抗缪勒管激素与性激素预测卵巢反应性的临床研究  

Clinical study on predicting ovarian response by anti-Müllerian hormone and sex hormone

作　　者：蔡小华 李涛[1] 欧建平[1] 蔡柳洪[1] 邢卫杰[1] 朱洁茹[1] CAI Xiaohua;LI Tao;OU Jianping;CAI Liuhong;XING Weijie;ZHU Jieru(Center for Reproductive Medicine,the Third Affiliated Hospital of SunYat-sen University,Guangzhou,Guangdong 510630,China)

机构地区：[1]中山大学附属第三医院生殖医学中心

出　　处：《检验医学与临床》2019年第17期2493-2496,2578,共5页Laboratory Medicine and Clinic

摘　　要：目的探讨控制性卵巢刺激过程中抗缪勒管激素(AMH)与性激素预测卵巢反应性的预测价值。方法选择该院300例行体外受精(IVF)或卵胞浆内单精子注射(ICSI)助孕治疗的患者,患者于月经第3~5天测定血清AMH、促卵泡激素(FSH)、雌二醇(E2)水平,记录年龄、体质量指数(BMI)、促性腺激素(Gn)天数、Gn总量、获卵数、成熟卵子数、优质胚胎数,所有患者均采取促性腺激素释放激素激动剂(GnRH-a)长方案超促排卵。根据获卵数分3组:低反应组(获卵数≤5)、正常反应组(5<获卵数≤15)和高反应组(获卵数>15),比较3组各指标与获卵数的相关性,分析各检测指标预测卵巢反应性的截断值。结果3组间的BMI、Gn天数比较,差异无统计学意义(P>0.05);年龄及Gn总量上低反应组>正常反应组>高反应组(P<0.05),成熟卵子数及优质胚胎数上高反应组>正常反应组>低反应组(P<0.05)。3组间的E2水平比较,差异无统计学意义(P>0.05),AMH水平高反应组>正常反应组>低反应组(P<0.05),FSH水平低反应组>正常反应组>高反应组(P<0.05)。获卵数与AMH呈正相关,与年龄、FSH、E2呈负相关。AMH、年龄、FSH、E2预测卵巢低反应的受试者工作特征(ROC)的曲线下面积(AUC)分别为0.814、0.705、0.638、0.588,其中AMH、年龄、FSH对卵巢低反应预测的诊断截值分别为2.3ng/mL,37.6岁,7.3mIU/mL。AMH、年龄、FSH、E2预测卵巢高反应的ROC的AUC分别为0.706、0.676、0.607、0.563,其中AMH、年龄、FSH对卵巢高反应预测的诊断截值分别为3.5ng/mL,30.5岁,8.4mIU/mL。AMH、年龄、FSH3个指标联合预测卵巢低反应的ROC的AUC是0.816,预测高反应的ROC的AUC是0.732。结论AMH预测价值优于其他性激素指标。Objective To explore the predictive value of anti-Mullerian hormone and sex hormone in predicting ovarian responsiveness and ovarian responsiveness during controlled ovarian stimulation.Methods A total of 300 patients who underwent in vitro fertilization(IVF)or intracytoplasmic sperm injection(ICSI)were enrolled.The patients were tested for serum AMH,FSH and E2 levels on the 3rd to 5th day of menstruation.The age,body mass index(BMI),gonadotropin(Gn)days,total Gn,the number of eggs obtained,the number of mature eggs,the number of high quality embryos were recorded.All patients were treated with gonadotropin-releasing hormone agonist(GnRH-a)long protocol.According to the number of oocytes retrieved,they were divided into three groups:low response group(the number of oocytes retrieved≤5),normal response group(5<the number of oocytes retrieved≤15)and high response group(the number of oocytes retrieved>15).The correlation between each index and the number of the number of oocytes retrieved was evaluated,and the cut-off value of each test index to predict ovarian response was analyzed.Results There were no significant differences in BMI and Gn days between the 3 groups(P>0.05).The age and total Gn dosages in low response group were less than normal reaction group and high response group(P<0.05),the number of mature eggs and the number of high-quality embryos in high response group were more than normal reaction group and low response group(P<0.05).There was no significant difference in E2 between the 3 groups(P>0.05),AMH in high response group were more than normal response group and low response group(P<0.05),FSH level in low response group was more than normal response group and high response group(P<0.05).The number of eggs obtained was significantly positively correlated with AMH,and negatively correlated with age,FSH and E2 level.The ROC AUC of AMH,Age,FSH and E2 for predicting ovarian low response were 0.814,0.705,0.638 and 0.588,respectively.The diagnostic thresholds of AMH,Age and FSH for predicting ovaria

关 键 词：卵巢反应性 抗缪勒管激素 促卵泡激素 雌二醇 年龄 

分 类 号：R719[医药卫生—妇产科学]