年轻女性抗苗勒管激素水平与IVF/ICSI-ET后早期自然流产的关系分析  

Analysis of the relevance between anti-Müllerian hormone and early spontaneous abortion after IVF/ICSI-ET in young women

作　　者：张红霞 黄铄[1] 马晓伟[1] 王海燕[1] 李蓉[1] 乔杰[1] Zhang Hongxia;Huang Shuo;Ma Xiaowei;Wang Haiyan;Li Rong;Qiao Jie(Reproductive Medical Center,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》2024年第1期32-36,共5页Chinese Journal of Reproduction and Contraception

基　　金：国家杰出青年科学基金(81925013);北京大学第三医院院临床重点项目(BYSYZD2023007)。

摘　　要：目的探讨抗苗勒管激素(anti-Müllerian hormone,AMH)水平与年轻女性体外受精/卵胞质内单精子注射-胚胎移植(in vitro fertilization/intracytoplasmic sperm injection and embryo transfer,IVF/ICSI-ET)术后早期自然流产的关系。方法采用回顾性队列研究,分析2017年1月至2020年12月期间在北京大学第三医院生殖医学中心首次行IVF/ICSI-ET助孕获得妊娠的<35岁的患者资料(n=2640)。按AMH水平,根据年龄进行1∶2匹配,患者分为2组:低AMH组(AMH<1.1μg/L)880例和正常AMH组(1.1μg/L≤AMH<4.0μg/L)1760例,比较两组一般情况及早期自然流产率。采用二分类logistic回归控制混杂因素,分析AMH水平和早期自然流产的关系。结果①两组中女方年龄、男方年龄差异均无统计学意义(均P>0.05),低AMH组基础卵泡刺激素[follicle-stimulating hormone,FSH,7.1(6.1,9.2)U/L]高于正常AMH组[6.9(5.3,8.0)U/L,P<0.001],而窦卵泡计数[6(3,8)]、人绒毛膜促性腺激素(human chorionic gonadotropin,hCG)注射日雌激素水平[4446.5(2999.5,6264.1)pmol/L]、孕激素水平[1.9(1.4,2.6)nmol/L]均低于正常AMH组[9(6,12),P<0.001;6264.0(4609.5,8913.5)pmol/L,P<0.001;2.0(1.4,2.7)nmol/L,P=0.001]。低AMH组获卵数[(7.4±3.9)枚]和优质胚胎数[3(2,5)枚]均低于正常AMH组[(10.8±3.9)枚,P<0.001;4(3,7)枚,P<0.001],低AMH组单胚胎移植率[14.1%(124/880)]高于正常AMH组[8.6%(275/1760),P<0.001],两组间不孕因素构成差异有统计学意义(P<0.001)。②低AMH组早期自然流产率[12.2%(107/880)]高于正常AMH组[8.9%(156/1760),P=0.008]。两组间晚期自然流产率差异无统计学意义(P=0.631)。③二分类logistic分析调整促排卵方案、hCG注射日雌激素、孕激素水平和移植胚胎数影响后,低AMH水平(<1.1μg/L)是早期自然流产的因素之一(OR=1.343,95%CI:1.019~1.769,P=0.036)。结论在进行IVF/ICSI-ET助孕的<35岁女性中,低AMH患者有更高的早期流产率。AMH水平对于年轻女性助孕后的流产率具有一定的预测价值。Objective To explore the effect of anti-Müllerian hormone(AMH)level on early spontaneous abortion of young women with in vitro fertilization/intracytoplasmic sperm injection and embryo transfer(IVF/ICSI-ET).Methods A retrospective cohort study was performed to analyze the clinical data of the first cycle IVF/ICSI-ET women in Reproductive Medical Center,Peking University Third Hospital from January 2017 to December 2020.Totally 2640 young women(less than 35 years old,matched according to age with 1∶2 of case-control)were included in this study.They were divided into two groups according to AMH level,880 cases in low AMH group(AMH<1.1μg/L)and 1760 cases in normal AMH group(1.1μg/L≤AMH<4.0μg/L),the general characteristics and early spontaneous abortion rate between the two groups were compared.Binary logistic regression was used to control confounding factors and analyze the relationship between AMH level and early spontaneous abortion.Results (1)There was no significant difference in the age of women and men between the two groups(all P>0.05).The basal follicle-stimulating hormone[FSH,7.1(6.1,9.2)U/L]in low AMH group was significantly higher than that in normal AMH group[6.9(5.3,8.0)U/L,P<0.001],while the antral follicle count[6(3,8)],the levels of estrogen[4446.5(2999.5,6264.1)pmol/L]and progesterone[1.9(1.4,2.6)nmol/L]on human chorionic gonadotropin(hCG)injection day were lower than those in the normal AMH group[9(6,12),P<0.001;6264.0(4609.5,8913.5)pmol/L,P<0.001;2.0(1.4,2.7)nmol/L,P=0.001].The number of oocytes retrieved(7.4±3.9)and the number of high-quality embryos[3(2,5)]in low AMH group were significantly lower than those in normal AMH group[10.8±3.9,P<0.001;4(3,7),P<0.001],and the single embryo transfer rate in low AMH group[14.1%(124/880)]was significantly higher than that in normal AMH group[8.6%(275/1760),P<0.001].There was a significant difference in infertility factors between the two groups(P<0.001).(2)The rate of early spontaneous abortion[12.2%(107/880)]in low AMH group was significantly h

关 键 词：抗苗勒管激素 生殖技术 辅助 卵巢储备功能下降 早期自然流产 

分 类 号：R714.21[医药卫生—妇产科学]