抗苗勒管激素水平与卵巢反应性的相关性分析

Analysis of the Correlation between Anti-Müllerian Hormone and Ovarian Responses

目的:探讨育龄期女性抗苗勒管激素(AMH)水平与卵巢反应性的关系。方法:选择第一周期进行体外受精-胚胎移植(IVF-ET)治疗的患者1445例,在启动周期前采用酶联免疫吸附法(ELISA)检测患者血清AMH水平,用超声诊断仪检测卵巢窦卵泡计数(AFC),并结合年龄、体质量指数(BMI)等因素,计算其在卵巢低反应组(获卵数≤3个)和卵巢高反应组(获卵数>15个)的受试者工作特征(ROC)曲线下面积(AUC)。结果:Spearman相关及多元线性回归分析均显示,获卵数与AFC和AMH呈显著正相关(P<0.05),与年龄和方案选择呈显著负相关(P<0.05);多元线性回归分析示获卵数与BMI无明显相关性(P>0.05)。预测卵巢低反应时,AFC和AMH的AUC(分别是0.926和0.883)明显大于BMI和年龄的AUC(分别是0.454和0.181),AMH预测值为1.47μg/L,AFC的预测值为8个。预测卵巢高反应时,AFC和AMH的AUC(分别是0.764和0.759)明显大于BMI和年龄的AUC(分别是0.433和0.389),AMH的预测值为3.35μg/L,AFC的预测值为14个。结论:育龄期女性血清AMH水平与获卵数具有较强的相关性,能独立预测患者的卵巢反应性,且联合超声检测AFC可指导临床医生合理选择促排卵方案,获得优质胚胎,有效指导其生育。

Objective:To investigate the relationship between the levels of anti-mullerian Hormone(AMH)and ovarian responses in reproductive women.Methods:A total of 1445 patients in the first cycle in vitro fertilization-embryo transfer(IVF-ET)were enrolled.The serum AMH level in patients were detected by enzyme-linked immunosorbent(ELISA),and ovarian antral follicle count(AFC)were tested by ultrasound before launching cycle.Combined with the factors such as age,body mass index(BMI),area under the curve of receiver operating characteristic(ROC-AUC)was calculated in poor ovarian response group(the number of retrieved oocytes≤3)and high ovarian response group(the number of retrieved oocytes>15).Results:Spearman correlation and multiple linear regression analysis showed that the number of retrieved oocytes was strongly positive correlation with AMH and AFC(P<0.05),and negatively correlated with age and the promotion scheme(P<0.05).Multiple linear regression analysis showed that there was no significantly correlation between the number of retrieved oocytes and BMI(P>0.05).AUC of AFC and AMH(0.926 and 0.883,respectively)were significantly greater than AUC of BMI and age(0.454 and 0.181,respectively)in prediction of poor ovarian response.The predictive value of AMH was 1.47μg/L,and the predictive value of AFC was 8 for predicting poor ovarian response.AUC of AFC and AMH(0.764 and 0.759,respectively)was significantly greater than AUC of the BMI and age(0.433 and 0.389,respectively)in high ovarian response.The predictive value of AMH was 3.35μg/L,and the predictive value of AFC was 14 for predicting high ovarian response.Conclusions:The serum AMH level in reproductive women was strongly correlated with the number of retrieved oocytes,which can independently predict the ovarian response.Moreover,combined with ultrasonic detecting of AFC,it can guide clinicians to reasonably choose the promotion scheme,obtain high-quality embryos and effectively guide their fertility.