Center,Department of OB&GYN,The Second Affiliated Hospital of Wenzhou Medical University,Wenzhou 325027,Zhejiang,China;Pediatric Endocrinology,Genetics,and Metabolism,The Second Affiliated Hospital of Wenzhou Medical University,Wenzhou 325027,Zhejiang,China)

机构地区：[1]温州医科大学附属第二医院生殖中心,浙江温州325000 [2]温州医科大学附属第二医院儿童内分泌遗传代谢科,浙江温州325000

出　　处：《中国男科学杂志》2024年第5期42-48,共7页Chinese Journal of Andrology

基　　金：温州市基础性科研项目(Y20220414);浙江省医药卫生科技计划(2023RC050)。

摘　　要：目的探讨男性不育不同病因患者使用睾丸精子行卵胞质内单精子注射(ICSI)临床妊娠结局预测模型的构建和验证。方法回顾性分析2020年1月至2022年6月,在本院生殖中心就诊的不同病因行手术取精ICSI治疗的不孕症夫妇共345例。使用训练集构建Logistic回归临床妊娠预测模型,使用测试集对模型进行准确性和可靠性验证。结果当睾丸容积(TV)>12 mL、男性卵泡刺激素(FSH)<13.3 IU/L、梗阻性无精子症(OA)和女性年龄<33岁时,与较高的预测临床妊娠率有关(P<0.05)。模型在训练集上的ROC曲线下面积(AUC)为0.881(95%CI:0.841~0.921),在测试集上的AUC为0.900(95%CI:0.825~0.975)。结论我们构建的以TV、男性FSH、OA病因、勃起功能障碍、非梗阻性无精子症和女性年龄为自变量的临床妊娠预测模型,具有较高的准确性和可靠性,可为使用睾丸精子ICSI治疗的患者提供一种有价值的咨询策略。Objective To investigate the construction and validation of the prediction model for clinical pregnancy outcome using intracytoplasmic sperm injection(ICSI)with testicular spermatozoa in patients with different etiologies of male infertility.Methods Clinical data of 345 infertile couples with different etiology who received surgical sperm retrieval for ICSI treatment at the Reproductive Center from January 2020 to June 2022 were retrospectively analyzed.The logistic regression pregnancy prediction model was constructed using the training set,and the test set validated the model for accuracy and reliability.Results When testicular volume(TV)>12 mL,male follicle-stimulating hormone(FSH)<13.3 IU/L,obstructive azoospermia(OA),and female age<33 years were associated with higher predicted clinical pregnancy rates(P<0.05).The area under the ROC curve(AUC)of the model was 0.881(95%CI:0.841-0.921)in the training set and 0.900(95%CI:0.825-0.975)in the test set.Conclusions The established pregnancy prediction model with independent variables as TV,male FSH,OA,erectile dysfunction,non-obstructive azoospermia,and female age has high accuracy and reliability,which provides a valuable counseling tool for patients treated with testicular sperm ICSI.

关 键 词：不育 男性 精子注射 细胞质内 妊娠结局 预测模型 

分 类 号：R321.1[医药卫生—人体解剖和组织胚胎学] R698.2[医药卫生—基础医学]