基础窦卵泡数对卵巢低反应及体外受精临床结局预测的Meta分析  

A Meta-analysis of antral follicle count predicting ovarian poor response and IVF outcome

作　　者：邓伟[1] 倪亚莉[1] 谢广妹[1] 高喜红[1] 

机构地区：[1]甘肃省妇幼保健院,兰州730050

出　　处：《疑难病杂志》2014年第4期415-420,共6页Chinese Journal of Difficult and Complicated Cases

基　　金：甘肃省科技厅国际合作项目(No.1011WCGA165)

摘　　要：目的：对基础窦卵泡数（ AFC）预测卵巢低反应性及体外受精临床结局的能力进行Meta分析。方法计算机检索PUBMED、EMBASE、Cochrane图书馆、中国生物医学文献数据库、万方数据库等，收集符合纳入标准的研究，检索时限均为从建库至2013年4月，并追溯纳入研究的参考文献和手工检索相关会议资料。由2位研究者按照纳入与排除标准独立筛选文献、提取资料和评价质量后，采用MetaDisc1．4软件进行Meta分析。结果共纳入14篇文献2306个周期。结果显示：AFC对卵巢低反应（ POR）的汇总受试者工作特征曲线（ SROC）的AUC＝0．8250， Q＊＝0．7581；对未临床妊娠（NCP）的AUC＝0．5283，Q＊＝0．5212。表明AFC对POR的准确性及诊断价值较高，具有较好的预测能力；而对NCP的诊断价值较低。亚组分析中，当AFC诊断阈值由＜4个增多至＜6或7个时，POR方面合并敏感度由0．47升至0．81，合并阳性似然比由4．11降至2．76；NCP方面合并敏感度由0．21升至0．41，合并阳性似然比由1．17升至1．96；表明随着AFC诊断阈值的增高，其对POR及NCP的准确预测能力逐渐增强；研究对象发生POR的概率逐渐降低；但发生NCP的可能性增高，此点与临床不符。结论 AFC对卵巢低反应有较好的预测能力，可作为独立预测指标；但对体外受精结局的预测能力相对较差，尚需结合其他诊断指标来综合判断妊娠结局。Objective To assessment the predictive value of antral follicle count for ovarian poor response and IVF outcome.Methods We searched PUBMED, EMBASE, Cochrane Library, Chinese Biomedical Literature Database , data-base, etc.Articles collected studies met the inclusion criteria , were retrieved from time building a database to April 2013, with retrospective references and manual included in the study retrieve relevant meeting materials .By the two researchers ac-cording to inclusion and exclusion criteria independently screened the literature and evaluation of the quality of the extracted data, using MetaDisc1.4 Meta-analysis software.Results 2 306 cycles in 14 literatures were included.The results showed that：AFC low ovarian response （POR） summary receiver operating characteristic curve （SROC） of AUC =0.825 0, Q＊ =0.758 1;for non-clinical pregnancy （NCP） of AUC =0.528 3, Q＊ =0.521 2.AFC indicate the accuracy and diagnostic value of POR is high, has a better predictive capability;while lower diagnostic value of the NCP .Subgroup analysis showed that, when the AFC diagnostic threshold increased by a 〈4 to 〈6 or 7, POR aspects combined sensitivity rose from 0.47 to 0.81, positive likelihood ratio from the merger fell from 4.11 to 2.76;NCP combined aspects of the sensitivity rose from 0.21 to 0.41, positive likelihood ratio combined rose from 1.17 to 1.96;show that with the increase of AFC diagnostic threshold , and its ability to accurately predict and NCP POR gradually increased; probability study POR occurs gradually reduced; yet occurred NCP＆#39;s possibility of increased , its discrepancies with clinic .Conclusion AFC has good prediction ability to the ovarian poor response , but has poorer prediction ability to IVF outcome .Prediction of pregnancy outcome remains to be com-bined with other diagnostic indicator to overall judgment .

关 键 词：基础窦卵泡数 卵巢低反应性 体外受精临床结局 META分析 

分 类 号：R714.8[医药卫生—妇产科学]