血清CA125在控制性超排卵技术中的应用

发布时间：2018-08-04 21:55

【摘要】：目的:采用一系列包含回顾性病例对照研究和前瞻性队列研究的序贯实验,来探索在控制性超排卵过程中,血清CA125作为降调节完成辅助指标的可行性,以及血清CA125在预测胚胎移植术后患者妊娠的价值。方法:(1)回顾性分析我院2015年6月至2016年6月超长方案促排患者(纳入164例),分为妊娠组(110例)与未孕组(54例),比较两组降调节完成后血清CA125水平差异,并通过统计学方法结合临床实际,求出与患者胚胎移植术后临床结局相关的因素,以及各因素对临床结局影响程度。(2)通过前瞻性队列研究,纳入我中心2016年7月-2017年1月GnRH-a超长方案控制性超排卵患者100例,根据回顾性病例对照研究结果,按照降调节完成后血清CA125水平将患者分为两组,病例组(降调节完成后血清CA125≤10.5U/ml)64例,对照组(降调节完成后血清10.5U/ml)36例。记录并比较两组患者基础资料、促排卵用药、COH获卵情况、胚胎培养情况及临床结局。结果:回顾性病例对照研究结果如下:(1)妊娠组与未孕组之间年龄、BMI、AFC、基础FSH、E2、bFSH/bLH比值,降调节药物剂量、促排卵天数、HCG日雌激素/目标卵泡数,HCG日孕激素/目标卵泡数,MII卵率,2PN胚胎率,胚胎移植日内膜厚度,移植胚胎平均分级间无显著统计学差异。(2)两组bLH,降调节完成后血清CA125,促排药物总用量之间有显著统计学差异。(3)妊娠影响因素的二元logistic回归方程提示:胚胎移植术后患者临床妊娠与bFSH/bLH比值及降调节完成后血清CA125水平呈负相关关系;OR(bFSH/bLH)=0.662,OR(调节完成后血清CA125水平)=0.904。(4)调节完成后血清CA125与临床妊娠结局所做ROC曲线下面积为0.749,cutoff值为10.5U/ml,灵敏度87%,特异度55.5%,约登指数0.425。前瞻性临床研究结果如下:(1)病例组与对照组比较,两组之间年龄、身高、体重、BMI、不孕年限、不孕类型、输卵管异常检查途径、AFC、AMH、bFSH、bFSH/bLH、bE2、PRL、TSH、自然周期血清CA125水平、自然周期CRP水平等基础资料之间无统计学差异;降调节完成后血清E2水平、血清LH水平、降调节所用GnRH-a总剂量、促排卵药物Gn总量、促排平均每天Gn用量、HCG日目标卵泡个数、HCG日E2/目标卵泡数、HCG日孕激素等促排卵情况无统计学差异;男方精液密度、A级精子、B级精子、精子形态、DFI、HDS等男方检查结果无统计学差异;OPU卵母细胞个数、卵泡输出率、受精方式、MII卵个数、正常受精胚胎数、2PN胚胎个数、2PN胚胎率、优质胚胎数等获卵结果无统计学差异;ET胚胎分级、移植日内膜厚度等移植胚胎无统计学差异;异位妊娠率、多胎妊娠率、验尿日HCG、验尿日E2、验尿日P、验尿日CA125、验尿日CRP等临床结局无统计学差异。(2)病例组与对照组相比较,bLH、CA125降低比、降调节完成后血清CA125水平、降调节完成后血清CRP水平、控制性促排卵天数、MII卵率、卵裂率、优质胚胎率、着床率、妊娠率等有统计学差异,P0.05。病例组MII率、卵裂率、优胚率、着床率、妊娠率均较对照组高。结论:(1)降调节完成后血清CA125水平与胚胎移植术后妊娠存在负相关关系。(2)在控制性超排卵过程中,血清CA125可以作为降调节完成的辅助指标。(3)降调节完成后血清CA125小于10.5 U/ml时,可以获得更高的MII卵率,更高的卵裂率,优胚率,着床率和妊娠率。(4)血清CA125在预测胚胎移植术后患者妊娠方面的有一定的应用价值。
[Abstract]:Objective: To explore the feasibility of using a series of sequential trials involving retrospective case control study and prospective cohort study to explore the feasibility of serum CA125 as an auxiliary index for lowering regulation during controlled ovarian hyperstimulation, and the value of serum CA125 in predicting pregnancy induced pregnancy after embryo transfer. (1) retrospective analysis of our hospital 6 in 2015. The patients (164 cases) were divided into pregnancy group (110 cases) and unpregnant group (54 cases) from month to June 2016. The difference of serum CA125 level between the two groups was compared, and the factors associated with the clinical outcome after the implantation of the patients and the influence of the factors on the clinical outcome were calculated. (2) through prospective cohort study, 100 cases of controlled superovulation in January -2017 July 2016 were included in our center. According to the results of retrospective case control study, the patients were divided into two groups according to the serum CA125 level of the reduced regulation, 64 cases (CA125 < 10.5U/ml) in the case group and the control group (drop regulation). After complete serum 10.5U/ml), 36 cases were recorded and compared with two groups of basic data, ovulation promotion, ovulation, embryo culture, embryo culture and clinical outcome. Results: the results of retrospective case control study were as follows: (1) age, BMI, AFC, base FSH, E2, bFSH/bLH ratio between pregnancy and unpregnant groups, lowering the dosage of FSH, reducing the number of ovulation, HCG The number of daily estrogen / target follicles, HCG day progesterone / target follicle number, MII oocyte rate, 2PN embryo rate, endometrial