基于广义相加模型分析血清AMH对ART治疗中获卵数和累计活产结局的效应研究  

Effect of serum AMH level on number of oocytes retrieved and cumulative pregnancy rate based on generalized additive model

作　　者：张玲 周佳 吕松杰 潘晖 ZHANG Ling;ZHOU Jia;LU Song-jie;PAN Hui(Urumqi Youai Hospital,Urumqi 830000)

机构地区：[1]乌鲁木齐友爱医院,乌鲁木齐830000

出　　处：《生殖医学杂志》2023年第8期1140-1149,共10页Journal of Reproductive Medicine

基　　金：新疆维吾尔自治区自然科学基金项目(2021D01B22)。

摘　　要：目的利用广义相加模型(GAM)分析血清抗苗勒管激素(AMH)水平与辅助生殖技术(ART)治疗中不同阶段结局指标(获卵数与累积活产)的非线性关系。方法回顾性分析2016年1月至2021年12月在我院行IVF/ICSI治疗的不孕症女性患者的临床资料,共纳入653例患者(653个周期)。根据年龄不同分为<35岁的年轻组(457例)和≥35岁的高龄组(196例),比较两组患者的基本资料及治疗指标,利用单因素GAM和经协变量校正的多因素GAM分别拟合AMH与获卵数、单次取卵累积活产的关系模型,分析AMH的非线性效应及意义。结果纳入研究的653例患者的年龄范围21~47岁,所有周期的累积活产率为40.7%。年轻组的累积活产率为44.0%,高龄组的累积活产率为33.2%。GAM结果显示,血清AMH水平与获卵数存在非线性效应。年轻人群中,经协变量校正后,AMH非参数部分的有效自由度(EDF)为3.485(P<0.001);随着AMH增加,其对获卵数产生的效应呈持续正向关联,且在<2.7 ng/ml或>5.8 ng/ml时效应显著上升。在高龄人群中,经协变量校正后,AMH非参数部分的EDF为2.660(P<0.001),且关联呈倒U型,在4~6 ng/ml时效应值最大。血清AMH与累积活产率存在的关联没有统计学意义,在年轻组中,经协变量校正后AMH提供的EDF为1.000,表现为直线效应,且无统计学意义(P=0.878);在高龄组中,AMH提供的EDF为3.265,但曲线效应无统计学意义(P=0.301)。结论在ART治疗中,AMH水平与获卵数呈现非线性关联,在不同年龄组中AMH的效应趋势变化不同,AMH可以作为获卵数的独立预测因素;但无论哪个年龄段,AMH水平对累积活产的效应有限。Objective:To explore the nonlinear correlation between serum level of anti-Müllerian hormone(AMH)and ART outcomes including number of oocytes retrieved and cumulative pregnancy rate at different stages by using generalized additive model(GAM).Methods:The clinical data of infertile female patients included 653 patients(653 cycles),who underwent IVF/ICSI treatment in our hospital from January 2016 to December 2021,were retrospectively analyzed.The patients were divided into young group(<35 years old,n=457)and elderly group(≥35 years old,n=196)based on age.The basic data and treatment indicators of the patients of two groups were compared.Using single factor GAM and multivariate GAM corrected by covariates to fit the relational model between AMH level and the number of oocytes retrieved or the cumulative live birth rate of single oocytes retrieval respectively,to analyze the nonlinear effect and significance of AMH level.Results:A total of 653 patients aged 21-47 years old were enrolled.The cumulative live birth rate of all cycles was 40.7%.The cumulative live birth rate of the young group was 44.0%,while that of the elderly group was 33.2%.GAM results showed that serum AMH level had a nonlinear effect on number of oocytes retrieved.In the young group,the effective degree of freedom(EDF)of non-parametric part of AMH was 3.485 after covariate correction(P<0.001).With the increase of AMH level,its effect on number of oocytes retrieved showed a continuous positive correlation,and the effect increased significantly at<2.7 or>5.8 ng/ml.In the elder group,the effective degree of freedom of the non-parametric part of AMH was 2.660 after covariate correction(P<0.001),and the correlation presented inverted U-shaped,with the maximum effect value at 4-6 ng/ml.Meanwhile,the correlation between serum AMH level and cumulative live birth rate was not significant.In the young group,the effective degree of freedom provided by AMH after covariable-adjusted was 1.000,which showed a linear correlation and had no statistical signific

关 键 词：抗苗勒管激素 累积活产率 广义相加模型 获卵数 

分 类 号：R711.6[医药卫生—妇产科学]