胚胎移植后11天血β-hCG水平与妊娠结局关系的研究

目的:探讨体外受精-胚胎移植后11天单次血β-hCG水平的临床预测价值,分析其与不同妊娠结局的关系。方法:选取胚胎移植后11天测定血清β-hCG确定妊娠并继续妊娠至12周以上的患者192例,分为无效妊娠组(包括生化妊娠、异位妊娠和妊娠早期流产)和继续妊娠组(包括单胎妊娠、双胎妊娠和三胎妊娠),比较各组间的血清β-hCG水平,分析其与各妊娠结局的关系。结果:胚胎移植后11天,无效妊娠组的血β-hCG水平为81·43±73·15U/L明显低于继续妊娠组的323·75±315·29U/L,具有显著性差异(P<0·001);单胎妊娠组血β-hCG水平均明显低于双胎妊娠组和三胎妊娠组,差异亦具有显著性(P<0·001)。当血中β-hCG介于10~50U/L时,生化妊娠和异位妊娠的阳性预测价值为81·8%,阴性预测价值达94·4%;当血β-hCG≤100U/L时,早期流产的阳性预测价值为80·8%,阴性预测价值为77·8%;当血β-hCG>250U/L时,双胎、三胎妊娠的阳性预测价值为83·3%,阴性预测价值为74·4%。结论:胚胎移植后11天单次血清β-hCG水平能有效地预测体外受精-胚胎移植周期不同的妊娠结局,具有临床指导意义。

The Study on the Relationship between Serum β-HCG Level 11 Days after Embryo Transfer and Pregnancy Outcome

Objective: To assess the clinical value of a single maternal serum β-human chorionic gonadotropin(β-HCG) assay 11 days after embryo transfer in COS(Controlled Ovarian Stimulated) cycle and predict the following pregnancy outcome. Methods: A total of 192 pregnancies following embryo transfer were included. Invalid pregnancies were defined as biochemical pregnancies, ectopic pregnancies and the first trimester abortions. Ongoing pregnancies were defined as singleton pregnancies, twins pregnancies and multiple pregnancies whose gestation were achieved more than 12 weeks. Serum β-HCG concentrations were compared among different groups, and their relationship with pregnancy outcomes were analyzed. Results: At the post-embryo-transfer day 11, the mean β-HCG concentration of the ongoing pregnancy group (323.75±315.29miu/ml) was significantly higher than that of the invalid pregnancy group (81.43±73.15miu/ml) (P<0.001). In multiple gestations, the levels of β-HCG were significantly higher compared with singleton pregnancies(P< 0.001). If the β-HCG level was 10-50U/L, the positive predictive value of biochemical pregnancies and ectopic pregnancies was 81.8% , the negative predictive value was 94.4%. If β-HCG level was ≤100U/L, the positive predictive value of the first trimester abortions was 80.8%, the negative predictive value was 77.8%. If β-HCG level was﹥250U/L, the positive predictive value of multiple pregnancy was 83.3%, the negative predictive value was 74.4%. Conclusions: A single serum β-HCG level at the day 11 after embryo transfer is an effective predictive value for clinical pregnancy outcome in COS(Controlled Ovarian Stimulated) cycle and helps plan the subsequent follow-up.