单倍体胚胎移植后血清hCG水平对活产的预测价值
本研究为回顾性队列研究，纳入6410例单倍体胚胎移植后初始血清hCG阳性的周期，按hCG范围分组。结果显示初始hCG水平与活产率呈阶梯式上升关系，组1（2.5-<11 mIU/mL）活产率仅1.6%，组6（≥100 mIU/mL）达87.8%，ROC曲线下面积0.83，最佳阈值为75.7 mIU/mL。
要点
- 单倍体胚胎移植后第9天血清hCG水平可阶梯式预测活产。
- hCG 2.5-<11 mIU/mL组活产率极低（1.6%），≥100 mIU/mL组达87.8%。
- hCG预测活产的ROC曲线下面积0.83，最佳阈值为75.7 mIU/mL。
核心结论
- 单倍体胚胎移植后初始血清hCG水平是活产的强预测因子，随hCG阈值升高呈阶梯式关系。
研究设计与样本
- 回顾性队列研究，单中心，纳入6410例单倍体胚胎移植后初始血清hCG阳性（>2.5 mIU/mL）的周期，移植后9天测量hCG。
主要发现
- 总体活产率为71.0%，组1（hCG 2.5-<11 mIU/mL）活产率最低（1.6%），组6（hCG≥100 mIU/mL）最高（87.8%）。
- 调整后相邻组活产概率递增：组2 vs 1 aRR 6.76 [3.02-15.11]，组3 vs 2 aRR 3.08 [2.27-4.19]，组4 vs 3 aRR 1.80 [1.59-2.04]，组5 vs 4 aRR 1.16 [1.08-1.25]，组6 vs 5 aRR 1.15 [1.10-1.21]。
- 囊胚活检日亚组间活产率相似，但组3（hCG 25-<50 mIU/mL）中第5天囊胚活产率（28.8%）低于第6天和第7天（42.7%、41.9%）。
- ROC曲线下面积为0.83（0.81-0.84），最佳阈值为hCG 75.7 mIU/mL。
关键数值与推荐
- 初始血清hCG阳性定义为>2.5 mIU/mL，移植后9天测量。
- hCG分组：组1 2.5-<11、组2 11-<25、组3 25-<50、组4 50-<75、组5 75-<100、组6 ≥100 mIU/mL。
- 预测活产的最佳hCG阈值为75.7 mIU/mL，ROC曲线下面积0.83（0.81-0.84）。
临床怎么用
- 可利用初始血清hCG水平为单倍体胚胎移植患者提供活产概率咨询。
- hCG极低（2.5-<11 mIU/mL）时活产可能性极小，需加强咨询。
- hCG≥100 mIU/mL时活产概率高，可给予积极预期。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
OBJECTIVE: To evaluate live birth outcomes on the basis of initial serum human chorionic gonadotropin (hCG) level following single euploid embryo transfer. DESIGN: Retrospective cohort study. SUBJECTS: Single center study that included patients who underwent single euploid embryo transfer with initial positive hCG (>2.5 mIU/mL), measured nine days after transfer. Cycles were grouped by hCG range: Group 1 (hCG 2.5 to <11 mIU/mL), group 2 (11 to <25), group 3 (25 to <50), group 4 (50 to <75), group 5 (75 to <100), and group 6 (≥100). EXPOSURE: Initial serum hCG level. MAIN OUTCOME MEASURES: The primary outcome was live birth per positive hCG. Subgroup analysis was performed by blastocyst biopsy day (days 5, 6, or 7). Poisson regression models were used to estimate stepwise comparisons between adjacent hCG groups; receiver operating characteristic analysis was performed to determine the predictive value of initial hCG level for live birth. RESULTS: A total of 6,410 single euploid embryo transfer cycles with initial positive serum hCG were included. Overall live birth after positive hCG was 71.0%. Higher initial hCG level increased live birth chance in a stepwise fashion, with lowest chance of live birth in group 1 (hCG 2.5 to <11) (1.6%), and highest in group 6 (hCG ≥100) (87.8%). Adjusted analysis demonstrated increasing probability of live birth between adjacent groups: group 2 vs. 1 aRR 6.76 [3.02-15.11], group 3 vs. 2 aRR 3.08 [2.27-4.19], group 4 vs. 3 aRR 1.80 [1.59-2.04], group 5 vs. 4 aRR 1.16 [1.08-1.25], and group 6 vs. 5 aRR 1.15 [1.10-1.21]. Live birth was similar across blastocyst biopsy subgroups, except in group 3 (25 to <50 mIU/mL), where day 5 blastocysts had the lowest live birth (28.8%) vs. days 6 and 7 blastocysts (42.7%, 41.9%). The area under the receiver operating characteristic curve was 0.83 (0.81-0.84), with an hCG of 75.7 mIU/mL representing the optimal threshold. CONCLUSION: Initial serum hCG level after single euploid embryo transfer is a strong predictor of live birth, with a stepwise relationship between rising hCG thresholds. Findings from this study provide a valuable counseling tool for both physicians and patients utilizing single euploid embryo transfer.
引用
- Clarke EA, Jones C, Reckhow J, et al. Prognostic utility of serum beta human chorionic gonadotropin level following single euploid embryo transfer for live birth. Fertil Steril. 2026. PMID: 42092529. doi:10.1016/j.fertnstert.2026.04.025
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。