抗苗勒激素与抑制素B对体外受精-胚胎移植结局的影响  

Effects of anti-müllerian hormone and inhibin B on the outcome of in vitro fertilization-embryo transfer

作　　者：程萍[1] 张昌军[2] 王华[2] 

机构地区：[1]湖北省十堰市湖北医药学院附属太和医院妇产科,442000 [2]湖北省十堰市湖北医药学院附属人民医院生殖医学中心

出　　处：《中国妇幼保健》2012年第9期1346-1351,共6页Maternal and Child Health Care of China

摘　　要：目的:研究行体外受精-胚胎移植(IVF-ET)的患者血清及卵泡液中抗苗勒激素(AMH)、抑制素B(IN-HB)与卵泡发育、卵巢反应能力、胚胎质量及妊娠结局之间的关系。方法 :用酶联免疫吸附实验(ELISA)检测24例因输卵管因素行IVF-ET患者(24个周期)卵泡早期(月经第3天)、卵泡中期、取卵日(OPU日)、胚胎移植日(ET日)和胚胎移植后3天(ET+3)血清中AMH、INHB水平及取卵日卵泡液中AMH、INHB水平,了解其与卵泡发育、卵巢反应能力、胚胎质量及妊娠结局之间的关系。结果:①随着卵泡的发育,血清INHB水平逐渐升高,AMH水平逐渐降低(P均<0.001);②取卵日卵泡中的INHB、AMH水平显著高于血清水平(分别为P<0.001及P<0.05);③在超促排卵过程中,各个时期的血清INHB水平随着获卵数的增加而明显升高(P均<0.05),卵泡液AMH水平随获卵数不同而变化,获卵数0～9个时最低,10～15个时达最大值,≥16个时浓度明显降低(P均<0.05);④高质量胚胎比≥0.5组卵泡液AMH水平较高质量胚胎比<0.5组显著升高(P<0.05);⑤在妊娠组与非妊娠组之间,卵泡早期、卵泡中期、取卵日、胚胎移植日和胚胎移植后3天血清中INHB、AMH水平及取卵日卵泡液中INHB水平无差异(P>0.05),妊娠组卵泡液AMH水平明显高于非妊娠组(P<0.05)。结论:IVF超促排卵过程各个时期的血清INHB水平只能反映卵巢的反应能力,不能预测IVF-ET妊娠结局;取卵日卵泡液中INHB水平与妊娠结局无相关性。各个时期的血清AMH水平不能预测IVF-ET妊娠结局,取卵日卵泡液中AMH水平可以作为IVF-ET妊娠结局的预测因子。泡液中AMH可能通过改变局部微环境引起胚胎质量的改变,进而影响IVF-ET结局。Objective： To research the relationship between antimtillerian hormone （AMH） and inhibin B in serum and follicular fluid and the development of follicles, ovarian reaction ability, quality of embryos, and pregnancy outcome of the patients receiving in vitro fertilizationembryo transfer （IVFET） . Methods： Enzymelinked immunosorbent assay （ELISA） was used to detect the levels of AMH and inhibin B in serum during the early follicular phase （on the third day of menstruation）, middle follicular phase, on the day of oocyte pickup （ OPU）, on the day of embryo transfer, on the third day after embryo transfer and the levels of AMH and inhibin B in follicular fluid on the day of OPU; the relationship between the levels of AMH and inhibin B and follicular development, ovarian reaction ability, quality of embryo, and pregnancy outcome was analyzed. Results： The serum level of inhibin B increased gradually with the development of follicles, while the level of serum AMH decreased gradually （P 〈 0. 001, P 〈 0. 001, respectively） . The levels of AMH and inhibin B in follicular fluid on the day of OPU were significantly higher than those in serum （P 〈0. 001, P 〈0. 05, respectively） . During the course of controlled ovarian hyperstimulation （COH）, the serum levels of inhibin B at different phases increased significantly with the increase of the number of retrieved oocytes （ P 〈 0. 05 ）, the levels of AMH in follicular fluid varied with the number of retrieved oocytes, the level of AMH in follicular fluid was the lowest when the number of retrieved oocytes was 0 - 9, while the level of AMH in follicular fluid was the highest when the number of retrieved oocytes was 10 - 15, the level of AMH in follicular fluid decreased significantly when the number of retrieved oocytes was more than 16 （including 16） （P 〈0.05） . The level of AMH in follicular fluid in ratio of high quality embryo1〉0. 5 group was significantly higher than that in ratio of high quality embryo 〈 0. 5 g

关 键 词：抗苗勒激素 抑制素 B 体外受精-胚胎移植 妊娠 

分 类 号：R321.3[医药卫生—人体解剖和组织胚胎学]