胚胎植入前非整倍体遗传学检测患者血清抗苗勒管激素水平与囊胚整倍体率的相关性研究  

Relationship between serum anti-Müllerian hormone and rate of euploid blastocysts in patients undergoing preimplantation genetic testing for aneuploidies(PGT-A)

作　　者：李珊 黄铄[1] 胡凯伦 黄锦[1] 陈立雪[1] 李蓉[1] Li Shan;Huang Shuo;Hu Kailun;Huang Jin;Chen Lixue;Li Rong(Reproductive Medicine Center of Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院生殖医学中心,北京100191

出　　处：《中华生殖与避孕杂志》2023年第5期483-489,共7页Chinese Journal of Reproduction and Contraception

基　　金：北京市科技计划项目(Z191100006619076);国家杰出青年科学基金(81925013)。

摘　　要：目的分析卵胞质内单精子注射(intracytoplasmic sperm injection,ICSI)后进行胚胎植入前非整倍体遗传学检测(preimplantation genetic testing for aneuploidies,PGT-A)的患者中,其血清抗苗勒管激素(anti-Müllerian hormone,AMH)水平对囊胚整倍体率及整倍体胚胎数量的影响。方法采用回顾性队列研究,收集2018年1月1日至2020年12月31日期间于北京大学第三医院生殖医学中心行ICSI并进行PGT-A的504例患者的临床资料。根据促排卵治疗前血清AMH水平,将研究对象分为低AMH组(AMH<1.00μg/L,85例)与正常AMH组(AMH≥1.00μg/L,419例)。采用倾向评分匹配方法,基于年龄、体质量指数(body mass index,BMI)、复发性流产病史、促排卵方案进行1∶1匹配(卡钳值=0.02),匹配后比较两组患者(每组各82例)的囊胚整倍体率及整倍体囊胚数量。应用受试者工作特征(receiver operator characteristic,ROC)曲线评估AMH水平对PGT-A周期存在至少一个整倍体胚胎的预测作用。结果①低AMH组胚胎整倍体率[50.0%(0,100.0%)]及整倍体胚胎数[1(0,1)个]显著低于正常AMH组[60.0%(33.3%,100.0%),P=0.025;1(1,2)个,P<0.001]。②匹配后低AMH组和正常AMH组患者的胚胎整倍体率分别为50.0%(0,100.0%)、50.0%(19.2%,100.0%),组间差异无统计学意义(P=0.265),低AMH组患者的整倍体囊胚数[1(0,1)个]低于正常AMH组[1(1,2)个,P=0.004],低AMH组中至少存在一个整倍体囊胚的周期比例[57.3%(47/82)]显著低于正常AMH组[76.8%(63/82),P=0.008]。③共378个(75.0%)周期得到至少一个可移植整倍体胚胎。AMH与年龄联合预测存在至少一个整倍体胚胎的曲线下面积(area under the curve,AUC,0.78)较单一指标年龄的AUC值更优(0.75,P=0.024)。结论在调整年龄、BMI、复发性流产病史、促排卵方案等因素的影响下,血清AMH水平与PGT-A囊胚整倍体率无关。年龄结合血清AMH可用于预测每促排卵周期存在至少一个整倍体胚胎的可能性。Objective To analyze the impact of serum anti-Müllerian hormone(AMH)on the rate and number of euploid blastocysts among women undergoing intracytoplasmic sperm injection(ICSI)and preimplantation genetic testing for aneuploidies(PGT-A).Methods A retrospective cohort study was performed by analyzing clinical data from 504 patients approaching ICSI cycle with PGT-A in Reproductive Medicine Center of Peking University Third Hospital from January 1st 2018 to December 31st 2020.According to serum AMH level measured before ovarian stimulation,subjects were divided into two groups:the low AMH group(AMH<1.00μg/L,85 patients)and the normal AMH group(AMH≥1.00μg/L,419 patients).Rates and number of euploid blastocysts were compared between the two groups(82 patients per group)after using propensity score matching(PSM)to adjust confounding variables,including age,body mass index(BMI),history of recurrent miscarriage and ovarian stimulation protocols.Results 1)The rate and number of euploid blastocysts were significantly lower in the low AMH group[50.0%(0,100.0%),1(0,1)]than in the normal AMH group[60.0%(33.3%,100.0%),P=0.025;1(1,2),P<0.001].2)After PSM,the rate of euploid blastocysts was 50.0%(0,100.0%)in the low AMH group and 50.0%(19.2%,100.0%)in the normal AMH group,with no significant difference(P=0.265).Patients in the low AMH group had significantly fewer euploid blastocysts[1(0,1)vs.1(1,2),P=0.004]and were less likely to have at least one euploid blastocyst[57.3%(47/82)vs.76.8%(63/82),P=0.008].3)A total of 378(75.0%)cycles had at least one euploid embryo.The area under the curve(AUC)value of AMH combined with age in predicting the presence of at least one euploid embryo was better than that of age alone(0.78 vs.0.75,P=0.024).Conclusion Serum AMH level is not independently associated with the rate of blastocyst euploidy after adjusting for age,BMI,history of recurrent abortion and ovulation induction protocol.AMH combined with age can be used to predict the possibility of having at least one euploid embryo per cycle

关 键 词：倾向性评分 抗苗勒管激素 非整倍体 胚胎植入前非整倍体遗传学检测 

分 类 号：R714.8[医药卫生—妇产科学]