血清CA125在控制性超排卵技術中的應用
發(fā)布時間：2018-08-04 21:55
【摘要】：目的:采用一系列包含回顧性病例對照研究和前瞻性隊列研究的序貫實驗,來探索在控制性超排卵過程中,血清CA125作為降調節(jié)完成輔助指標的可行性,以及血清CA125在預測胚胎移植術后患者妊娠的價值。方法:(1)回顧性分析我院2015年6月至2016年6月超長方案促排患者(納入164例),分為妊娠組(110例)與未孕組(54例),比較兩組降調節(jié)完成后血清CA125水平差異,并通過統(tǒng)計學方法結合臨床實際,求出與患者胚胎移植術后臨床結局相關的因素,以及各因素對臨床結局影響程度。(2)通過前瞻性隊列研究,納入我中心2016年7月-2017年1月GnRH-a超長方案控制性超排卵患者100例,根據(jù)回顧性病例對照研究結果,按照降調節(jié)完成后血清CA125水平將患者分為兩組,病例組(降調節(jié)完成后血清CA125≤10.5U/ml)64例,對照組(降調節(jié)完成后血清10.5U/ml)36例。記錄并比較兩組患者基礎資料、促排卵用藥、COH獲卵情況、胚胎培養(yǎng)情況及臨床結局。結果:回顧性病例對照研究結果如下:(1)妊娠組與未孕組之間年齡、BMI、AFC、基礎FSH、E2、bFSH/bLH比值,降調節(jié)藥物劑量、促排卵天數(shù)、HCG日雌激素/目標卵泡數(shù),HCG日孕激素/目標卵泡數(shù),MII卵率,2PN胚胎率,胚胎移植日內膜厚度,移植胚胎平均分級間無顯著統(tǒng)計學差異。(2)兩組bLH,降調節(jié)完成后血清CA125,促排藥物總用量之間有顯著統(tǒng)計學差異。(3)妊娠影響因素的二元logistic回歸方程提示:胚胎移植術后患者臨床妊娠與bFSH/bLH比值及降調節(jié)完成后血清CA125水平呈負相關關系;OR(bFSH/bLH)=0.662,OR(調節(jié)完成后血清CA125水平)=0.904。(4)調節(jié)完成后血清CA125與臨床妊娠結局所做ROC曲線下面積為0.749,cutoff值為10.5U/ml,靈敏度87%,特異度55.5%,約登指數(shù)0.425。前瞻性臨床研究結果如下:(1)病例組與對照組比較,兩組之間年齡、身高、體重、BMI、不孕年限、不孕類型、輸卵管異常檢查途徑、AFC、AMH、bFSH、bFSH/bLH、bE2、PRL、TSH、自然周期血清CA125水平、自然周期CRP水平等基礎資料之間無統(tǒng)計學差異;降調節(jié)完成后血清E2水平、血清LH水平、降調節(jié)所用GnRH-a總劑量、促排卵藥物Gn總量、促排平均每天Gn用量、HCG日目標卵泡個數(shù)、HCG日E2/目標卵泡數(shù)、HCG日孕激素等促排卵情況無統(tǒng)計學差異;男方精液密度、A級精子、B級精子、精子形態(tài)、DFI、HDS等男方檢查結果無統(tǒng)計學差異;OPU卵母細胞個數(shù)、卵泡輸出率、受精方式、MII卵個數(shù)、正常受精胚胎數(shù)、2PN胚胎個數(shù)、2PN胚胎率、優(yōu)質胚胎數(shù)等獲卵結果無統(tǒng)計學差異;ET胚胎分級、移植日內膜厚度等移植胚胎無統(tǒng)計學差異;異位妊娠率、多胎妊娠率、驗尿日HCG、驗尿日E2、驗尿日P、驗尿日CA125、驗尿日CRP等臨床結局無統(tǒng)計學差異。(2)病例組與對照組相比較,bLH、CA125降低比、降調節(jié)完成后血清CA125水平、降調節(jié)完成后血清CRP水平、控制性促排卵天數(shù)、MII卵率、卵裂率、優(yōu)質胚胎率、著床率、妊娠率等有統(tǒng)計學差異,P0.05。病例組MII率、卵裂率、優(yōu)胚率、著床率、妊娠率均較對照組高。結論:(1)降調節(jié)完成后血清CA125水平與胚胎移植術后妊娠存在負相關關系。(2)在控制性超排卵過程中,血清CA125可以作為降調節(jié)完成的輔助指標。(3)降調節(jié)完成后血清CA125小于10.5 U/ml時,可以獲得更高的MII卵率,更高的卵裂率,優(yōu)胚率,著床率和妊娠率。(4)血清CA125在預測胚胎移植術后患者妊娠方面的有一定的應用價值。
[Abstract]:Objective: To explore the feasibility of using a series of sequential trials involving retrospective case control study and prospective cohort study to explore the feasibility of serum CA125 as an auxiliary index for lowering regulation during controlled ovarian hyperstimulation, and the value of serum CA125 in predicting pregnancy induced pregnancy after embryo transfer. (1) retrospective analysis of our hospital 6 in 2015. The patients (164 cases) were divided into pregnancy group (110 cases) and unpregnant group (54 cases) from month to June 2016. The difference of serum CA125 level between the two groups was compared, and the factors associated with the clinical outcome after the implantation of the patients and the influence of the factors on the clinical outcome were calculated. (2) through prospective cohort study, 100 cases of controlled superovulation in January -2017 July 2016 were included in our center. According to the results of retrospective case control study, the patients were divided into two groups according to the serum CA125 level of the reduced regulation, 64 cases (CA125 < 10.5U/ml) in the case group and the control group (drop regulation). After complete serum 10.5U/ml), 36 cases were recorded and compared with two groups of basic data, ovulation promotion, ovulation, embryo culture, embryo culture and clinical outcome. Results: the results of retrospective case control study were as follows: (1) age, BMI, AFC, base FSH, E2, bFSH/bLH ratio between pregnancy and unpregnant groups, lowering the dosage of