生殖医学杂志

目的 探讨冻融胚胎移植(FET)第14天血清β-HCG水平与活产率的相关性及其对活产率的预测价值。方法 回顾性分析2016年1月至2021年6月在我院生殖医学中心行FET的1 741个周期的临床资料，并根据临床结局分为活产组(794个周期)及非活产组(947个周期)。比较两组患者的一般资料，采用多因素logistic回归分析筛选出FET活产率的独立预测因子，采用Spearman相关性分析年龄、FET第14天血β-HCG与活产率的相关性，并通过计算受试者工作特征(ROC)曲线下面积(AUC)评估其预测价值。结果 两组患者的体质量指数(BMI)、移植胚胎数量、不孕因素、受精方式、促排卵方案比较无显著性差异(P>0.05);活产组的年龄、不孕年限显著低于非活产组，内膜厚度、FET第14天血β-HCG水平显著高于非活产组(P均<0.05);两组的不孕类型、移植胚胎类型比较亦有显著性差异(P<0.05)。单因素logistic回归分析显示，年龄、不孕类型(原发、继发)、不孕年限、内膜厚度、移植胚胎类型(卵裂胚、囊胚)、FET第14天血β-HCG是FET活产率相关的预测因子(P<0.05);多因素logistic回归分析显示，年龄(OR=0.931,95%CI:0.905～0.958,P=0.000)、FET第14天血β-HCG(OR=1.003,95%CI:1.003～1.003,P=0.000)是FET活产率的独立预测因子。Spearman相关性分析显示，FET活产率与年龄呈弱负相关(P<0.01),与FET第14天血β-HCG呈中度正相关(P<0.01)。ROC曲线分析表明，年龄的AUC为0.358,敏感度和特异性分别为100.00%、0.32%;FET第14天血β-HCG的AUC为0.926,敏感度和特异性分别为97.23%、80.25%。结论 FET第14天血β-HCG水平与活产率相关，活产率随着血β-HCG水平升高呈上升趋势；且FET第14天血β-HCG水平可用于预测活产率，其敏感度和特异性均较高。

Objective:To investigate the correlation between serum β-HCG level on the 14^th day and live birth rate in frozen-thawed embryo transfer(FET) and its predictive value for live birth rate.Methods:The clinical data of 1 741 FET cycles performed in the reproductive medicine center of our hospital from January 2016 to June 2021 were retrospectively analyzed. According to the clinical outcome, they were divided into live birth group(794 cycles) and non-live birth group(947 cycles). The general data of the two groups of patients were compared. Multivariate logistic regression analysis was used to screen independent predictors of live birth rate in FET. Spearman correlation analysis was used to analyze the correlation between the age, serum β-HCG level on the 14^th day of FET and live birth rate. The value of independent predictors in predicting the live birth rate of FET was evaluated by calculating the area under the receiver operating characteristic(ROC) curve.Results:There were no significant differences in body mass index(BMI),number of transferred embryos, infertility factors, fertilization methods and ovulation induction protocols between the two groups(P>0.05). The age and infertility years of live birth group were significantly lower than those of non-live birth group(P<0.05). The endometrial thickness and the serum β-HCG level on the 14^th day in live birth group were significantly higher than those in non-live birth group(P<0.05). There were significant differences in infertility type and embryo transfer type between live birth group and non-live birth group(P<0.05). Univariate logistic regression analysis showed that age, type of infertility(primary and secondary),years of infertility, endometrial thickness, type of transferred embryos(blastomere, blastocyst),serum β-HCG level on the 14^th day of FET were the predictors related to the live birth rate in FET(P<0.05). Multivariate logistic regression analysis showed that age(OR=0.931,95%CI:0.905-0.958 P=0.000),serum β-HCG on the 14^th day of FET(OR=1.003,95%CI:1.003-1.003,P=0.000) were the independent predictors related to live birth rate in FET. Spearman correlation analysis showed that the live birth rate of FET was weakly negatively correlated with age(P<0.01),and was moderate positive correlated with serum β-HCG level on the 14^th day of FET(P<0.01). ROC curve analysis showed that the area under curve(AUC) of age was 0.358,and the sensitivity and specificity were 100.00% and 0.32% respectively. The AUC of serum β-HCG level on 14^th day of FET was 0.926,and the sensitivity and specificity were 97.23% and 80.25% respectively.Conclusions:The serum β-HCG level on the 14^th day of FET is related to the live birth rate, and the live birth rate increases with the increase of blood β-HCG level. The serum β-HCG level on the 14^th day of FET can be used to predict the live birth rate, with high sensitivity and specificity.