AMH联合E2、FSH/LH检测对不孕症患者卵巢储备功能及反应性的评估作用

Assessment of ovarian reserve function and responsiveness in infertility patients by AMH combined with E and FSH/LH

目的探讨抗苗勒管激素(AMH)联合雌二醇(E2)、促卵泡激素(FSH)/黄体生成素(LH)检测对不孕症患者卵巢储备功能及反应性的评估作用。方法选取2016年3月至2018年12月湖北省襄阳市第一人民医院诊治的193例不孕症患者作为研究对象。均于月经期第2d~第3d检测血清AMH、E2和FSH/LH水平,另记录获取卵子数目。根据获卵数将患者分为卵巢反应正常组(n=149)、卵巢低反应组(n=25)、卵巢高反应组(n=19),比较三组患者血清AMH、基础E2和FSH/LH水平,并绘制基于血清AMH、基础E2和FSH/LH水平单项及联合预测卵巢储备功能及反应性的工作曲线(ROC),分析其灵敏度、特异度及曲线下面积(AUC)。结果193例不孕症患者血清AMH为(1.82±0.41)ng/mL,基础E2水平为(30.45±2.37)pg/mL,基础FSH/LH为(1.64±0.35);193例不孕症患者中卵巢低反应25例(12.95%),卵巢正常反应149例(77.20%),卵巢高反应19例(9.84%);卵巢反应正常组、卵巢高反应组的血清AMH水平均明显高于卵巢低反应组,差异具有统计学意义(P<0.05),卵巢高反应组的AMH水平高于卵巢反应正常组,差异具有统计学意义(P<0.05);卵巢反应正常组、卵巢高反应组的基础E2、FSH/LH水平均明显低于卵巢低反应组,差异具有统计学意义(P<0.05),卵巢高反应组的基础E2、FSH/LH水平均明显低于卵巢反应正常组,差异具有统计学意义(P<0.05);血清AMH、基础E2、FSH/LH及联合预测不孕症患者卵巢低反应的AUC分别为0.824、0.652、0.765、0.911,灵敏度分别为72.00%、60.00%、64.00%、84.00%,特异度分别为82.55%、83.22%、79.87%、88.59%;血清AMH、基础E2、FSH/LH及联合预测不孕症患者卵巢高反应的AUC分别为0.714、0.791、0.691、0.936,灵敏度分别为73.68%、68.42%、73.68%、84.21%,特异度分别为82.55%、83.89%、74.50%、88.59%。结论不孕症患者血清AMH水平在卵巢高反应性、卵巢正常反应性、卵巢低反应性中呈逐渐降低趋势,而基础E2、FSH/LH则逐渐升高,血清AMH、基础E2、基础FSH/LH均对卵巢反应性具有一定的预测价值,但此3项指标联合预测的价值优于各指标单独预测。

Objective To investigate the assessment effect of anti-Mullerian hormone(AMH)combined with estradiol(E2)and follicle stimulating hormone(FSH)/luteinizing hormone(LH)on the ovarian reserve function and responsiveness in infertility patients.Methods 193 infertility patients in Xiangyang First People′s Hospital from March 2016 to December 2018 were selected,and the serum AMH,E2,FSH/LH levels of them were measured on the 2 nd and 3 rd day of menstruation,and the number of eggs obtained were recorded.The patients were divided into normal ovarian response group,low ovarian response group and high ovarian response group according to the number of eggs obtained.The serum AMH,basal E2,FSH/LH levels were compared among the 3 groups,and the receiver operating characteristic curve(ROC)for predicting ovarian reserve function and responsiveness of serum AMH,basic E2 and FSH/LH levels were drawn,and their sensitivity,specificity and area under curve(AUC)were analyzed.Results In the 193 infertility patients,the mean serum AMH level,basal E2 level and basal FSH/LH was(1.82±0.41)ng/mL,(30.45±2.37)pg/mL and(1.64±0.35)respectively.Among the 193 infertility patients,there were 25 cases with low ovarian response(12.95%),149 cases with normal ovarian response(77.20%)and 19 cases with high ovarian response(9.84%).The serum AMH levels in the normal ovarian response group and the high ovarian response group were significantly higher than those in the low ovarian response group,and the AMH levels in the high ovarian response group was higher than that in the normal ovarian response group,all with statistically significant differences(all P<0.05).The basal E2 and FSH/LH levels in the normal ovarian response group and high ovarian response group were significantly lower than those in the low ovarian response group,and the basal E2 and FSH/LH levels in the high ovarian response group were significantly lower than those in the normal ovarian response group,all with statistically significant differences(all P<0.05).The AUC of serum AMH,basal E2,FSH/LH and combined prediction of ovarian hyporesponsiveness in infertility patients were 0.824,0.652,0.765 and 0.911 respectively,and the sensitivity was 72.00%,60.00%,64.00%and 84.00%respectively,and the specificity was 82.55%,83.22%,79.87%and 88.59%respectively.The AUC of serum AMH,basal E2,FSH/LH and combined prediction of ovarian hyperresponsiveness in infertility patients were 0.714,0.791,0.691 and 0.936 respectively,and the sensitivity was 73.68%,68.42%,73.68%and 84.21%respectively,and the specificity was 82.55%,83.89%,74.50%and 88.59%respectively.Conclusions Serum AMH levels decrease gradually in infertility patients with ovarian hyperresponsiveness,ovarian normal responsiveness and ovarian hyporesponsiveness,while basal E2 and FSH/LH levels increase gradually.Serum AMH,basal E2 and FSH/LH levels all have certain predictive value for ovarian responsiveness,but the value of the combined prediction of the three indicators is better than that of the individual indicator.