抗缪勒管激素在来曲唑联合克罗米芬治疗多囊卵巢综合征不孕症患者中的预测价值  

Predictive Value of Anti-Mullerian Hormone in the Treatment of Polycystic Ovary Syndrome Infertility with Letrozole Combined with Clomiphene

作　　者：胡轶华 彭娟[2] HU Yihua;PENG Juan(Department of Obstetrics and Gynecology,Changyuan Maternal and Child Health Hospital,Changyuan City,He’nan Province 453400;不详)

机构地区：[1]河南省长垣市妇幼保健院妇产科,453400 [2]郑州大学第三附属医院盆底重建科

出　　处：《医学理论与实践》2022年第14期2363-2365,2368,共4页The Journal of Medical Theory and Practice

摘　　要：目的:探讨抗缪勒管激素(AMH)在来曲唑联合克罗米芬治疗多囊卵巢综合征(PCOS)不孕症患者中对排卵结局的预测价值。方法:选取2019年10月—2020年10月本院妇科收治的78例PCOS不孕症患者作为研究对象,所有患者均给予来曲唑联合克罗米芬治疗。连续治疗3个月经周期后,根据排卵结局分为排卵组和无排卵组。对比两组患者基础血清性激素、AMH水平及双侧卵巢窦状卵泡计数(AFC)。通过Logistic回归分析初步评价各因素对来曲唑联合克罗米芬促排卵效果的影响,再通过分析ROC工作曲线以探究AMH等变量对促排卵效果的预测能力。结果:来曲唑联合克罗米芬治疗的78例PCOS不孕症患者中共有46例成功排卵。两组患者的年龄、BMI、不孕时间等基本资料比较,差异无统计学意义(P>0.05)。两组患者血清中FSH、LH、PRL基础水平比较,差异无统计学意义(P>0.05);与无排卵组相比,排卵组患者血清中T、E_(2)、AMH基础水平和窦卵泡计数均显著较低(P<0.05)。Logistic回归分析表明E_(2)、AMH可能是来曲唑联合克罗米芬促排卵成功的影响因素(P<0.05)。ROC工作曲线分析显示E_(2)对应的AUC为0.65(P>0.05)。AMH对应的AUC为0.74(P<0.05),最佳临界值为9.48ng/ml,灵敏度为64.27%,特异度为73.34%。结论:在来曲唑联合克罗米芬治疗PCOS不孕症患者中,血清AMH水平对排卵效果具有预测价值,血清AMH浓度高于9.48ng/ml时,可能易发生促排卵治疗失败。Objective:To explore the value of anti-Mullerian hormone(AMH)in predicting ovulation outcome in patients with polycystic ovary syndrome(PCOS)infertility treated with letrozole combined with clomiphene.Methods:A total of 78 patients with PCOS infertility treated in our hospital from October 2019 to October 2020 were selected as subjects.All patients were treated with letrozole combined with clomiphene.After 3 consecutive menstrual cycles,the patients were divided into ovulation group and anovulatory group according to the outcome of ovulation.The basic levels of serum sex hormone,AMH and antral follicle count(AFC)were compared between the two groups.The effects of various factors on the ovulation induction effect of letrozole combined with clomiphene citrate were preliminarily evaluated by Logistic regression analysis,and then the ROC working curve was analyzed to explore the predictive ability of variables such as AMH on the ovulation induction effect.Results:Among 78 PCOS infertile patients treated with letrozole and clomiphene,46 cases were ovulated successfully.There was no significant difference in age,BMI and time of infertility between the two groups(P>0.05).There was no significant difference in the basic levels of FSH,LH and PRL between the two groups(P>0.05),but the basic levels of T,E_(2),AMH and antral follicle count in the ovulation group were significantly lower than those in the anovulatory group(P<0.05).Logistic regression analysis showed that E_(2)and AMH may be the influencing factors of ovulation induced by letrozole combined with clomiphene.ROC working curve analysis showed that the corresponding AUC of E_(2)was 0.65(P>0.05).The corresponding AUC of AMH was 0.74(P<0.05),the best critical value was 9.48ng/ml,the sensitivity was 64.27%,and the specificity was 73.34%.Conclusion:In the treatment of PCOS infertility with letrozole combined with clomiphene,the level of serum AMH can predict the effect of ovulation.When the concentration of serum AMH is higher than that of 9.48ng/ml,the failure of ovu

关 键 词：抗缪勒管激素 多囊卵巢综合征 不孕症 来曲唑 克罗米芬 

分 类 号：R711.75[医药卫生—妇产科学]