血浆D-二聚体对IVF/ICSI患者控制性促排卵后妊娠结局的预测价值

目的评估血浆D-二聚体水平对IVF/ICSI治疗患者OHSS的发生和不良妊娠结局的预测价值。方法选取2016年6月至2017年5月于本院行IVF/ICSI治疗的69例患者,在降调日、扳机日以及验孕日取血,使用Mini VIDAS全自动化荧光酶标免疫测试系统进行D-二聚体检测,分析D-二聚体在促排卵过程中的动态变化,扳机日D-二聚体水平与OHSS发生倾向相关性,并分析正常妊娠组(即成功分娩)和妊娠失败组(即未能成功妊娠或分娩)两组间验孕日D-二聚体的变化情况。结果 (1)D-二聚体浓度在降调日、扳机日及验孕日分别为(280±160)ng/ml、(240±190)ng/ml、(1 100±540)ng/ml,降调日与扳机日D-二聚体浓度无显著性差异(P>0.05),而在验孕日显著上升(P<0.001)。(2)扳机日E₂水平[(9 530±4 484)pmol/L]与D-二聚体浓度[(240±190)ng/ml]之间无显著相关性(r=-0.1,P>0.05)。(3)取卵个数≥20个疑似OHSS或已确诊OHSS的患者与接受新鲜胚胎移植患者(取卵<2...

Predictive value of D-dimer level for pregnancy outcome in patients undergoing IVF/ICSI treatment

Objective:To assess the predictive value of D-dimer levels for ovarian hyper-stimulation syndrome(OHSS)after controlled ovarian hyperstimulation(COH)and pregnancy outcome in women with IVF/ICSI.Methods:Sixty nine patients who received IVF/ICSI in our hospital from June 2016 to May 2017 were selected.The blood samples were collected by anticoagulation with sodium citrate on the day of down regulation,HCG trigger day and pregnancy test day.D-dimer was detected by Mini VIDAS fully automated fluorescence enzyme immunity test.The dynamic changes of D-dimer during ovulation induction and the correlation between D-dimer level on HCG trigger day and OHSS tendency were analyzed.The changes of D-dimer levels on the day of pregnancy test were compared between the successful delivery group and pregnancy failure group.Results:The average levels of D-dimer were[(280±160)ng/ml]on the day of down regulation,[(1100±540)ng/ml]on HCG trigger day and[(240±190)]on pregnancy test day respectively.There was no significant difference in the concentration of D-dimer between the day of down regulation and HCG trigger day(P>0.05),but it increased significantly on the day of pregnancy test(P<0.001).There was no significant correlation between E2 level[(9530±4484)pmol/L]and D-dimer concentration[(240±190)ng/ml]on trigger day(r=-0.1,P>0.05).There was no significant difference in D-dimer concentration on the trigger day between the patients with the number of retrieved oocytes≥20 tended to suffer OHSS and the patients with fresh embryo transfer(retrieved oocytes<20)[(250±220)ng/ml vs.(240±190)ng/ml,P>0.05].There was no significant difference in D-dimer concentration on the day of pregnancy test between the successful delivery group and pregnancy failure group[(1200±580)ng/ml vs.(900±420)ng/ml,P>0.05].Conclusions:The concentration of D-dimer in plasma is not enough to evaluate the hypercoagulable state in the process of COH.The level of D-dimer on HCG trigger day or pregnancy test day has no predictive effect on the occurrence of OHSS and pregnancy failure.Therefore,we need more coagulation or fibrinolysis indicators to evaluate the hypercoagulability during COH.Clinicians should be more discreetly evaluate the prothrombosis state instead of only relying on the level of D-dimer to judge the prognosis of patients..