FSH, reducing the number of ovulation, HCG The number of daily estrogen / target follicles, HCG day progesterone / target follicle number, MII oocyte rate, 2PN embryo rate, endometrial thickness of embryo transfer day and the average grading of transplanted embryos were not statistically significant. (2) the two groups of bLH, after the fall regulation, the serum CA125 and the total dosage of the drug were significantly different. (3) two yuan logistic of pregnancy influencing factors. The regression equation showed that the ratio of clinical pregnancy to bFSH/bLH after embryo transfer and the level of serum CA125 after the reduction of regulation were negatively correlated; OR (bFSH/bLH) =0.662, OR (4) of serum CA125 level after completion of regulation, =0.904. (4) was completed in the serum CA125 and the clinical pregnancy outcome, the area of the ROC curve was 0.749, and the cutoff was 10.5U/ml, spirit Sensitivity 87%, specificity of 55.5%, 0.425. prospective clinical research results as follows: (1) the case group compared with the control group, two groups of age, height, weight, BMI, infertility years, infertility type, fallopian tube abnormal examination, AFC, AMH, bFSH, bFSH/bLH, bE2, PRL, TSH, natural cycle serum CA125 level, natural cycle CRP level and other basic data There was no statistical difference in serum E2 level, serum LH level, total dose of GnRH-a used for lowering regulation, total amount of Gn for ovulation induction, average daily Gn dosage, number of follicles on HCG daily target follicles, HCG day E2/ target follicle number, HCG day progesterone ovulation, male sperm density, A-level sperm, B grade sperm, There were no statistical differences in sperm morphology, DFI, HDS and other men's examination results; there was no statistical difference between the number of OPU oocytes, the rate of follicle output, the mode of fertilization, the number of MII eggs, the number of normal fertilized embryos, the number of 2PN embryos, the embryo rate of 2PN, the number of high quality embryos and so on; there was no statistical difference between the ET embryo classification, the thickness of the endometrium and other transplanted embryos. The pregnancy rate, multiple pregnancy rate, urine test day HCG, urine test day E2, urine test day P, urine test day CA125, urinalysis day CRP and other clinical outcomes were not statistically different. (2) the case group compared with the control group, bLH, CA125 reduction ratio, reduced serum CA125 level after the completion of regulation, reduced serum CRP level after regulation, control ovulation days, MII oviposit rate, cleavage rate, excellent There were statistical differences in quality embryo rate, implantation rate, pregnancy rate and so on. The MII rate, cleavage rate, optimal embryo rate, implantation rate and pregnancy rate in P0.05. case group were higher than those of the control group. (1) there was a negative correlation between serum CA125 level and pregnancy after the completion of the control. (2) in the process of controlled ovulation, serum CA125 could be reduced to the end of regulation. (3) when the serum CA125 is less than 10.5 U/ml after the fall regulation, a higher MII oval rate, higher cleavage rate, superior embryo rate, implantation rate and pregnancy rate are obtained. (4) serum CA125 has a certain value in predicting pregnancy after embryo transfer.
