摘要
目的分析优质单囊胚移植早期妊娠丢失的影响因素,根据影响因素建立列线图预测模型,探讨列线图预测模型对优质单囊胚移植早期妊娠丢失的预测价值。方法行冻融胚胎移植激素替代内膜准备方案的2 560个优质单囊胚移植周期,分析临床资料与优质单囊胚移植周期结局的关系;采用单因素与多因素logistic回归分析冻融周期优质单囊胚移植发生早期妊娠丢失的影响因素;根据影响因素,采用饱和模型法建立冻融周期优质单囊胚移植发生早期妊娠丢失的列线图预测模型,采用自抽样法对列线图预测模型进行内部验证;绘制ROC曲线,评估列线图预测模型对冻融周期优质单囊胚移植发生早期妊娠丢失的预测效能。结果行优质单囊胚移植的冻融胚胎移植周期早期妊娠丢失发生率在年龄、体质量指数、既往孕次、冻融胚胎移植次数、内膜厚度、授精方式、不孕类型、胚胎发育时间上差异有统计学意义(P<0.05);年龄(OR=1.06,95%CI:1.02~1.09,P<0.001)、体质量指数(OR=1.04,95%CI:1.00~1.07,P=0.038)、既往孕次(OR=1.17,95%CI:1.01~1.36,P=0.035)、内膜厚度(OR=0.84,95%CI:0.78~0.92,P<0.001)、移植胚胎发育时间(OR=1.66,95%CI:1.22~2.25,P=0.001)是冻融周期优质单囊胚移植发生早期妊娠丢失的影响因素;根据影响因素建立的列线图预测模型的预测方程为—2.46 505+0.05 437×年龄+0.03 590×体质量指数—0.16 519×内膜厚度+0.52 149×(D5=1)+0.08 493×既往孕次;内部验证提示模型稳定;列线图预测模型预测冻融周期优质单囊胚移植发生早期妊娠丢失的AUC为0.63(95%CI:0.59~0.67,P=0.018),灵敏度为43%,特异度为80%。结论年龄、体质量指数、既往孕次、囊胚发育时间、移植内膜厚度是冻融周期优质单囊胚移植发生早期妊娠丢失的影响因素,根据影响因素建立的列线图预测模型对冻融周期优质单囊胚移植发生早期妊娠丢失有一定预测价值。
Objective To analyze the influencing factors of early pregnancy loss after high-quality single blastocyst transplantation, to establish the nomography prediction model according to the influencing factors, and to investigate the value of nomography prediction model to the prediction of early pregnancy loss after high-quality single blastocyst transplantation. Methods The correlation of clinical data with the outcome of high-quality single blastocyst transplantation was analyzed in 2 560 high-quality single blastocyst transfer cycles of frozen-thawed embryo transfer(FET) in the FET cycle hormone replacement endometrial preparation program. Univariate analysis and multivariate logistic regression were used to analyze the influencing factors of early pregnancy loss after high-quality single blastocyst transplantation. According to the influencing factors, full mode was used to establish nomography prediction model of early pregnancy loss after EFT cycle high-quality single blastocyst transplantation. Bootstrap method was used to perform built-in verification of nomography model. ROC curve was drawn to evaluate the efficiency of nomography to the prediction of early pregnancy loss after EFT cycle high-quality single blastocyst transplantation. Results The early pregnancy loss showed significant differences in age, body mass index, previous gravidity, FET times, endometrial thickness, insemination method, infertility type and the time of embryo development(P<0.05). Age(OR=1.06,95%CI:1.02-1.09,P<0.001),body mass index(OR=1.04,95%CI:1.00-1.07,P=0.038),previous gravidity(OR=1.17,95%CI:1.01-1.36,P=0.035),endometrial thickness(OR=0.84,95%CI:0.78-0.92,P<0.001),and time of embryo development(OR=1.66,95%CI:1.22-2.25,P=0.001)were the influencing factors of early pregnancy loss.The nomography prediction model was—2.46 505+0.05 437× age+0.03 590×body mass index —0.16 519×endometrial thickness+0.52 149×(D5=1)+0.08 493×previous gravidity.Built-in verification showed model stable.The AUCof nomography prediction model for p
作者
李蕾
范英英
李净羽
王雪
田沛哲
张翠莲
LI Lei;FAN Ying-ying;LI Jing-yu;WANG Xue;TIAN Pei-zhe;ZHANG Cui-lian(Henan University People’s Hospital,Reprductive Center of Henan Provincial People’s Hospital,Henan Provincial Reproductive Hospital,Zhengzhou,Henan 450003,China;Zhengzhou University People’s Hospital,Reprductive Center of Henan Provincial People’s Hospital,Henan Provincial Reproductive Hospital,Zhengzhou,Henan 450003,China)
出处
《中华实用诊断与治疗杂志》
2021年第10期1007-1012,共6页
Journal of Chinese Practical Diagnosis and Therapy
基金
国家自然科学基金(U2004130)。
关键词
冻融胚胎移植
单囊胚移植
早期妊娠丢失
列线图
预测模型
frozen-thawed embryo transfer
single blastocyst transfer
early pregnancy loss
nomogram
prediction model
