Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, P. R. China.
Am J Reprod Immunol. 2023 Jul;90(1):e13710. doi: 10.1111/aji.13710. Epub 2023 May 3.
This study aimed to evaluate whether D-dimer can predict the clinical outcomes of patients with unexplained recurrent implantation failure (URIF) during freeze-thaw embryo transfer (FET) cycles.
Our study was divided into two parts. The first part was a retrospective study that included 433 patients. Plasma D-dimer levels were monitored in all patients before FET, and the patients were classified into two groups according to whether they delivered at least one live infant or not. D-dimer was compared between groups, and receiver operating characteristic (ROC) curves were constructed to analyze the impact of D-dimer on live birth. The second part was a prospective study that included 113 patients who were categorized into high and low D-dimer groups based on the ROC curve analysis from the retrospective study. Clinical outcomes were compared between these two groups.
In the first part, we found that plasma D-dimer levels in patients with live birth were significantly lower than those in patients without live birth. According to the ROC curve, 0.22 mg/L was the cutoff value for D-dimer in the prediction of the live birth rate (LBR) (AUC 0.806, 95% CI: 0.763, 0.848). The second part of the study confirmed that clinical pregnancy rate (50.98% vs. 32.26%, P = .044) and LBR (41.18% vs. 22.58%, P = .033) of patients with D-dimer ≤0.22 mg/L were all significantly higher than those of patients with D-dimer > 0.22 mg/L.
Our study indicates that D-dimer > 0.22 mg/L is a useful index for predicting URIF during FET cycles.
本研究旨在评估 D-二聚体在冻融胚胎移植（FET）周期中能否预测不明原因反复种植失败（URIF）患者的临床结局。
本研究分为两部分。第一部分为回顾性研究，纳入 433 例患者。所有患者在 FET 前均监测血浆 D-二聚体水平，并根据是否至少分娩 1 名活婴将患者分为两组。比较两组间 D-二聚体水平，构建受试者工作特征（ROC）曲线分析 D-二聚体对活产的影响。第二部分为前瞻性研究，纳入根据回顾性研究 ROC 曲线分析分为高、低 D-二聚体组的 113 例患者。比较两组间临床结局。
第一部分发现，有活产患者的血浆 D-二聚体水平明显低于无活产患者。根据 ROC 曲线，D-二聚体预测活产率（LBR）的截断值为 0.22mg/L（AUC 0.806，95%CI：0.763，0.848）。第二部分研究证实，D-二聚体≤0.22mg/L 患者的临床妊娠率（50.98%比 32.26%，P=0.044）和 LBR（41.18%比 22.58%，P=0.033）均明显高于 D-二聚体＞0.22mg/L 患者。
本研究表明，D-二聚体＞0.22mg/L 是预测 FET 周期中 URIF 的有用指标。
