血清E2、AMH水平对卵巢储备功能低下病人IVF-ET妊娠失败风险的预测研究

Predictive risk factors of serum E2 and AMH levels for pregnancy failure in patients with diminished ovarian reserve undergoing IVF-ET

目的:探讨血清雌二醇(E2)、抗苗勒管激素(AMH)水平对卵巢储备功能低下(DOR)病人行体外受精-胚胎移植(IVF-ET)术后妊娠结局的预测价值。方法:收集86例诊断为DOR并且行IVF-ET术的病人临床资料,根据IVF-ET术后的妊娠结局将病人分为未妊娠组(n=40)和妊娠组(n=46),分别对2组病人的临床资料进行单因素、多因素logisitic回归分析和ROC曲线分析。结果:在未妊娠组中出现FSH/LH≥1.8、窦卵泡数目<5个、获卵数<8个、血清AMH<0.6 ng/mL、血清E2<34.06 pg/mL的比例高于妊娠组(P<0.01);并且FSH/LH≥1.8、血清AMH<0.6 ng/mL和血清E2<34.06 pg/mL是DOR病人IVF-ET术后妊娠失败的独立危险因素(P<0.05~P<0.01);同时血清AMH和E2联合预测IVF-ET术后妊娠失败的ROC曲线下面积均高于AMH和E2单项的曲线下面积(P<0.01),且血清AMH和E2单独预测IVF-ET妊娠失败时,2个指标的截断值分别为0.609 ng/mL、31.63 pg/mL。结论:血清AMH与E2水平可作为DOR病人IVF-ET术后妊娠失败的预测指标,且二者联合对于预测DOR病人妊娠结局具有更好的评估价值。

Objective:To explore the predictive value of serum estradiol(E2)and anti-müllerian hormone(AMH)for pregnancy failure risk in vitro fertilization-embryo transfer(IVF-ET)patients diagnosed with diminished ovarian reserve(DOR).Methods:A total of 86 DOR patients with IVF-ET pregnancy were enrolled in this study.According to pregnancy outcomes,they were divided into non-pregnancy group(n=40)and pregnancy group(n=46).The baseline data and pregnancy outcomes were comparel between two groups.Univariate and multivariate logisitic regression analysis and ROC curve analysis were used to evaluate the value of serum E2 and AMH in predicting pregnancy failure risk.Results:In non-pregnancy group,the incidence of FSH/LH≥1.8,the number of antral follicle less than 5,the number of retrieved oocytes less than 8,serum AMH lower than 0.6 ng/mL and serum E2 lower than 34.06 pg/mL were higher than those in pregnancy group(P<0.01).And the factors such as FSH/LH≥1.8,serum AMH lower than 0.6 ng/mL and serum E2 lower than 34.06 pg/mL were independent risk factors for pregnancy failure in DOR patients(P<0.05 to P<0.01).In the meanwhile,the area under the ROC curve of serum AMH combined with E2 in predicting IVF-ET pregnancy failure was significantly higher than that with AMH and E2 alone(P<0.01).The cutoff values of serum AMH and E2 in predicting IVF-ET pregnancy failure were 0.609 ng/mL and 31.63 pg/mL,respectively.Conclusions:For DOR patients,the levels of serum AMH and E2 can be used to predict the risk of IVF-ET pregnancy failure.And the combination of serum AMH and E2 has a better evaluation value in predicting the pregnancy outcome of DOR patients.