摘要
目的探索接受体外受精或卵母细胞胞质内单精子注射法(IVF/ICSI)治疗的患者控制性促排卵(COS)后发生卵巢低反应(POR)的相关危险因素,并建立预测POR发生的预测模型列线图。方法回顾性分析2016年9月1日至2020年9月1日于河南省人民医院行IVF/ICSI治疗的患者17164个周期的临床资料,通过logistic回归筛选影响POR发生的独立危险因素,即为预测模型入组变量;筛选其中入组变量记录完整的13266个周期,按照3∶1分为建模组(9896个)和验证组(3370个);建立预测模型,并依据预测模型中的回归系数建立列线图,通过受试者工作特征曲线下面积(AUC)评估列线图的预测性能。结果在17164个周期中多因素logistic回归分析显示,年龄、不孕症类型、体质指数、抗苗勒管激素、基础卵泡生成素、基础雌二醇、窦卵泡数、既往POR次数、卵巢手术史、促排卵方案、平均促性腺激素量是影响POR发生的独立危险因素(P均<0.05)。使用建模组的数据,根据上述因素建立POR发生风险的预测模型列线图,并用验证组的数据进行验证,建模组的AUC是0.893(95%CI为0.885~0.900),验证组的AUC是0.890(95%CI为0.878~0.903)。结论本研究筛选出了IVF/ICSI治疗患者COS后发生POR的影响因素,经验证本研究建立的预测POR发生的列线图能够有效、简便、清晰和直观地预测POR的发生。
Objective To explore the related factors of poor ovarian response(POR)in patients receiving controlled ovarian stimulation(COS)and to establish the nomogram for predicting POR in patients who received in vitro fertilization or intracytoplasmic sperm injection(IVF/ICSI).Methods In this retrospective research,clinical data of 17164 cycles of patients who received IVF/ICSI treatment at Henan Provincial People′s Hospital from September 1st,2016 to September 1st,2020 were analyzed.Independent correlative factors affecting the occurrence of POR were screened by logistic regression,which were the model enrollment variables in the prediction model.Totally 13266 cycles with well-record of enrollment variables were screened,and these data were randomly divided into model group(9896 patients)and validation group(3370 patients)according to 3∶1.The nomogram was established according to the regression coefficient of the relevant variables.The prediction accuracy of the nomogram was evaluated by calculating area under the receiver operating characteristic curve(AUC).Results Multivariate logistic regression analysis showed age,infertility type,body mass index,anti-Müllerian hormone,basal follicle stimulating hormone,basal estrogen,antral follicle number,previous times of POR,history of ovarian surgery,ovulation stimulation protocol and average amount of gonadotropin were independent correlative factors affecting the occurrence of POR(all P<0.05).In the model group,according to the above factors,the prediction model and nomogram of POR risk were constructed and the validation group verified the model.The AUC of the model group was 0.893(95%CI:0.885-0.900),and the AUC of the validation group was 0.890(95%CI:0.878-0.903).Conclusion The influencing factors of POR after COS in patients treated by IVF/ICSI are screened,and the nomogram for predicting POR established in this study is proved to be effective,simple,intuitive and clear in predicting the occurrence of POR.
作者
王雪
范英英
李蕾
张少娣
张翠莲
Wang Xue;Fan Yingying;Li Lei;Zhang Shaodi;Zhang Cuilian(Reproductive Medicine Institute,Henan Provincial People′s Hospital,Zhengzhou 450003,China)
出处
《中华妇产科杂志》
CAS
CSCD
北大核心
2022年第2期110-116,共7页
Chinese Journal of Obstetrics and Gynecology
基金
国家自然科学基金(U2004130)。
关键词
不育
女(雌)性
体外受精
卵巢储备功能
排卵诱导
列线图
预测
影响因素分析
卵巢低反应
Infeitility,female
Fertilization in vitro
Ovarian reserve
Ovulation induction
Nomograms
Forecasting
Root cause analysis
Poor ovarian response
