子宫内膜异位症合并不孕症患者基础FSH和AMH水平及其与获卵数的相关性研究  

Study on changes of serum levels of bFSH or AMH and correlation with the number of oocytes retrieved in infertility patients with endometriosis

作　　者：刘闯 王红娜 张翠翠 孙超 李胜男 张建芳 LIU Chuang;WANG Hong-na;ZHANG Cui-cui;SUN Chao;LI Sheng-nan;ZHANG Jian-fang(Reproductive Medicine Center,Department of Obstetrics&Gynecology,Xi Jing Hospital of Air Force Military Medical University,Xi’an 710000)

机构地区：[1]空军军医大学西京医院妇产科生殖医学中心,西安710000

出　　处：《生殖医学杂志》2022年第8期1087-1092,共6页Journal of Reproductive Medicine

摘　　要：目的探究子宫内膜异位症(EMs)合并不孕症患者血清基础FSH(bFSH)和抗苗勒管激素(AMH)水平的变化以及与获卵数的相关性。方法采用回顾性队列研究,分析2018年1月至2021年8月在西京医院妇产科生殖医学中心行辅助生殖技术助孕患者的临床资料(共589个周期),根据是否存在EMs分为对照组(单纯输卵管梗阻性不孕患者,431个周期)和EMs组(EMs合并不孕患者,158个周期)。采用单因素分析EMs患者血清bFSH、AMH水平与获卵数的关系,并采用多元回归调整不齐的基线资料。进一步以EMs为效应修饰因子,采用似然比检验bFSH和AMH水平与获卵数的交互作用。结合平滑曲线拟合和阈值分析,研究EMs组中bFSH或AMH与获卵数之间关系和效应值的变化。结果(1)EMs组女方年龄和原发不孕比例显著高于对照组(P<0.01);两组间促排卵方案亦存在显著性差异(P<0.01)。与对照组比较,EMs组血清bFSH水平显著升高[(7.77±3.77)U/L vs.(6.60±1.82)U/L],AMH水平显著降低[(2.37±2.06)ng/ml vs.(3.10±2.16)ng/ml],获卵数亦显著降低[(7.66±4.66)vs.(9.64±3.10)](P<0.01);(2)多元回归分析校准女方年龄、不孕类型和促排卵方案后,以对照组为参考,结果显示EMs组获卵数减少(β=-1.62)、AMH水平降低(β=-0.62),bFSH水平升高(β=0.86),均具有统计学意义(P<0.01)。(3)进一步行交互作用分析,提示EMs增加了bFSH或AMH与获卵数之间效应值β的绝对值,且具有统计学意义(P<0.01)。(4)曲线拟合及阈值效应分析显示,EMs组bFSH水平与获卵数呈线性负相关,效应值β(95%CI)为-0.51(-0.70,-0.33)(P<0.01);AMH水平与获卵数呈正相关,当AMH<3.9 ng/ml时,EMs组中AMH与获卵数的效应值β(95%CI)为2.58(2.12,3.04)(P<0.01)。结论EMs影响血清bFSH、AMH水平,减少IVF周期获卵数,即降低了卵巢储备功能;在EMs患者中,AMH<3.9 ng/ml时提示卵巢储备功能开始下降。Objective:To study the changes of serum levels of basal FSH(bFSH) and anti-Mullerian hormone(AMH) in infertility patients with endometriosis(EMs) and the correlation with the number of oocytes retrieved.Methods:The clinical data of 589 cycles was retrospectively collected from the database of Reproductive Medicine Center of Xi Jing Hospital, the Air Force Military Medical University between January 1,2018 to August 31,2021. According to the presence or absence of EMs, they were divided into control group(431 cycles in infertility patients with simple oviduct obstruction) and EMs group(158 cycles in infertility patients with EMs). Univariate regression was used to assess the correlation between the serum level of bFSH or AMH and the number of oocytes retrieved in infertility patients with EMs, and the baseline data were adjusted by multiple regression. Furthermore, the interaction between bFSH or AMH levels and the number of oocytes retrieved was tested by likelihood ratio using EMs as the effect modifier. Combined with smooth curve fitting and threshold analysis, the correlation between the level of bFSH or AMH and the number of oocytes retrieved and the change of effect size were analyzed.Results:(1)The female age and the proportion of primary infertility in the EMs group were significantly higher than those in control group(P<0.01),and there was also a significant difference in ovulation-induced protocols(P<0.01). The serum level of bFSH[(7.77±3.77)U/L vs.(6.60±1.82) U/L] was significantly increased in EMs group(P<0.01),and the AMH level[(2.37±2.06) ng/ml vs.(3.10±2.16) ng/ml] and the number of oocytes retrieved[(7.66±4.66) vs.(9.64±3.10)] were significantly decreased(P<0.01).(2)After multiple regression was applied to adjust the female age, infertility type and ovulation-induced protocol, taking the control group as a reference, the results showed that the number of oocytes retrieved(β=-1.62) and the AMH level(β=-0.62) were significantly decreased(P<0.01),while the serum level of bFSH(β=0.86) was sign

关 键 词：子宫内膜异位症 基础卵泡刺激素 抗苗勒管激素 获卵数 

分 类 号：R711.6[医药卫生—妇产科学] R711.71[医药卫生—临床医学]