FSH/LH、25(OH)D及AMH对卵巢储备功能及体外受精-胚胎移植结局的预测  

Prediction of ovarian reserve function and in vitro fertilization-embryo transfer outcome by FSH/LH,25(OH)D and AMH

作　　者：吴媛媛[1] 张瑜[1] 李朋粉[1] WU Yuanyuan;ZHANG Yu;LI Pengfen(Department of Reproductive Medicine,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan,China,450014)

机构地区：[1]郑州大学第二附属医院生殖医学部,河南郑州450014

出　　处：《分子诊断与治疗杂志》2024年第10期1867-1870,1875,共5页Journal of Molecular Diagnostics and Therapy

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20230319)。

摘　　要：目的探讨卵泡刺激素/黄体生成素(FSH/LH)、25-羟维生素D[25(OH)D]及抗苗勒氏管激素(AMH)对卵巢储备功能及体外受精-胚胎移植(IVF-ET)结局的预测价值。方法选取2020年8月至2022年9月于郑州大学第二附属医院行IVF-ET助孕女性112例,根据获卵数分为3个亚组:低反应组(获卵个数≤3个)36例、正常反应组(获卵个数4~15个)48例,高反应组(获卵个数≥16个)28例。对比不同卵巢反应者FSH/LH、25(OH)D、AMH水平;根据COH方案治疗后14 d人绒毛膜促性腺激素(β-HCG)水平,判断患者妊娠结局,收集不同妊娠结局患者临床资料[年龄、不孕类型、不孕病程、优质胚胎数、获卵总个数、受精率、移植胚胎数、LH/FSH、25(OH)D及AMH水平];采用二元Logistic回归分析影响不良妊娠结局的危险因素;计算FSH/LH、25(OH)D、AMH单一及联合对患者不良结局的预测效果。结果不同卵巢反应者中FSH/LH、25(OH)D及AMH水平比较:高反应组>正常反应组>低反应组,差异具有统计学意义(P<0.05)。112例患者中,正常妊娠组77例和非正常妊娠组35例。两组不孕类型、优质胚胎数、不孕病程、获卵总个数、受精率比较差异无统计学意义(P>0.05);两组Gn用量、年龄、移植胚胎数、FSH/LH、25(OH)D及AMH水平比较差异具有统计学意义(P<0.05)。二元Logistic回归分析显示:Gn用量(≥2014.58 U)、年龄(≥39岁)、FSH/LH(≥1.8)、移植胚胎数(≥1.34个)、25(OH)D(≥25.05μg/L)及AMH(≥2.92 ng/mL)为影响妊娠结局的独立危险因素(P<0.05)。ROC结果显示,FSH/LH、25(OH)D、AMH联合预测妊娠结局的敏感度和特异度分别为0.812、0.755,AUC=0.827(95%CI:0.731~0.923),明显高于三指标单独预测(P<0.05)。结论FSH/LH、25(OH)D、AMH水平在高卵巢反应中呈升高状态,三者可作为监测、预防行IVF-ET助孕女性不良妊娠结局的重要指标,且联合预测价值更高。Objective To explore the predictive value of ovarian reserve function and the outcome of in vitro fertilization embryo transfer(IVF-ET)by follicle stimulating hormone/Luteinizing hormone(FSH/LH),25-hydroxyvitamin D(25(OH)D)and Anti Miillerian Hormone(AMH)detection.Methods 112 pregnant women who underwent IVF-ET assisted pregnancy in the Second Affiliated Hospital of Zhengzhou University from August 2020 to September 2022 were selected,the assisted pregnancy were divided into 3 subgroups according to the number of eggs retrieved:low response group(number of retrieved eggs≤3)with 36 cases,normal response group(number of retrieved eggs 4-15)with 48 cases,the high response group(number of retrieved eggs≥16)with 28 cases.The FSH/LH,25(OH)D,and AMH levels of patients with different ovarian responders were compared;judged the pregnancy outcomes of patients based on the human chorionic gonadotropin(β-HCG)levels 14 days after treatment with the COH regimen,and collected clinical data of patients with different pregnancy outcomes[age,type of infertility,duration of infertility,number of high-quality embryos,total number of retrieved eggs,fertilization rate,number of transplanted embryos,LH/FSH,25(OH)D and AMH levels];the binary Logistic regression analysis was used to risk factors affecting adverse pregnancy outcomes;the predictive value of FSH/LH,25(OH)D,and AMH alone and combined on adverse pregnancy outcomes was analyzed.Results Comparison of FSH/LH,25(OH)D and AMH levels among different ovarian responders:high response group>normal response group>low response group,the difference was statistically significant(P<0.05).Among the 112 patients,77 were in the normal pregnancy group and 35 were in the abnormal pregnancy group.There was no statistically significant difference in the type of infertility,number of highquality embryos,duration of infertility,total number of retrieved eggs,and fertilization rate between the two groups(P>0.05);there were statistically significant differences in Gn dosage,age,number of transpl

关 键 词：卵泡刺激素/黄体生成素 25-羟维生素D 卵巢储备功能 抗苗勒氏管激素 体外受精-胚胎移植 

分 类 号：R714.8[医药卫生—妇产科学]