thickness of embryo transfer day and the average grading of transplanted embryos were not statistically significant. (2) the two groups of bLH, after the fall regulation, the serum CA125 and the total dosage of the drug were significantly different. (3) two yuan logistic of pregnancy influencing factors. The regression equation showed that the ratio of clinical pregnancy to bFSH/bLH after embryo transfer and the level of serum CA125 after the reduction of regulation were negatively correlated; OR (bFSH/bLH) =0.662, OR (4) of serum CA125 level after completion of regulation, =0.904. (4) was completed in the serum CA125 and the clinical pregnancy outcome, the area of the ROC curve was 0.749, and the cutoff was 10.5U/ml, spirit Sensitivity 87%, specificity of 55.5%, 0.425. prospective clinical research results as follows: (1) the case group compared with the control group, two groups of age, height, weight, BMI, infertility years, infertility type, fallopian tube abnormal examination, AFC, AMH, bFSH, bFSH/bLH, bE2, PRL, TSH, natural cycle serum CA125 level, natural cycle CRP level and other basic data There was no statistical difference in serum E2 level, serum LH level, total dose of GnRH-a used for lowering regulation, total amount of Gn for ovulation induction, average daily Gn dosage, number of follicles on HCG daily target follicles, HCG day E2/ target follicle number, HCG day progesterone ovulation, male sperm density, A-level sperm, B grade sperm, There were no statistical differences in sperm morphology, DFI, HDS and other men's examination results; there was no statistical difference between the number of OPU oocytes, the rate of follicle output, the mode of fertilization, the number of MII eggs, the number of normal fertilized embryos, the number of 2PN embryos, the embryo rate of 2PN, the number of high quality embryos and so on; there was no statistical difference between the ET embryo classification, the thickness of the endometrium and other transplanted embryos. The pregnancy rate, multiple pregnancy rate, urine test day HCG, urine test day E2, urine test day P, urine test day CA125, urinalysis day CRP and other clinical outcomes were not statistically different. (2) the case group compared with the control group, bLH, CA125 reduction ratio, reduced serum CA125 level after the completion of regulation, reduced serum CRP level after regulation, control ovulation days, MII oviposit rate, cleavage rate, excellent There were statistical differences in quality embryo rate, implantation rate, pregnancy rate and so on. The MII rate, cleavage rate, optimal embryo rate, implantation rate and pregnancy rate in P0.05. case group were higher than those of the control group. (1) there was a negative correlation between serum CA125 level and pregnancy after the completion of the control. (2) in the process of controlled ovulation, serum CA125 could be reduced to the end of regulation. (3) when the serum CA125 is less than 10.5 U/ml after the fall regulation, a higher MII oval rate, higher cleavage rate, superior embryo rate, implantation rate and pregnancy rate are obtained. (4) serum CA125 has a certain value in predicting pregnancy after embryo transfer.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.8

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