早卵泡期血清抗苗勒管激素水平在预测卵巢低反应中的价值探讨  

Value of Serum Anti-Müllerian Hormone Levels of Early Follicular Phase for Predicting Low Ovarian Response

作　　者：杨泽星[1,2] 朱琼媛[1] 赵富鲜[1] 王华伟[2] 唐莉[2] 

机构地区：[1]昆明医科大学第四附属医院,云南昆明650021 [2]昆明医科大学第一附属医院,云南昆明650032

出　　处：《实用妇产科杂志》2016年第8期593-596,共4页Journal of Practical Obstetrics and Gynecology

基　　金：云南省教育厅科学研究基金(编号:20130237);国家自然科学基金(编号:81260510)

摘　　要：目的:探讨早卵泡期血清抗苗勒管激素(AMH)水平对卵巢储备功能低下患者在控制性超排卵(COH)中预测卵巢低反应的应用价值及前景。方法:分析2013年10月至2015年6月在昆明医科大学第四附属医院接受体外受精/单精子卵母细胞内注射-胚胎移植(IVF/ICSI-ET)205个周期的患者,其中包括卵巢低反应患者70例(获卵数<5个)和卵巢正常反应患者135例(15个>获卵数≥5个)。在患者月经第二天或第三天清晨抽空腹静脉血,测定抗苗勒管激素(AMH)、基础卵泡刺激素(b FSH)、基础黄体生成素(b LH)及基础雌二醇(b E2)水平,同时行阴道B超检查测定窦卵泡数(AFC),以获卵数为评价标准。结果:年龄、AMH、AFC、b FSH及b FSH/b LH和获卵数存在相关性(P<0.05),其中AMH相关性最强(r=0.597,P=0.000),其余相关性由强到弱为:AFC>b FSH水平>b FSH/b LH比值>年龄。预测卵巢低反应ROC曲线下面积AMH最大,其余次序和相关性一致。预测卵巢低反应的AMH水平界值<1.275μg/L(ROC曲线下面积0.823,灵敏度0.786,特异度0.852)。结论:血清AMH水平是反映卵巢储备能力的理想指标,可预测COH中卵巢低反应,用于指导临床选择合适的治疗方案。Objective：To evaluate the relationships between the value of serum anti-MOllerian hormone（AMH） of early follicular phase and controlled ovarian hyperstimulation （COH） during in vitro fertilization, and predict its potential role on evaluating poor ovarian response. Methods：The clinical data of 205 patients in COH cycles inclu- ding 70 cycles with poor ovarian response（the number of retrieved oocytes 〈5） and 135 cycles with normal response（ 15 〉 the number of retrieved oocytes ≥5） were analyzed retrospectively from October 2013 to June 2015 in the Fourth Affiliated Hospital of Kunming medical university. The serum levels of AMH, bFSH, bLH and bE2 were measured on day 2 or 3 in spontaneous menstrual cycle of the patients. The patients received transvaginal ultrasound examination,and their antral follicle counts（AFC）,the number of retrieved oocytes were taken as the evaluating criterion. Results： The numbers of retrieved oocytes were correlated with AMH, AFC, bFSH levels, age, bFSH/bLH （ P 〈 0. 05）, among which the correlation of AMH was the strongest （ r = 0. 597, P = 0. 000 ）, the others（the correlation arranged from strong to week） were AFC, bFSH levels, bFSH/bLH and age, respectively. The area under the receive operating characteristic curve（ROC） of AMH,AFC, bFSH levels, age, ratios of bFSH/ bLH were reducing gradually. The cut-off value of AMH for predicting ovarian response was less than 1. 275 μg/L （with 0. 823 of area under ROC,0. 786 of sensitivity and 0. 852 of specificity）. Conclusions： Serum AMH levels might be a better parameter for predicting poor ovarian response. It could be used as a marker for selecting the suitable scheme of COH to reduce the cancellation rate of poor ovrian responders.

关 键 词：血清抗苗勒管激素 控制性超排卵 卵巢储备功能 卵巢低反应 

分 类 号：R321-33[医药卫生—人体解剖和组织胚胎学]