不同血清抗米勒管激素水平下促性腺激素剂量对多囊卵巢综合征患者卵泡期长效长方案妊娠结局的影响  

Effects of gonadotropin dose on pregnancy outcome in patients with polycystic ovary syndrome by using long-acting GnRH agonist long protocol in follicular phase under different serum anti-mullerian hormone levels

作　　者：杨乐蓝 赵冬梅[1] 王亚芹 谭丽[1] 项云改[1] 程兰兰 YANG Lelan;ZHAO Dongmei;WANG Yaqin;TAN LI;XIANG Yungai;CHENG Lanlan(Reproductive Medicine Center,the Second Affiliated Hospital,Zhengzhou University,Zhengzhou 450014)

机构地区：[1]郑州大学第二附属医院生殖医学部,郑州450014

出　　处：《郑州大学学报（医学版）》2022年第5期699-703,共5页Journal of Zhengzhou University(Medical Sciences)

基　　金：河南省科技厅科技攻关项目(182102310425)。

摘　　要：目的:探讨多囊卵巢综合征(PCOS)患者在卵泡期长效长方案助孕治疗中,血清抗米勒管激素水平(AMH)水平和促性腺激素(Gn)剂量对妊娠结局的预测价值。方法:选取2019年3月至2022年3月在郑州大学第二附属医院生殖医学部就诊接受体外受精-胚胎移植(IVF-ET)助孕治疗行卵泡期长效长方案的PCOS患者420例,根据血清AMH水平分为3组:低AMH水平组(血清AMH<5.01μg/L,n=105)、中AMH水平组(血清AMH 5.01~9.09μg/L,n=210)、高AMH水平组(血清AMH>9.09μg/L,n=105),比较3组的妊娠结局。采用Logistic回归分析不同AMH水平组临床妊娠的影响因素。采用ROC曲线分析低、中AMH水平组Gn剂量对临床妊娠的预测价值。结果:低AMH水平组Gn剂量高于中、高AMH水平组;高AMH水平组HCG日E2水平、获卵数及卵巢过度刺激综合征高风险周期取消率高于低、中水平组;高AMH水平组新鲜周期移植率低于低、中水平组(P<0.05)。Logistic回归结果显示低、中AMH水平组Gn剂量是PCOS患者临床妊娠的影响因素。ROC曲线显示在低AMH水平组,Gn剂量对临床妊娠影响的AUC为0.707(95%CI为0.604~0.810),Gn剂量最佳截断值为2789 IU,敏感度为0.828,特异度为0.605;在中AMH水平组,Gn剂量对临床妊娠影响的AUC为0.616(95%CI为0.540~0.692),Gn剂量最佳截断值为2220 IU,敏感度为0.692,特异度为0.552。结论:低、中AMH水平组Gn剂量对妊娠结局有一定的预测价值。Aim:To investigate the predictive value of serum anti-mullerian hormone(AMH)level and gonadotropin(Gn)dose on pregnancy outcome in patients with polycystic ovary syndrome(PCOS)by using long-acting GnRH agonist long protocol in follicular phase.Methods:A total of 420 patients with PCOS who underwent in vitro fertilization-embryo transfer(IVF-ET)by using the long-acting GnRH agonist long protocol in follicular phase in the Reproductive Medicine Center of the Second Affiliated Hospital of Zhengzhou University,from March 2019 to March 2022 were collected in this study.According to serum AMH level,the PCOS patients were allocated into 3 groups:low AMH level group(AMH level<5.01μg/L,n=105),medium AMH level group(AMH level 5.01-9.09μg/L,n=210),high AMH level group(AMH level>9.09μg/L,n=105).The pregnancy outcome was compared among the 3 groups.Logistic regression analysis was used to analyze the relationship between AMH level,Gn dose and clinical pregnancy.ROC curve was used to analyze the predictive value of Gn dose on clinical pregnancy in the low and medium AMH level groups.Results:Gn dose in the low AMH level group were significantly higher than those in the medium/high level groups(P<0.05);the E2 level on HCG day,the number of oocytes retrieved and the OHSS high-risk cycle cancellation rate in the high AMH level group were significantly higher than those in the low/medium level group while the fresh cycle transplantation rate was lower(P<0.05);Logistic regression analysis results showed that in the low/medium AMH level groups,Gn dose was the influencing factor of clinical pregnancy in PCOS patients.ROC curve showed that in the low AMH level group,the AUC of the effect of Gn on clinical pregnancy was 0.707(95%CI was 0.604-0.810),the best cut-off value of Gn dose was 2789 IU,the sensitivity was 0.828,and the specificity was 0.605;in the medium AMH level group,the AUC of the effect of Gn on clinical pregnancy was 0.616(95%CI was 0.540-0.692),the best cut-off value of Gn dose was 2220 IU,the sensitivity was 0.692,and

关 键 词：多囊卵巢综合征 抗米勒管激素 促性腺激素 控制性促排卵 卵巢过度刺激综合征 妊娠 

分 类 号：R711.6[医药卫生—妇产科学]