摘要
目的：探讨体外受精-新鲜胚胎移植术后第14日后血清β-h CG浓度对临床妊娠结局的预测性。方法：对727例移植2枚第3日胚胎后第14日测血清β-h CG浓度〉7 IU/L的生化妊娠者追踪其临床结局,并回顾性分析正常宫内妊娠、异位妊娠、早期流产与血清β-h CG浓度的关系。结果：本组生化妊娠者,当其血清β-hC G在〈45 IU/L时,无正常宫内妊娠;46~100 IU/L时生化妊娠流产率为50.00%,正常宫内妊娠的发生率为25.00%,异位妊娠发生率为10.71%,早期流产率为14.29%。生化妊娠流产发生率随着血清β-h CG水平升高而下降,血清β-h CG〉200 IU/L发生率仅为4.17%。血清β-h CG〉400 IU/L者异位妊娠发生率（0.19%）与≤400 IU/L（10.20%）相比明显下降（P=0.007）;当血清β-h CG〉500 IU/L时,早期流产率明显低于血清β-h CG〈500 IU/L（4.66%vs12.88%,P=0.002）。正常宫内妊娠血清β-h CG截断值为379.25 IU/L,ROC曲线下面积为0.868,95%CI=0.828~0.907。异位妊娠者中71.43%妇女存在输卵管性不孕因素,而早期流产者和生化妊娠流产者中存在男方因素性不孕分别占74.00%和68.75%。结论：胚胎移植后第14日血清β-h CG水平是有效预测妊娠的指标。当血清β-h CG≤45 IU/L时继续黄体支持治疗意义不大;血清β-h CG在46.00~379.25 IU/L范围内虽可继续黄体支持保胎,但要警惕异位妊娠及早期流产的发生,尤其是对有输卵管性不孕或男方因素性不孕的患者。
Objective： To study the predictive value of serum β-hCG level for pregnant outcomes on day 14 after fresh embryo transfer. Methods： A total of 727 women, who got chemical pregnancy （serum β-hCG〉 7 IU/L） after transferred two fresh day 3 embryos, were enrolled. The subsequent pregnant outcomes were retrospectively analyzed, such as intrauterine pregnancy, ectopic pregnancy and first-trimester abortion. The relevance between the infertility etiology and the pregnant outcomes was investigated at the same time. Results： When serum β-hCG level was less than 45 IU/L, no intrauterine pregnancy occurred; at the range of 46-100 IU/L, the chemical pregnancy loss was found in 50.00% women, and the occurrence of intrauterine pregnancy, ectopic pregnancy and first-trimester abortion were 25.00%, 10.71% and 14.29%, separately. The incidence rate of the chemical pregnancy loss decreased with the raising of serum β-hCG level, and was below 4.17% when the serum β-hCG〉200 IU/L. Prevalence of ectopic pregnancy significantly declined when the serum β-hCG 〉400 IU/L （0.19% vs 10.20%, P=0.007）. Prevalence of first-trimester abortion decreased when the serum β-hCG 〉500 IU/L （4.66% vs 12.88%, P=0.002）. The serum β-hCG cut-offvalue of intrauterine pregnancy on day 14 after embryo transfer was 379.25 IU/L, and the ROC area was 0.868, 95%CI=0.828- 0.907. Women with tubal infertility factor accounted for 71.43% in ectopic pregnancy. Male infertility factor was found in 74.00% first-trimester abortion women, and 68.75% in chemical pregnancy loss. Conclusion： Serum β-hCG on day 14 after transfer two day 3 fresh embryos, is an effective measure to predict pregnant outcomes. When serum β-hCG is under 45 IU/L, it is not necessary to continue luteal support; when the value between 46.00- 379.25 IU/L, luteal support should be continued, however, ectopic pregnancy and early miscarriage should be alerted, especially in those women with tubal and male infertility factors.
出处
《生殖与避孕》
CAS
CSCD
北大核心
2015年第8期566-570,共5页
Reproduction and Contraception
基金
国家自然科学基金委青年基金资助
项目号:81300547
