外周血硫酸脱氢表雄酮水平对IVF-ET中卵巢低反应与妊娠结局的预测价值  

Predictive Value of Serum DHEAS Level for Poor Ovarian Response and Pregnant Outcome in IVF-ET Cycles

作　　者：郭静[1] 张清学[1] 李予[1] 黄佳[1] 王文军[1] 黄丽丽[1] 赵晓苗[1] 杨冬梓[1] 

机构地区：[1]中山大学附属第二医院妇产科生殖中心,广东广州510120

出　　处：《中山大学学报（医学科学版）》2014年第1期156-160,F0003,共6页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：2010年卫生部临床重点学科项目(2010439)

摘　　要：[目的]评估月经早期外周血硫酸脱氢表雄酮（DHEAS）水平对IVF-ET助孕中卵巢低反应（POR）和妊娠结局的预测价值.[方法]单中心回顾性队列研究.共纳入1208例行第一周期IVF/ICSI助孕的病人,年龄20～ 44岁,排除PCOS患者.采用低剂量长效GnRH激动剂长方案.主要指标为①IVF治疗周期前3个月内月经周期第1～3天外周血FSH、LH、雌二醇（E2）、总睾酮（T）和DHEAS水平;经阴道B超检测AFC和平均卵巢容积（MOV）；②IVF-ET中的卵巢刺激指标和妊娠结局.[结果]不孕女性中DHEAS水平有随年龄增加而逐渐下降的趋势,但在各年龄层间无显著差异.年龄＜35岁的女性中,DHEAS水平与基础FSH、基础FSH/LH、基础E2、AFC、MOV、COH后卵巢反应性及妊娠结局均无关.35≤年龄＜40岁的女性中,DHEAS水平与基础FSH显著负相关（r=-0.28;P=0.011）；POR组DHEAS水平显著低于非POR组;妊娠组DHEAS水平显著高于未妊娠组.对于35≤年龄≤44岁的女性,DHEAS是预测其卵巢低反应较可靠的指标（ROC-AUC：0.838）,界值2.58 μmol/L的灵敏度为85.7％,特异度为85％ （OR 0.998; 95％CI 0.996-0.999; p=0.023）；但不能可靠预测妊娠结局（ROC-AUC：0.662,P=0.04）.[结论]本研究认为外周血DHEAS水平是35≤年龄≤44岁病人中卵巢反应的保护因素,作为单一指标时对该人群卵巢低反应发生有适中的预测价值,但是对不妊娠结局的预测不可靠.未来研究需要进一步确认这组病人中伴随低水平DHEAS的低反应患者进行DHEA预处理后是否能够获益.[Objective ] This study aimed to estimate the predictive value of serum dehydroepiandrosterone sulphate （DHEAS） level in early follicle phase for poor ovarian response and negative pregnancy outcome in IVF-ET treatment. [Methods] This was a retrospective study in single centre. 1208 Chinese women aged 20-44 years undergoing the first cycle of IVF/ICSI-ET. Patients with polycyctic ovarian syndrome were exclude. All patients received standard ovarian stimulation under pituitary suppression with GnRH agonist. Main outcome measures included 1） serum FSH, LH, total testosterone （T）, estradiol （E2） and DHEAS levels on Day 3 of the menstrual cycle before treatment cycle; antral follicle count （AFC） and mean ovarian volume （MOV） were obtained from transvaginal sonography; 2） ovarian stimulation parameters and pregnancy outcome. [Results] DHEAS concentration had no noticeable difference among age-related groups. DHEAS level had no association with basal FSH, FSH/LH, E2, AFC, Mov, oocytes yield and IVF pregnancy outcome in patients younger than 35 years old. DHEAS negatively correlated with basal FSH in patients with 35 ≤ aged〈40 （r = -0.28, P = 0.011 ）. DHEAS level was significantly lower in patients with POR than non-POR, and significantly higher in pregnant patients than non-pregnant patients. DHEAS was a preferable predictor with an ROC-AUC of 0.838 and a threshold of 2.58 umol/L （a sensitivity of 85.7% and a specificity of 85%, respectively） for poor ovarian response in patients 35 ≤ aged ≤ 44 （OR 0.998; 95%CI 0.996-0.999; P = 0.023）, but not a reliable predictor for pregnancy outcome （ROC-AUC was 0.662, P = 0.04）. [ConcIusion] Our data suggest that serum DHEAS, as a single parameter, is a preferable predictor for poor ovarian response in older patients （35 ≤aged ≤44）, but it is not a reliable predictor for pregnancy outcome. Future studies need to identify whether patients who are potential poor ovarian responders and with low levels of DHEAS in this subgroup wo

关 键 词：辅助生殖技术 体外受精-胚胎移植 卵巢低反应 硫酸脱氢表雄酮 雄激素 

分 类 号：R711.6[医药卫生—妇产科学]