血清抗苗勒管激素水平与胚胎新鲜移植自然流产的关系

The relationship between serum anti Mullerian hormone level and spontaneous abortion after fresh embryo transfer

目的:探讨体外受精(IVF)患者血清抗苗勒管激素(AMH)水平与发生早期自然流产关系。方法:回顾性收集2016年7月-2018年6月在本院生殖中心接受IVF治疗并获得宫内单胎妊娠妇女242例,其中发生早期自然流产38例为病例组,活产分娩204例为对照组。检测两组血清AMH水平,采用受试者工作特征曲线(ROC)分析AMH对早期自发流产的预测价值,多因素logistic回归分析血清AMH水平与IVF妊娠结局关系。结果:病例组和对照组体质指数、不孕年限、流产史、基础黄体生成素、基础E2、Gn用量、Gn天数、绒毛膜促性腺激素日内膜厚度等IVF相关因素无差异(P>0.05),而两组年龄、原发不孕占比、基础FSH水平、AMH水平存在差异(P<0.05)。ROC曲线分析提示,血清AMH对IVF患者早期自然流产具有一定的预测价值,其最佳临界值为3.14 ng/ml,AUC曲线下面积为0.753(95%CI:0.693~0.806),敏感性为44.7%,特异性为94.6%。原发不孕、低基础卵泡刺激素水平及低AMH水平是IVF后早期自发流产的危险因素。结论:患者AMH水平与IVF术后发生早期自然流产相关,可作为早期自然流产发生风险的参考指标之一。

Objective: To investigate the correlation between serum anti-Miller hormone(AMH) level and early spontaneous abortion after in vitro fertilization(IVF). Methods: During July 2016 to June 2018, 242 women with intrauterine single pregnancy after IVF were included and were divided 38 women with early spontaneous abortion in study group and 204 women with live birth in control group. Serum AMH levels were measured. The predictive value of AMH level for early spontaneous abortion was analyzed by Receiver operating characteristic curve(ROC). Multivariate logistic regression was used to analyze the relationship between serum AMH level and pregnancy outcomes of women after IVF. Results: There were no significant different in BMI value, infertility years, abortion history, basal levels of LH and E2, and IVF related factors, such as Gn dosage, days of Gn used and endometrium thickness on HCG day between the two groups(P>0.05), but there were significant different in age, proportion of primary infertility, basic FSH level, and AMH level between the two groups(P<0.05). ROC curve analysis indicated that serum AMH level had certain predictive value for predicting early spontaneous abortion of women after IVF. The optimal threshold of serum AMH level for predicting early spontaneous abortion was 3.14 ng/ml, and its area under the AUC curve was 0.753(95% CI: 0.693-0.806), its sensitivity was 44.7%, and its specificity was 94.6%. Multivariate logistic regression model found that primary infertility, low levels of basal FSH and AMH were the risk factors of spontaneous abortion of women after IVF. Conclusion: AMH level of women after IVF is related to their early spontaneous abortion, which can be used as one of the reference indicators of the risk of women with early spontaneous abortion.