New endometrial immune cell-based score (EI-score) for the prediction of implantation success for patients undergoing IVF/ICSI
New endometrial immune cell-based score (EI-score) for the prediction of implantation success for patients undergoing IVF/ICSI
复制标题
新的基于子宫内膜免疫细胞的评分（EI 评分），用于预测接受 IVF/ICSI 患者的植入成功率。
DOI：
10.1016/j.placenta.2020.07.025
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发表时间：
2020-09-15
期刊：
影响因子：
3.8
通讯作者：
Zeng, Yong
中科院分区：
文献类型：
--
作者：
Diao, Lianghui;Cai, Songchen;Zeng, Yong
问题：有限的证据表明，子宫内膜免疫因素是否有助于首次尝试体外受精/卵胞浆内单精子注射（IVF/ICSI）patients.Method的种植成功率：回顾性研究中进行了139对符合条件的夫妇在推导队列和29对夫妇在验证队列。检测子宫内膜免疫细胞标志物的表达，包括自然杀伤细胞CD 56、泛巨噬细胞CD 68、M2巨噬细胞CD 163、调节性T细胞FOXP 3、未成熟树突状细胞CD 1a、成熟树突状细胞CD 83、细胞毒性T细胞CD 8、成熟NK和T细胞CD 57。妊娠组与着床失败组子宫内膜免疫细胞的分布差异有统计学意义。多因素Logistic回归分析显示，CD 68（+）泛巨噬细胞和CD 163（+）M2-巨噬细胞的百分比以及移植策略与种植结局相关（分别为P < 0.001，P = 0.029，P = 0.004）。EI评分通过列线图构建，并通过基于CD 68（+）泛巨噬细胞、CD 163（+）M2-巨噬细胞和转移策略的临床决策曲线进行验证。EI评分在偏离队列中的表现显示cindex为0.82（95%CI 0.74-0.89），在验证队列中准确率达到79.3%。结论：在首次IVF/ICSI患者中，分泌中期的子宫内膜免疫学特征与植入结局相关。EI-Score可以帮助临床医生通过列线图计算植入成功的概率。通过决策曲线分析和临床影响曲线确定最佳决策点，辅助临床决策。
Problem: Limited evidence revealed whether endometrial immunological factors contribute to implantation success in the first-attempted in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) patients.Method: The retrospective study was conducted among 139 eligible couples in the derivation cohort and 29 couples in the validation cohort. The expression of endometrial immune cell markers, including CD56 for natural killer cell, CD68 for pan-macrophage, CD163 for M2 macrophage, FOXP3 for regulatory T cell, CD1a for immature dendritic cell, CD83 for mature dendritic cell, CD8 for cytotoxic T cell and CD57 for mature NK and T cells were examined.Results: The profiles of endometrial immune cells showed significant difference between the pregnant and implantation failure group in the derivation cohort. Multivariate logistic regression analysis showed that the percentage of CD68(+) pan-macrophage and CD163(+) M2-macrophage, as well as the transfer strategy are associated with implantation outcomes (P < 0.001, P = 0.029, P = 0.004, respectively). The EI-score was constructed by a nomogram and validated by a clinical decision curve based on CD68(+) pan-macrophage, CD163(+) M2-macrophage, and the transfer strategy. The performance of the EI-score in the deviation cohort showed a cindex of 0.82 (95% CI 0.74-0.89), and the accuracy rate reached 79.3% in the validation cohort.Conclusions: The endometrial immunological profiles in the mid-secretory phase is associated with implantation outcome in the first IVF/ICSI patients. EI-Score could help clinicians calculate the probability of implantation success via nomogram. Optimal decision point is determined by decision curve analysis and clinical impact curve, to aid in clinical decisions.