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目的:探讨体外受精-新鲜胚胎移植术后第14日后血清β-h CG浓度对临床妊娠结局的预测性。方法:对727例移植2枚第3日胚胎后第14日测血清β-h CG浓度>7 IU/L的生化妊娠者追踪其临床结局,并回顾性分析正常宫内妊娠、异位妊娠、早期流产与血清β-h CG浓度的关系。结果:本组生化妊娠者,当其血清β-hC G在<45 IU/L时,无正常宫内妊娠;46~100 IU/L时生化妊娠流产率为50.00%,正常宫内妊娠的发生率为25.00%,异位妊娠发生率为10.71%,早期流产率为14.29%。生化妊娠流产发生率随着血清β-h CG水平升高而下降,血清β-h CG>200 IU/L发生率仅为4.17%。血清β-h CG>400 IU/L者异位妊娠发生率(0.19%)与≤400 IU/L(10.20%)相比明显下降(P=0.007);当血清β-h CG>500 IU/L时,早期流产率明显低于血清β-h CG<500 IU/L(4.66%vs12.88%,P=0.002)。正常宫内妊娠血清β-h CG截断值为379.25 IU/L,ROC曲线下面积为0.868,95%CI=0.828~0.907。异位妊娠者中71.43%妇女存在输卵管性不孕因素,而早期流产者和生化妊娠流产者中存在男方因素性不孕分别占74.00%和68.75%。结论:胚胎移植后第14日血清β-h CG水平是有效预测妊娠的指标。当血清β-h CG≤45 IU/L时继续黄体支持治疗意义不大;血清β-h CG在46.00~379.25 IU/L范围内虽可继续黄体支持保胎,但要警惕异位妊娠及早期流产的发生,尤其是对有输卵管性不孕或男方因素性不孕的患者。
OBJECTIVE: To investigate the predictive value of serum β-h CG concentration on clinical pregnancy outcome after in vitro fertilization-fourteenth day after fresh embryo transfer. Methods: The clinical outcome of 727 biopsies with 2 β 3 day embryos on the 14th day after the serum β-h CG concentration> 7 IU / L was followed up. The normal intrauterine pregnancy, ectopic pregnancy, Relationship between early abortion and serum β-h CG concentration. Results: In this group of biochemical pregnancies, there was no normal intrauterine pregnancy when the serum β-hC G was less than 45 IU / L, the rate of abortion was 50.00% at 46-100 IU / L, and the occurrence of normal intrauterine pregnancy The rate was 25.00%, the incidence of ectopic pregnancy was 10.71%, and the rate of early miscarriage was 14.29%. The rate of abortion of biochemical pregnancy declined with the increase of serum β-h CG level, the incidence of serum β-h CG> 200 IU / L was only 4.17%. The incidence of ectopic pregnancy (0.19%) was significantly lower than that of ≤400 IU / L (10.20%) when serum β-h CG> 400 IU / L (P = 0.007) L, the rate of early miscarriage was significantly lower than that of serum β-h CG <500 IU / L (4.66% vs 12.88%, P = 0.002). Normal intrauterine pregnancy serum β-h CG cut-off value of 379.25 IU / L, the area under the ROC curve was 0.868, 95% CI = 0.828 ~ 0.907. 71.43% of women with ectopic pregnancy had tubal infertility factors, while male infertility accounted for 74.00% and 68.75% respectively in early abortion and biochemical pregnancy abortion. Conclusion: Serum β-h CG level on the 14th day after embryo transfer is an effective indicator of pregnancy. When the serum β-h CG ≤ 45IU / L continued luteal support treatment is not significant; serum β-hCG in 46.00 ~ 379.25 IU / L range may continue luteal support miscarriage, but to guard against ectopic pregnancy and early Abortion occurs, especially for those who have tubal infertility or male infertility factors.