女性HBV携带者循环HBV DNA载量与AMH水平及IVF-ET助孕结局的关系

Relationship between circulating HBV DNA load and AMH level and IVFET assisted pregnancy outcome in female HBV carriers

目的探讨女性乙型肝炎病毒(hepatitis B virus,HBV)携带者循环乙型肝炎病毒脱氧核糖核酸(HBV DNA)载量与抗苗勒氏激素(anti-Mullerian hormone,AMH)水平及体外受精-胚胎移植(in vitro fertilization-embryo transfer,IVF-ET)助孕结局的关系。方法选取2018年1月至2019年1月因女性不孕在保定市第一中心医院接受IVF-ET治疗的120例患者进行研究,根据女性乙肝表面抗原(hepatitis B surface antigen,HBs Ag)阴性或阳性将其分为对照组53例、HBV携带组67例。采用实时荧光聚合酶链式反应检测仪测定血清循环HBV DNA载量,采用酶联免疫吸附法检测血清AMH水平。患者均采用控制性超促排卵长方案进行促排卵,根据移植后临床妊娠情况将HBV携带者分为妊娠组14例,未妊娠组53例。结果 HBV携带者血清循环HBV DNA载量显著高于对照组(P<0.05),血清AMH水平明显低于对照组(P<0.05)。HBV携带者血清循环HBV DNA载量与AMH水平呈负相关(P<0.05)。HBV携带者临床妊娠率低于对照组(P<0.05),流产率高于对照组(P<0.05)。HBV携带未妊娠组获卵率、正常受精率、D 3优胚率及血清AMH水平均低于妊娠组(P<0.05),血清循环HBV DNA载量高于妊娠组(P<0.05)。D 3优胚率、循环HBV DNA及AMH均是影响HBV携带者IVF-ET治疗后未妊娠的独立危险因素(P<0.05)。结论女性HBV携带者血清循环HBV DNA载量升高及AMH水平降低,可能与IVF-ET助孕结局有关。

Objective To investigate the relationships between the circulating HBV DNA load and the level of anti-Mullerian hormone(AMH),the outcome of in vitro fertilization-embryo transfer(IVF-ET) in female hepatitis B virus carriers.Methods According to the negative or positive HBs Ag,120 patients who received IVF-ET treatment for female infertility in Baoding First Central Hospital from January 2018 to January 2019 were divided into control group(53 cases) and female HBV carrier group(67 cases).The circulating HBV DNA load in serum was measured by real-time fluorescence polymerase chain reaction(PCR) and the serum AMH level was measured by enzyme-linked immunosorbent assay(ELISA).All the patients were given controlled ovarian hyperstimulation(COH) long protocol to ovulation induction,and according to the clinical pregnancy after transplantation,HBV carriers were divided into pregnancy group(14 cases) and non pregnancy group(53 cases).Results The load of circulating HBV DNA of female HBV carriers was significantly higher than that of the control group(P<0.05),and the level of serum AMH was significantly lower than that of the control group(P<0.05).There was a negative correlation between the circulating HBV DNA load and AMH level in female HBV carriers(P<0.05).The clinical pregnancy rate of HBV carriers was significantly lower than that of the control group(P<0.05),and the abortion rate was significantly higher than that of the control group(P<0.05).The egg acquisition rate,normal fertilization rate,D 3 excellent embryo rate and serum AMH level of HBV carriers in the non pregnant group were significantly lower than those in the pregnant group(P<0.05),and the circulating HBV DNA load in serum was significantly higher in the pregnant group(P<0.05).The D 3 excellent embryo rate,circulating HBV DNA and AMH were all independent risk factors of non pregnancy in HBV carriers after IVF-ET treatment(P<0.05).Conclusion The load of circulating HBV DNA is increased,and the level of AMH in female HBV carriers is increased,which may be related to the outcome of IVF-ET.