血清、宫颈黏液抗米勒管激素、MMP/TIMP平衡结合阴道超声检查在二胎备孕妇女卵巢储备功能评估中的应用  

Evaluation of ovarian reserve function in women preparing for a second child by anti⁃Müllerian hormone and MMP/TIMP in serum and cervical mucus combined with transvaginal ultrasound

作　　者：梁坤铃 茹银转 叶燕霞 Liang Kunling;Ru Yinzhuan;Ye Yanxia(Clinical Laboratory,Dongguan Shijie Hospital,Dongguan 523290,China)

机构地区：[1]东莞市石碣医院检验科,广东东莞523290 [2]东莞市石碣医院院感办,广东东莞523290 [3]东莞市第八人民医院妇产科

出　　处：《海军医学杂志》2024年第7期715-719,共5页Journal of Navy Medicine

基　　金：东莞市社会发展科技项目(20211800902202)。

摘　　要：目的研究血清、宫颈黏液抗米勒管激素(AMH)、基质金属蛋白酶(MMP)/金属蛋白酶组织抑制因子(TIMP)平衡结合阴道超声检查在二胎备孕妇女卵巢储备功能评估中的应用价值。方法纳入研究对象共76例,为2021年11月至2022年9月于东莞市石碣医院接受孕前检查的二胎备孕妇女。对所有受试者均开展阴道超声检查,并按照超声窦卵泡个数的差异分成正常组(卵巢功能正常,窦卵泡个数≥5个)32例及低下组(卵巢功能低下,窦卵泡个数<5个)44例。比较2组各项阴道超声参数,以及血清、宫颈黏液AMH和MMP/TIMP水平。采用Pearson线性相关法分析患者阴道超声参数、血清、宫颈黏液AMH、MMPs/TIMPs参数水平与窦卵泡个数的关系。通过受试者操作特征(ROC)曲线分析阴道超声参数及血清、宫颈黏液AMH、MMP/TIMP水平单独和联合诊断卵巢功能低下的效能。结果低下组子宫内膜厚度及卵巢容积分别为(3.83±1.17)mm、(5.59±1.34)cm³,相较于正常组[(4.54±1.52)mm、(7.62±2.41)cm³]更低(均P<0.05)。低下组血清AMH水平为(2.11±0.65)ng/ml,相较于正常组(4.65±3.78)ng/ml更低(P<0.05);而低下组和正常组的宫颈黏液AMH均为(0.08±0.02)ng/ml,差异无统计学意义(P>0.05)。低下组血清、宫颈黏液MMP/TIMP水平分别为1.19±0.65、1.34±0.32,相较于正常组(1.07±0.09、1.10±0.27)更高(均P<0.05)。经Pearson相关分析发现,低下组窦卵泡个数与子宫内膜厚度、卵巢容积及血清AMH水平均呈正相关,而与血清、宫颈黏液MMP/TIMP水平均呈负相关(均P<0.05)。经ROC曲线分析发现,阴道超声参数、血清AMH、血清和宫颈黏液MMP/TIMP水平联合诊断卵巢功能低下ROC曲线下面积为0.869,高于于各项指标单独诊断(均P<0.05)。结论血清AMH、血清和宫颈黏液MMP/TIMP平衡结合阴道超声检查在二胎备孕妇女卵巢储备功能评估中的应用价值较高。Objective To investigate the value of anti⁃Müllerian hormone(AMH)in serum and cervical mucus,matrix metalloproteinases(MMPs)/tisszle inhibitor of metalloproteinase(TIMPs)combined with transvaginal ultrasound in evaluating ovarian reserve function in women preparing for a second child.Methods A total of 76 women who underwent pre⁃pregnancy examination and second pregnancy preparation in the Dongguan Shijie Hospital from November 2021 to September 2022 were included in the study.All the subjects underwent transvaginal ultrasound examination,and they were divided into normal group(n=32,normal ovarian function,antral follicle count≥5)and low group(n=44,ovarian hypofunction,antral follicle count<5)according to the number of sinus follicles.The transvaginal ultrasound parameters,AMH in serum and cervical mucus,and MMPs/TIMPs were compared between the two groups.Pearson linear correlation was used to analyze the relationships between ultrasound parameters,AMH in serum and cervical mucus,MMPs/TIMPs and antral follicle count.The receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficacies of transvaginal ultrasound parameters,AMH in serum and cervical mucus,MMP/TIMP alone and their combination for ovarian hypofunction.Results The endometrial thickness and ovarian volume of the low group were(3.83±1.17)mm and(5.59±1.34)cm³,respectively,which were lower than those of the normal group([4.54±1.52]mm,[7.62±2.41]cm³,both P<0.05).Serum AMH level in the low group was lower than that in the normal group([2.11±0.65]ng/ml vs[4.65±3.78]ng/ml,P<0.05).There was no significant difference in the cervical mucus AMH between the two groups(both[0.08±0.02]ng/ml,P>0.05).The MMPs/TIMPs in serum and cervical mucus of the low group were 1.19±0.65 and 1.34±0.32,which were higher than those of the normal group(1.07±0.09 and 1.10±0.27,both P<0.05).Pearson correlation analysis showed that antral follicle count was positively correlated with endometrial thickness,ovarian volume and serum AMH level,and

关 键 词：抗米勒管激素 卵巢功能低下 基质金属蛋白酶 基质金属蛋白酶抑制剂 阴道超声 

分 类 号：R446.1[医药卫生—诊断学]