改良长方案降调节前后抗缪勒氏管激素水平与卵巢过度刺激综合征的相关性分析  

The correlation between ovarian overstimulation and the level of anti-mullerian hormone before and after down-regulation

作　　者：童洁[1] 蔡嘉力[1] 任建枝[1] TONG Jie;CAI Jia-li;REN Jian-zhi(Center of Reproductive Medicine,174th Hospital of PLA,Xiamen 361000)

机构地区：[1]中国人民解放军第一七四医院生殖中心

出　　处：《中国优生与遗传杂志》2019年第11期1390-1393,共4页Chinese Journal of Birth Health & Heredity

基　　金：厦门市医学优势亚专科建设项目

摘　　要：目的讨论改良长方案降调节处理后抗缪勒氏管激素(AMH)变化情况是否能成为预测卵巢过度刺激综合征(OHSS)的有效手段。方法回顾性分析2017年1月至2017年12月于我院生殖中心行体外受精-胚胎移植(IVF-ET)/卵胞浆内单精子显微注射(ICSI)助孕的非多囊卵巢综合征患者,共1876例,比较降调节前后血清中AMH水平的变化情况,以及AMH的变化对OHSS发生率的影响。结果降调节后AMH增加大于1ng/ml的占全周期18.8%,减少大于1ng/ml的占全周期14.3%,剩余67%变化小于1ng/ml。降调节后的AMH每增加1ng/ml,其出现OHSS风险正向增加1.21倍(95%CI:1.047-1.405),与OHSS发生显著相关(P=0.01),而基础AMH每增加1ng/ml,OHSS风险正向增加1.14倍(95%CI:0.096-1.312),与OHSS发生无显著相关(P=0.057)。结论不同患者的AMH水平对GnRh-a的响应可能存在个体的差异,降调节后AMH相对基础AMH更具有预测卵巢过度刺激综合征的价值。Objective:To discuss whether the level of anti-mullerian hormone(AMH)before and after gonadotropinreleasing hormone agonist(GnRH-a)treatment can be used as a predictor of ovarian overstimulation.Methods:1876 nonpolycystic ovary syndrome(PCOS)women who undergoing IVF or ICSI treatment in the reproductive center of our hospital from January to December 2017 were included.We analyzed the changes of AMH before and after down-regulation,and the evalue of the association between the changes of AMH and OHSS incidence were analyzed.Results:After down-regulation,AMH level increased≥1 ng/m in 18.8%patients,AMH level decrease≥1 ng/ml in 14.3%patients and AMH level chang<1 ng/ml in 67%patients.AMH level after down-regulation is significantly correlated with OHSS incidence(P=0.01),OHSS incidence increased 1.21 times(95%CI:1.047-1.405)when the AMH level increased per 1 ng/ml after down-regulation;The basal AMH level is not significantly correlated with OHSS incidence(P=0.057),OHSS incidence increased 1.14 times(95%CI:0.096-1.312)when basal AHM level increased 1 ng/ml.Conclusion:AMH change in response to GnRH-a varies among individuals,for those undergoing significant changes in AMH after down-regulation,the changed AMH may be a better reliable marker for ovarian response and OHSS in long agonist protocol.

关 键 词：降调节 抗缪勒氏管激素 卵巢过度刺激综合征 

分 类 号：R321-33[医药卫生—人体解剖和组织胚胎学]