抗苗勒管激素评估促排卵治疗中卵巢反应性的临床应用

Clinical applications of anti-müllerian hormone in evaluating ovarian responses on ovulation induction

目的筛选促排卵治疗中对卵巢反应性预测准确率较高的指标。方法回顾性分析2018年1-12月于该院妇产科生殖医学中心接受辅助生殖助孕治疗的549例女性患者为研究对象,并根据获卵数将卵巢反应性分为高反应组(n=125)、正常反应组(n=336)及低反应组(n=88),对不同组建立Logistic回归模型,在年龄、体质量指数(BMI)、窦卵泡数(AFC)、促卵泡激素(FSH)及抗苗勒管激素(AMH)中筛选预测指标。以2019年1-5月的992例患者资料为依据对筛选后的预测指标进行验证。结果3组患者年龄、AFC、AMH比较,差异均有统计学意义(P<0.05)。用AMH预测卵巢低反应和高反应的cut-off值分别为1.87、5.22 ng/mL,且AMH对卵巢低反应的预测价值优于卵巢高反应。AMH联合年龄和(或)FSH后并不能明显提高AMH的预测效能。结论血清AMH是促排卵治疗中预测卵巢反应性的一个较为可靠的指标,各实验室根据各自的检测方法拟定各自的检测阈值非常必要,其在该实验室条件下的cut-off值对临床卵巢反应性的控制具有重要的指导意义。

Objective To explore and select the predictive indicators with higher accuracy of ovarian response on ovulation induction.Methods A retrospective analysis of basic clinical information and treatment outcome among 549 cases of female patients who accepted assisted reproduction technology treatment in Reproductive Medicine Centre of the First Affiliated Hospital of Army Military Medical University during January to December in 2018.All cycles were divided into three groups according to the ovarian response based on the number of retrieved oocytes,including high response(125 cases),poor response(88 cases),normal response(336 cases).The Logistic regression model was applied to different groups to screen the predictive indicators from age,body mass index(BMI),antral follicle count(AFC)and basal follicle stimulating hormone(FSH),serum anti-müllerian hormone(AMH).The results were tested and verified in 992 cases from January to May in 2019.Results The differences on age,AFC and AMH among three groups were significant(P<0.05).The cut-off value of AMH in predicting ovarian response and high ovarian response were 1.87,5.22 ng/mL respectively.The predictive value of AMH for low ovarian response was superior to high ovarian response.AMH combined with age and or FSH did not seem to have significant improvement to predict ovarian response.Conclusion AMH was a relatively reliable indicator in ovarian response prediction of ovulation induction.It is essential for each testing center to set its own cut-off value according to different testing methods and situations.The cut-off values under this experiment condition have a critical meaning as a guidance to the clinical application for ovarian response controlling.