胚胎发育动力学参数对囊胚移植周期妊娠结局的影响及预测模型建立

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摘要目的研究胚胎发育动力学参数对囊胚移植周期妊娠结局的影响，建立妊娠结局预测模型。方法选择2017年7月～2019年7月于大连市妇女儿童医疗中心生殖与遗传医学中心使用Time-lapse 培养箱培养并囊胚移植的704个周期，排除合并影响妊娠结局要素和移植两枚囊胚仅单胎妊娠的453个周期，余下251个周期的371个胚胎作为研究对象，进行回顾性队列研究。根据妊娠结局，分为未妊娠组（A组，N=115个周期，n=169个胚胎）和临床妊娠组（B组，N=136个周期n=202个胚胎）。分析患者胚胎的动力学指标t2、t3、t4、t5、t8、cc2、cc3、s2、s3、tM、tSB、tB 与妊娠结局的关系，通过二元Logistic 回归分析的方法，探索影响囊胚移植周期临床妊娠结局的胚胎发育动力学指标，建立临床妊娠结局预测模型，并对其进行验证。结果 Logistic 回归结果显示，t5、t8、s3、tM、tSB、tB 对妊娠结局有预测价值。通过预测模型的建立，得到囊胚移植周期妊娠率预测方程为：P=1/（1+y），y=exp{（-3.803+0.007×t5-0.004×t8-0.042×s3+0.023×tM+0.005×tSB+0.043×tB）}。根据研究数据计算的预测结局概率与实际结局数据绘制ROC曲线，求得曲线下面积为0.702（95%CI：0.679～0.791，P=0.047）。结论影响囊胚移植周期临床妊娠结局的胚胎动力学指标风险因素包括t5、t8、S3、tM、tSB、tB。ROC曲线检验显示，根据上述风险因素建立的临床妊娠结局预测模型具有一定的预测价值。

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	史艳彬
	张婉妮
	邵小光

关键词 ：囊胚移植, 临床妊娠, 胚胎动力学, Logistic 回归分析, 预测模型

Abstract：Objective To study the influence of embryo development dynamics parameters on pregnancy outcome in blastocyst transfer cycle,and to establish a prediction model of pregnancy outcome.Methods A total of 704 cycles of blastocyst transfer cultured in Time-lapse incubator from July 2017 to July 2019 in the Reproductive and Genetic Medicine Center of Dalian Municipal Women and Children′s Medical Center were collected,among of them 453 cycles for the factors affecting pregnancy outcome and the transfer of two blastocysts with singleton pregnancy were excluded,and the remaining 371 embryos of 251 cycles were selected as the research objects.According to the outcome of pregnancy,the patients were divided into two groups: non pregnancy group (group A,N=115 cycles,n=169 embryos) and clinical pregnancy group (group B,N=136 cycles,n=202 embryos).The relationship between the embryo dynamics indexes of t2,t3,t4,t5,cc2,cc3,s2,s3,tM,tSB,tB and pregnancy outcome was analyzed.Logistic regression analysis was used to explore the embryo development dynamics parameters that affected the clinical pregnancy outcome of the blastocyst transfer cycle,and the clinical pregnancy outcome prediction model was established and verified.Results The results of Logistic regression showed that t5,t8,s3,tM,tSB and tB had predictive value for pregnancy outcome.The prediction equation of pregnancy rate in blastocyst transfer cycle was: P=1/(1+y),y=exp{(-3.803+0.007×t5-0.004×t8-0.042×s3+0.023×tM+0.005×tSB+0.043×tB)}.The ROC curve was drawn based on the predicted outcome probability calculated by the research data and the actual outcome data,and the area under the curve was 0.702 (95%CI:0.679-0.791,P=0.047).Conclusion The risk factors of embryo dynamics in blastocyst transfer cycle include t5,t8,s3,tM,tSB and tB.ROC curve test shows that the clinical pregnancy outcome prediction model based on the above risk factors has certain predictive value.

Key words： Blastocyst transfer Clinical pregnancy Embryo dynamics Logistic regression analysis Predictive model

基金资助:辽宁省自然科学基金项目（20180550568）

引用本文:

史艳彬;张婉妮;邵小光. 胚胎发育动力学参数对囊胚移植周期妊娠结局的影响及预测模型建立[J]. 中国当代医药, 2021, 28(7): 8-11.
SHI Yan-bin; ZHANG Wan-ni; SHAO Xiao-guang▲. Influence of embryo development dynamics parameters on pregnancy outcome in blastocyst transfer cycle and establishment of prediction model. 中国当代医药, 2021, 28(7): 8-11.

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http://dangdaiyiyao.com/CN/ 或 http://dangdaiyiyao.com/CN/Y2021/V28/I7/8

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