Coagulation parameters predictive of repeated implantation failure in Chinese women: A retrospective study.
Coagulation parameters predictive of repeated implantation failure in Chinese women: A retrospective study.
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中国妇女反复植入失败的凝血参数：一项回顾性研究。
DOI：
10.1097/md.0000000000023320
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发表时间：
2020-11-25
期刊：
影响因子：
1.6
通讯作者：
Kang X
中科院分区：
文献类型：
--
作者：
Yang W;Sun Q;Zhou Z;Gao Y;Shi F;Wu X;Yang Y;Feng W;Wu Z;Kang X
重复着床失败（RIF）极大地影响了辅助生殖技术（ART）后的妊娠率，原因难以捉摸。本研究旨在探讨凝血参数与RIF的相关性，并建立一个预测中国女性RIF风险的模型。测定RIF患者和对照组凝血参数，包括凝血酶原时间（PT）、凝血酶时间（TT）、活化部分凝血酶原时间（APTT）、D-二聚体（DD）、纤维蛋白降解产物（FDP）、纤维蛋白原（FG）以及花生四烯酸（AA）和二磷酸腺苷（ADP）诱导的血小板聚集。采用目的性筛选法筛选出影响RIF的重要因素，建立Logistic回归模型。92例RIF患者与47例正常对照组比较，除APTT、FDP和ADP诱导的血小板聚集率外，其余凝血指标均有显著性差异。有目的的选择方法选择PT（比值比[OR]= 0.28，95% CI：0.12-0.66，P =.003）、APPT（比值比[OR]= 0.76，95% CI：0.63-0.91，P =.004）、TT（比值比[OR]= 0.75，95% CI：0.53-1.08，P =.124）和AA诱导的血小板聚集（比值比[OR]= 1.27，95% CI：1.11-1.44，P =.0003）作为RIF风险的重要预测因素。 ROC曲线分析表明，该模型的ROC曲线下面积（AUC）为0.85，预测概率的最佳截止点为P = 0.65，导致敏感性为0.83，特异性为0.75。 我们发现凝血参数包括PT、APTT、TT和AA诱导的血小板聚集是中国女性RIF的预测指标。我们的研究结果强调了抗凝治疗降低RIF风险的潜力。
Repeated implantation failure (RIF) greatly influences pregnancy rate after assisted reproductive technologies (ART) with elusive causes. Our study aimed to explore coagulation parameters in association with RIF and establish a model to predict the risk of RIF in Chinese women. Coagulation parameters, including prothrombin time (PT), thrombin time (TT), activated partial prothrombin time (APTT), D-dimer (DD), fibrin degradation products (FDP), fibrinogen (FG), and platelet aggregation induced by arachidonic acid (AA) and adenosine diphosphate (ADP) were measured in RIF patients and controls. A logistic regression model was built by using the purposeful selection to select important factors for the prediction of RIF. Between 92 RIF patients and 47 controls, we found a statistically significant difference in all of the coagulation parameters except APTT, FDP and platelet aggregation induced by ADP. The purposeful selection method selected PT (odds ratio [OR] = 0.28, 95% CI: 0.12-0.66, P = .003), APPT (odds ratio [OR] = 0.76, 95% CI: 0.63-0.91, P = .004), TT (odds ratio [OR] = 0.75, 95% CI: 0.53-1.08, P = .124), and platelet aggregation induced by AA (odds ratio [OR] = 1.27, 95% CI: 1.11-1.44, P = .0003) as important predictors of RIF risk. ROC curve analysis indicated that the area under ROC curve (AUC) of the model was 0.85 with an optimal cut-off point of the predicted probability being P = .65, leading to a sensitivity of 0.83 and a specificity 0.75. We found that coagulation parameters including PT, APTT, TT and platelet aggregation induced by AA are predictive of RIF in Chinese women. Our results highlight the potential of anti-coagulation therapies to lower the risk of RIF.