HCG日孕酮升高对妊娠结局的影响及其早期预测因素的探讨

发布时间：2018-10-31 12:28

【摘要】：目的:探讨注射人绒促性素(HCG)日孕酮(P)升高对妊娠结局的影响及基础P水平对HCG日P升高的早期预测情况。方法:对本中心行体外受精-胚胎移植(IVF-ET)患者有基础P水平检测结果的734个周期进行回顾性分析。将HCG日P为4.77 nmol/L设为临界值分为P升高组(204个周期)和P未升高组(530个周期),比较两组各项临床参数指标。懫用Logistic回归分析探讨影响注射HCG日P升高的相关因素,并对其相关指标进行预测HCG日P升高的最佳判断点的统计,根据最佳判断点探讨其与妊娠结局的关系。结果:两组间正常受精率、优质胚胎率比较,差异无统计学意义(P0.05),但与P未升高组比较,P升高组的胚胎着床率和临床妊娠率较低(P0.05),流产率较高(P0.05)。基础P水平与HCG日P升高多元回归分析显示有相关性(OR=20.5,95%CI 4.73~89.01,P=0.000)。基础P预测HCG日P升高的最佳判断点为2.38 nmol/L,对应的敏感度为46.1%,特异度为79.2%。但以此为界值将P升高组细分为两组,其与妊娠结局有关的各项指标间比较,差异均无统计学意义(P0.05)。结论:HCG日P升高对妊娠结局不利,但不影响卵母细胞及胚胎质量。基础P水平可作为HCG日P升高的早期预测因素,但不是直接影响妊娠结局的独立决定性因子。
[Abstract]:Objective: to investigate the effect of progesterone (P) on pregnancy outcome after injection of human choriotropin (HCG) and the early prediction of basal P level on HCG day P elevation. Methods: 734 cycles of in vitro fertilization-embryo transfer (IVF-ET) patients with basal P levels were retrospectively analyzed. The critical value of P = 4.77 nmol/L on HCG day was divided into two groups: P rising group (204 cycles) and P no rising group (530 cycles). The clinical parameters were compared between the two groups. Logistic regression analysis was used to study the related factors affecting the increase of P on the day of injection of HCG, and the statistics of the best judgment point for predicting the increase of P in HCG day were made, and the relationship between it and the outcome of pregnancy was discussed according to the best judgment point. Results: there was no significant difference in normal fertilization rate and high quality embryo rate between the two groups (P0.05), but the embryo implantation rate and clinical pregnancy rate of P increased group were lower than that of P group (P0.05). The abortion rate was higher (P0.05). Multiple regression analysis showed that there was correlation between basal P level and P rise on HCG day (OR=20.5,95%CI 4.73, 89.01, P = 0.000). The best judgment point of base P for predicting the increase of P on HCG day is 2. 38 nmol/L, the sensitivity is 46. 1 and the specificity is 79. 2%. However, the P elevation group was subdivided into two groups, and there was no significant difference between the indexes related to pregnancy outcome (P0.05). Conclusion: the increase of P on the day of HCG is unfavorable to the outcome of pregnancy, but does not affect the quality of oocytes and embryos. Basal P level can be used as an early predictor of P elevation on HCG day, but it is not an independent determinant factor directly affecting pregnancy outcome.
【作者单位】：天津医科大学研究生院;天津市中心妇产科医院;
【分类号】：R714.8

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