【學位授予單位】：蘭州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R714.8
本文編號：2165288
[Abstract]:Objective: To explore the feasibility of using a series of sequential trials involving retrospective case control study and prospective cohort study to explore the feasibility of serum CA125 as an auxiliary index for lowering regulation during controlled ovarian hyperstimulation, and the value of serum CA125 in predicting pregnancy induced pregnancy after embryo transfer. (1) retrospective analysis of our hospital 6 in 2015. The patients (164 cases) were divided into pregnancy group (110 cases) and unpregnant group (54 cases) from month to June 2016. The difference of serum CA125 level between the two groups was compared, and the factors associated with the clinical outcome after the implantation of the patients and the influence of the factors on the clinical outcome were calculated. (2) through prospective cohort study, 100 cases of controlled superovulation in January -2017 July 2016 were included in our center. According to the results of retrospective case control study, the patients were divided into two groups according to the serum CA125 level of the reduced regulation, 64 cases (CA125 < 10.5U/ml) in the case group and the control group (drop regulation). After complete serum 10.5U/ml), 36 cases were recorded and compared with two groups of basic data, ovulation promotion, ovulation, embryo culture, embryo culture and clinical outcome. Results: the results of retrospective case control study were as follows: (1) age, BMI, AFC, base FSH, E2, bFSH/bLH ratio between pregnancy and unpregnant groups, lowering the dosage of FSH, reducing the number of ovulation, HCG The number of daily estrogen / target follicles, HCG day progesterone / target follicle number, MII oocyte rate, 2PN embryo rate, endometrial thickness of embryo transfer day and the average grading of transplanted embryos were not statistically significant. (2) the two groups of bLH, after the fall regulation, the serum CA125 and the total dosage of the drug were significantly different. (3) two yuan logistic of pregnancy influencing factors. The regression equation showed that the ratio of clinical pregnancy to bFSH/bLH after embryo transfer and the level of serum CA125 after the reduction of regulation were negatively correlated; OR (bFSH/bLH) =0.662, OR (4) of serum CA125 level after completion of regulation, =0.904. (4) was completed in the serum CA125 and the clinical pregnancy outcome, the area of the ROC curve was 0.749, and the cutoff was 10.5U/ml, spirit Sensitivity 87%, specificity of 55.5%, 0.425. prospective clinical research results as follows: (1) the case group compared with the control group, two groups of age, height, weight, BMI, infertility years, infertility type, fallopian tube abnormal examination, AFC, AMH, bFSH, bFSH/bLH, bE2, PRL, TSH, natural cycle serum CA125 level, natural cycle CRP level and other basic data There was no statistical difference in serum E2 level, serum LH level, total dose of GnRH-a used for lowering regulation, total amount of Gn for ovulation induction, average daily Gn dosage, number of follicles on HCG daily target follicles, HCG day E2/ target follicle number, HCG day progesterone ovulation, male sperm density, A-level sperm, B grade sperm, There were no statistical differences in sperm morphology, DFI, HDS and other men's examination results; there was no statistical difference between the number of OPU oocytes, the rate of follicle output, the mode of fertilization, the number of MII eggs, the number of normal fertilized embryos, the number of 2PN embryos, the embryo rate of 2PN, the number of high quality embryos and so on; there was no statistical difference between the ET embryo classification, the thickness of the endometrium and other transplanted embryos. The pregnancy rate, multiple pregnancy rate, urine test day HCG, urine test day E2, urine test day P, urine test day CA125, urinalysis day CRP and other clinical outcomes were not statistically different. (2) the case group compared with the control group, bLH, CA125 reduction ratio, reduced serum CA125 level after the completion of regulation, reduced serum CRP level after regulation, control ovulation days, MII oviposit rate, cleavage rate, excellent There were statistical differences in quality embryo rate, implantation rate, pregnancy rate and so on. The MII rate, cleavage rate, optimal embryo rate, implantation rate and pregnancy rate in P0.05. case group were higher than those of the control group. (1) there was a negative correlation between serum CA125 level and pregnancy after the completion of the control. (2) in the process of controlled ovulation, serum CA125 could be reduced to the end of regulation. (3) when the serum CA125 is less than 10.5 U/ml after the fall regulation, a higher MII oval rate, higher cleavage rate, superior embryo rate, implantation rate and pregnancy rate are obtained. (4) serum CA125 has a certain value in predicting pregnancy after embryo transfer.
【學位授予單位】：蘭州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R714.8
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，本文編號：2165288
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