辅助生殖技术中中重度卵巢过度刺激综合征的三级风险预警模型的构建  

Construction of a three-level early warning model for moderate to severe ovarian hyperstimulation syndrome in assisted reproductive technology

作　　者：吴祝凤 刘俊 刘春林 罗琴红 李凤香 张秀 Wu Zhufeng;Liu Jun;Liu Chunlin;Luo Qinhong;Li Fengxiang;Zhang Xiu(Center of Reproductive Medicine,Women and Children's Medical Center Affiliated to Guangzhou Medical University,Guangzhou 510000,China)

机构地区：[1]广州医科大学附属妇女儿童医疗中心生殖医学中心,广州510000

出　　处：《中华生殖与避孕杂志》2025年第2期162-171,共10页Chinese Journal of Reproduction and Contraception

基　　金：广州市卫生健康科技项目(20221A011036)。

摘　　要：目的构建辅助生殖技术中发生中重度卵巢过度刺激综合征(ovarian hyperstimulation syndrome,OHSS)的三级预警模型,并对模型进行验证。方法采用病例对照研究方法,回顾性分析2013年4月至2023年4月期间在广州医科大学附属妇女儿童医疗中心生殖医学中心进行体外受精治疗的10181例不孕症患者,采用随机数字表法分为建模组(8145例)和验证组(2036例)。分析两组患者的临床资料,采用多因素logistic回归分析筛选出影响患者取卵术后中重度OHSS发生的危险因素,分控制性卵巢刺激前、扳机前、取卵后3 d三个节点建立预警模型并绘制列线图,通过受试者工作特征(receiver operating characteristic,ROC)曲线和校准曲线对各模型进行验证。结果窦卵泡计数(antral follicle count,AFC,OR=1.045,95%CI:1.020~1.071,P<0.001)、抗苗勒管激素(anti-Müllerian hormone,AMH)>3.36μg/L(OR=7.135,95%CI:2.084~24.432,P=0.002)、周期数(OR=0.149,95%CI:0.022~1.026,P=0.049)纳入控制性卵巢刺激前预测模型。AFC(OR=1.046,95%CI:1.018~1.074,P=0.001)、AMH>3.36μg/L(OR=5.780,95%CI:1.661~20.116,P=0.006)、促性腺激素释放激素激动剂方案(OR=3.895,95%CI:1.913~7.931,P<0.001)、雌激素峰值≥18350 pmol/L(OR=2.258,95%CI:1.092~4.666,P=0.028)、直径≥10 mm卵泡数量>20个(OR=2.377,95%CI:1.092~5.172,P=0.029)纳入扳机前预测模型。AMH>3.36μg/L(OR=8.374,95%CI:2.417~29.019,P=0.001)、雌激素峰值≥18350 pmol/L(OR=3.947,95%CI:1.533~10.167,P=0.004)、总获卵数(OR=1.042,95%CI:0.996~1.090,P=0.025)、腹胀(OR=60.181,95%CI:22.515~160.854,P<0.001)、新鲜移植(OR=21.766,95%CI:7.119~66.544,P<0.001)、人绒毛膜促性腺激素扳机(OR=17.752,95%CI:3.993~78.924,P<0.001)纳入取卵后3 d预测模型。3个模型ROC曲线下面积分别为0.830(95%CI:0.782~0.878)、0.859(95%CI:0.812~0.906)、0.948(95%CI:0.919~0.977)。3个模型验证组的ROC曲线下面积分别为0.922(95%CI:0.880~0.965)、0.936(95%CI:0.886~0.986)、0.971(95%CI:0.938~0.999)。校准曲�ObjectiveTo construct and validate a three-level early warning model of moderate to severe ovarian hyperstimulation syndrome(OHSS)in assisted reproductive technology.MethodsA case-control study was conducted.Totally 10181 infertility patients who underwent in vitro fertilization treatment in Reproductive Medicine Center,Women and Children's Medical Center Affiliated to Guangzhou Medical University from April 2013 to April 2023 were retrospectively analyzed and divided into modeling group(8145 cases)and validation group(2036 cases)by random number table method.The clinical data of the two groups were analyzed,and the risk factors affecting the occurrence of moderate and severe OHSS after oocytes retrieval were screened by multi-factor logistic regression analysis.The early warning model was established and the column diagram was drawn at three nodes which were before ovarian stimulation,before trigger and 3 d after oocyte retrieval.The receiver operating characteristic(ROC)curve and calibration curve were used to verify the models.ResultsThe antral follicle count(AFC,OR=1.045,95%CI:1.020-1.071,P<0.001),anti-Müllerian hormone(AMH)>3.36μg/L(OR=7.135,95%CI:2.084-24.432,P=0.002)and number of cycles(OR=0.149,95%CI:0.022-1.026,P=0.049)were included in the pre-stimulation prediction model.AFC(OR=1.046,95%CI:1.018-1.074,P=0.001),AMH>3.36μg/L(OR=5.780,95%CI:1.661-20.116,P=0.006),gonadotropin releasing hormone-agonist protocols(OR=3.895,95%CI=1.913-7.931,P<0.001),estrogen peak≥18350 pmol/L(OR=2.258,95%CI:1.092-4.666,P=0.028),the number of follicles with a diameter of≥10 mm>20(OR=2.377,95%CI:1.092-5.172,P=0.029)were included in the pre-trigger prediction model.AMH>3.36μg/L(OR=8.374,95%CI:2.417-29.019,P=0.001),estrogen peak≥18350 pmol/L(OR=3.947,95%CI:1.533-10.167,P=0.004),total number of oocytes retrived(OR=1.042,95%CI:0.996-1.090,P=0.025),abdominal distension(OR=60.181,95%CI:22.515-160.854,P<0.001),fresh transplantation(OR=21.766,95%CI:7.119-66.544,P<0.001),human chorionic gonadotropin trigger(OR=17.752,95%CI:3.99

关 键 词：生殖技术 辅助 受精 体外 胚胎移植 卵巢过度刺激综合征 风险预警 预测模型 

分 类 号：R711.6[医药卫生—妇产科学]