基础及促性腺激素刺激第6天血清抗苗勒管激素水平对卵巢反应性的预测价值  

Value of anti-Mullerian hormone serum concentrations of basal and day 6 after stimulation as predictors of ovarian response

作　　者：杨晓菁[1] 林文琴[2] 余蓉[1] 

机构地区：[1]温州医学院附属第一医院生殖医学中心,温州325000 [2]浙江大学医学院附属第一医院生殖医学中心,杭州310003

出　　处：《生殖医学杂志》2012年第4期324-328,共5页Journal of Reproductive Medicine

基　　金：浙江省教育厅项目(Y200804987)

摘　　要：目的探讨基础及促性腺激素(Gn)刺激第6天血清抗苗勒管激素(AMH)水平对体外受精-胚胎移植(IVF-ET)中卵巢反应性的预测价值。方法前瞻性观察91例行IVF-ET患者,超促排卵均采用促性腺激素释放激素激动剂(GnRH-a)+重组卵泡刺激素(rFSH)+人绒毛膜促性腺激素(hCG)黄体期长方案。根据获卵数或hCG注射日血清雌二醇(E_2)水平将患者分为三组:卵巢低反应组(A组,11例),卵巢正常反应组(B组,50例)及卵巢高反应组(C组,30例)。测定基础卵泡刺激素(bFSH)、E2、基础AMH水平,Gn刺激第6天AMH(D6AMH)、E_2水平(D6 E_2),hCG日E_2峰值。同时行阴道B超检查测定窦卵泡数(AFC)。获卵数作为卵巢反应性评价指标。结果基础AMH、D6AMH、获卵数及hCG日E_2峰值三组间比较均有显著性差异,C组>B组>A组(P<0.05)。D6AMH水平较基础AMH水平明显下降,有显著性差异(P<0.05)。获卵数与D6AMH、D6E_2、基础AMH、AFC呈正相关,多元逐步线性回归分析显示,D6AMH水平是影响获卵数最重要的因素。ROC曲线分析显示,预测卵巢低反应性时D6AMH有最大曲线下面积(AUC)为0.872,D6AMH临界值为1.159 ng/ml时,敏感度90%,特异度84%。预测卵巢高反应时D6AMH有最大AUC为。0.895,D6AMH临界值为3.22 ng/ml时,敏感度77%,特异度87%。结论基础AMH及D6AMH水平均能预测卵巢反应和获卵数,D6AMH相关性更强,是更理想的预测指标。Objective： To investigate the value on day 6 after stimulation in predicting （IVF-ET）. of serum levels of anti-Miillerian ovarian response during in vitro hormone （AMH） at baseline and fertilization and embryo transfer Methods： The prospective study enrolled 91 women given by GnRH-a ^- recombine follicle stimulating hormone （rFSH） ＋ human chorionic gonadotrophin （hCG） long term stimulation protocol during their first cycle of IVF-ET treatment. The patients were divided into three groups including poor response （group A, n=ll）, normal response （group B, n=50）, and over response （group C, n=30） based on the number of oocytes retrieved and serum levels of E2 on hCG administration day. The serum levels of FSH, estradiol （E2） at baseline, anti-Mtillerian hormone（AMH） at baseline and on day 6 after stimulation （D6AMH）, E2 on day 6 after stimulation （D6E2）and on hCG administration day, and the number of antral follicle count （AFC） were assessed. Ovarian response was evaluated by the number of oocytes retrieved. Results： The levels of AMH at baseline and day 6, the number of oocytes retrieved and the levels of E2 on hCG day had statistically significant differences among the three groups （ group C〉group B〉 group A, P〈0.05）. The serum levels of AMH at baseline and on day 6 after stimulation were significantly different in all three groups（P〈0.05）. Serum levels of AMH 6 days after stimulation were significantly lower than those at baseline （P〈0.05）. The number of oocytes retrieved was strongly correlated with the level of D6AMH, D6E2, the level of AMH at baseline and AFC. The results of multiple regression analysis showed that D6AMH was the most important factor in predicting the number of retrieved oocytes. ROC analyses showed that D6AMH had the largest area under curve （AUC） 0. 872 to predict the poor response, when 1. 159 ng/ml was selected as the AMH cut-off value with 90% sensitivity and 84% specificity. To predict the high response, D

关 键 词：抗苗勒管激素 促性腺激素释放激素激动剂 体外受精-胚胎移植 卵巢反应性 

分 类 号：R[医药卫生]