五种预测卵巢储备指标的临床研究  

Clinical study on five predictors for ovarian reserve

作　　者：邓波[1] 章晓梅[1] 任平[1] 官洁[1] 马艳萍[1] 武泽[1] 

机构地区：[1]云南省第一人民医院生殖遗传科,云南昆明650032

出　　处：《中国优生与遗传杂志》2006年第4期102-104,106,共4页Chinese Journal of Birth Health & Heredity

摘　　要：目的在体外受精—胚胎移植(IVF-ET)患者中对预测卵巢储备的各种指标进行临床研究,以寻找1~2种灵敏度高的指标用于普遍不孕人群。方法随机选择不同年龄段的92例不孕患者,在接受IVF-ET/ICSI前一个周期,于月经第3天抽取空腹血测定基础性激素及基础抑制素B水平,同时阴道B超下记数直径l^5mm窦卵泡数。采用促性腺激素释放激素激动剂(GnRH-a)/基因重组促卵泡激素(r-FSH)/人绒毛膜促性腺激素(hCG)长方案促排卵,观察IVF-ET过程中卵巢的反应性,获卵数≤4个为卵巢反应不良组,>4个为卵巢反应正常组。结果年龄≥35岁组与20~29岁组、30~34岁组间,基础FSH(bFSH)水平、抑制素B(INHB)水平、窦卵泡数、FSH用药支数、FSH刺激时间、周期取消率间差异有显著性(P<0.05),基础E2、获卵数差异无显著性。而20~29岁组与30~34岁组间各指标间无差异。卵巢反应不良组与卵巢反应正常组间,年龄、INHB水平、bFSH、窦卵泡数、获卵数、周期取消率间差异有极显著性(P<0.01),FSH用量,FSH刺激时间差异有显著性(P<0.05),而bE2及不孕原因则无显著性差异。获卵数与bFSH、bE2、INHB、窦卵泡数及年龄间行多元线性回归分析,发现获卵数与窦卵泡数呈正相关(β=0.572,P<0.01),与bFSH呈负相关(β=-0.265,P<0.05),与年龄、bE2、INHB均无相关性(P>0.05)。结论年龄≥35岁后,卵巢的反应性明显下降,而对于<35岁不孕患者,年龄不是一个敏感的指标。bFSH水平及窦卵泡数能较好地评估卵巢储备,且B超检查简便、无创,所以bFSH水平配合窦卵数综合评估,有助于提高预测价值。Objective： To compare five predictors for ovarian reserve in patients undergoing in vitro fertilization -embryo transfer （ IVF - ET） and intracytoplasmic sperm injection （ICSI）. In order to find out one or two higher sensitive predictors for common infertile women. Methods： 92 patients with different ages were chosen randomly before undergoing IVF/ICSI one cycle. Serum levels of FSH （bFSH）, Estradiel （bE2） and inhibinB （INHB） were measured on the day 3, The number of follicles （1 -5mm in size） was counted by transvaginal ultrasound on the same day. Using a standard long protocol （GnRHa/rFSH/hCG） for ovarian stimulation. low responders were defined as ≤ 4 retrieved oocytes and normal responders were defined as 〉 4 retrieved oocytes. Results： There were statistically significant differences in bFSH level, INHB level, the number of antral follicles, the ampules of rFSH required, the days of rFSH stimulating, cancel led rate between age≥35years and 〈 35years （ P 〈0. 05）, while no statistically significant differences in bE2 level, the number of oocytes retrieved. There were no statistically Significant in the parameters between patients of 20 ～ 29 and 30 ～ 34 years old. There were statistically significant differences in age, INHB, bFSH, the number of antral follicles and oocytes retrieved, cancelled rate, the ampules of rFSH required, the days of rFSH stimulating between low and normal respenders （ P 〈0. 01 and P 〈0. 05 ）, and there were no statistically significant differences in bE2 level and the reason of infertility between two groups. According to the multiple linear regression analysiS, positive correlativity existed between the number of oocytes retrieved and antral follicles, （ β =0. 572, P 〈0. 01 ）. The number ofoocytes retrieved was significantly negatively correlated with bFSH （ β = -0. 265, P 〈0. 05） ; but no correlation existed between the number of oocytes and age, bE2 level, INHB （ P 〉0. 05）. Conclusion： The ovarian resp

关 键 词：体外受精—胚胎移植 卵巢储备 抑制素B 窦卵泡数 

分 类 号：R714.8[医药卫生—妇产科学]