抗苗勒管激素在辅助生殖技术中预测卵巢反应性的价值

The prediction study of ovarian response by anti-Müllerian hormone in ART

目的:探讨抗苗勒管激素(anti-Mllerian hormone,AMH/MIS)在辅助生殖技术中预测卵巢反应性的价值。方法:按纳入标准选择80例第一次接受IVF-ET治疗的患者,于启动周期月经第2天用酶联免疫吸附法(ELISA)测定血清AMH水平;电化学免疫发光法测定基础血清FSH、LH、E2、T、PRL。同时用超声诊断仪为卵巢窦卵泡计数。记录促性腺激素总量、获卵数等。结果:(1)卵巢低反应组(n=14)与正常反应组(n=66)基础AMH水平分别为0.38±0.27ng/ml、2.10±1.25ng/ml,差异有统计学意义(P<0.05);(2)获卵数与基础血清AMH、窦状卵泡数(AFC)呈正相关,相关系数分别为0.776,0.577,与FSH、FSH/LH呈负相关,相关系数分别为-0.405,-0.528。多元线性回归分析各项指标对获卵数的影响按序依次为基础血清AMH、AFC、FSH、FSH/LH、年龄;(3)基础血清AMHROCAUC为0.961。卵巢低反应的基础血清AMHCut-off值为0.562ng/ml时,其灵敏度可达96%、特异性86%,阳性预测值92.3%,阴性预测值97%。结论:辅助生殖技术中基础血清AMH水平与目前临床常用指标相比,预测卵巢反应性的诊断价值最高,且灵敏、简便、经济。

Objective：To explore the value of anti-Mtillerian hormone （AMH/MIS） to predict ovarian response in IVF women. Methods：Eighty infertile women who had underwent the first cycle IVF-ET were recruited. Serum levels of AMH, E2, FSH, LH ,T and PRL were tested at cycle day 2, and antral follicle count（AFC） was estimated by ultrasound scanning. The information of retrieved oocytes number, mature oocytes and high quality embryos were also collected. Results： （1）Median serum AMH levels in the low and normal response group were （0.38±0.27ng/ml vs 2.10±1.25ng/ml） ,and the mean AMH levels had statistical significant difference in each group. （2）Linear correlation analysis showed that the oocytes retrieved was positively correlated to basal AMH level and AFC （ r = 0. 776, r = 0. 577 ） , however, it had nega- tive correlation to basal FSH level and FSH/LH（ r=-0. 405 ,r=-0. 528 ）. （3）Multivariate regression analysis demonstrated that the contribution of number of retrieved oocytes was mainly contributed by day 2 serum AMH, then was AFC, FSH, FSH/LH and age. （4）The AMH＇s ROCACC was 0.961. When 0. 562ng/ml was selected as the AMH cut-off value,the sensitivity was 96% and specificity was 86%. the positive predictive value was 92.3% and negative pre- dictive value 97%. Conclusious：Cycle day 2 serum AMH/MIS level is a better predictor of ovarian response in comparison with other currently available markers in ART.