血清抗缪勒管激素联合孕酮、雌二醇预测卵巢早衰治疗后妊娠失败的价值分析

Analysis on the value of serum anti-Müllerian hormone combined with progesterone,estradiol in predicting pregnancy failure after treatment in patients with premature ovarian failure

目的分析血清抗缪勒管激素(AMH)联合孕酮(P)、雌二醇(E2)预测卵巢早衰(POF)治疗后妊娠失败的价值.方法选择2017年1月-2019年1月于该院接受治疗的POF患者152例,根据治疗后妊娠结局将患者分为妊娠成功组(58例)与妊娠失败组(94例),检测并比较两组患者血清AMH、P、E2以及卵泡刺激素(FSH)、卵泡数(AFC)水平,分析血清AMH、P、E2与FSH、AFC的相关性,绘制ROC曲线分析AMH、P、E2以及联合检测对POF治疗后妊娠失败的预测价值.结果妊娠失败组血清AMH、P、E2以及AFC水平显著低于妊娠成功组(P<0.05),FSH水平显著高于妊娠成功组(P<0.05);Pearson相关性分析显示,血清AMH、P、E2与AFC呈正相关(r=0.51、0.42、0.36,P<0.05),与FSH呈负相关(r=-0.43、-0.33、-0.38,P<0.05);根据ROC曲线可知,AMH诊断POF治疗后妊娠失败的AUC为0.910,95% CI为0.853 ~ 0.967,P诊断的AUC为0.833,95% CI为0.766 ~0.900,E2诊断的AUC为0.866,95% CI为0.811 ~0.922,联合检测诊断的AUC为0.913,95% CI为0.859 ~0.967,联合检测对POF治疗后妊娠失败预测价值最高.联合检测评估POF治疗后妊娠失败的灵敏度、特异度优于AMH、P、E2单独检测.结论POF治疗后妊娠失败患者血清AMH、P、E2水平明显降低,AMH联合P、E2诊断价值高于各指标单独检测,三者联合诊断对POF治疗后妊娠失败具有一定的预测价值.

Objective To analyze the value of serum anti-Müllerian hormone(AMH)combined with progesterone(P),estradiol(E2)in predicting pregnancy failure after treatment in patients with premature ovarian failure(POF).Methods From January 2017 to January 2019,152 patients with POF treated in Yongkang Municipal Maternal and Child Health Care Hospital were selected and divided into successful pregnancy group(58 patients)and pregnancy failure group(94 patients)according to pregnancy outcome.The levels of serum AMH,P,E2,follicle-stimulating hormone(FSH),antral follicle count(AFC)in the two groups were detected and compared.The correlations between serum AMH,P,E2 and serum FSH,AFC were analyzed.ROC curve was drawn to analyze the predictive value of single detection and joint detection of AMH,P,E2 in predicting pregnancy failure after treatment in POF patients.Results The levels of serum AMH,P,E2,and AFC in pregnancy failure group were statistically significantly lower than those in successful pregnancy group(P<0.05),the level of serum FSH in pregnancy failure group was statistically significantly higher than that in successful pregnancy group(P<0.05).Pearson correlation analysis showed that serum AMH,P,E2 were positively correlated with AFC(r=0.51,0.42,0.36,P<0.05)and negatively correlated with FSH(r=-0.43,-0.33,-0.38,P<0.05).AUC and 95%CI of AMH in predicting pregnancy failure after treatment in POF patients were 0.910 and 0.853-0.967,respectively;AUC and 95%CI of P in predicting pregnancy failure after treatment in POF patients were 0.833 and 0.766-0.900,respectively;AUC and 95%CI of E2 in predicting pregnancy failure after treatment in POF patients were 0.866 and 0.811-0.922,respectively;AUC and 95%CI of joint detection in predicting pregnancy failure after treatment in POF patients were 0.913 and 0.859-0.967,respectively.The value of joint detection in predicting pregnancy failure after treatment in POF patients was the highest.The sensitivity and specificity of joint detection in predicting pregnancy failure after treatment in POF patients were superior to single detection of AMH,P,E2.Conclusion The levels of serum AMH,P,and E2 in POF patients of pregnancy failure after treatment decrease significantly,the diagnostic value of joint detection of AMH,P,E2 is superior to single detection.Joint detection of AMH,P,E2 has a certain value in predicting pregnancy failure after treatment in POF patients.