联合指标对多囊卵巢综合征患者发生卵巢高反应的预测价值

Predictive value of combined indicators for high ovarian response in patients with polycystic ovary syndrome

目的探讨年龄、体质指数(BMI)、窦卵泡计数(AFC)、血清促黄体生成素(LH)及抗苗勒氏激素(AMH)等各项指标对多囊卵巢综合征(PCOS)患者行长方案超促排卵发生卵巢高反应的预测价值。方法回顾性分析行体外受精(IVF)/卵胞质内单精子注射(ICSI)助孕的PCOS患者164例,记录患者不孕类型、不孕年限、年龄、体质指数(BMI)及早卵泡期经阴道超声计数AFC;于超促排卵前月经第3天抽取空腹血测定基础性激素、AMH水平,记录促性腺激素(Gn)启动用量、Gn天数、Gn总剂量、人绒毛膜促性腺激素(hCG)日雌二醇(E2)水平、获卵数。采用长方案促排卵,根据卵巢的反应性将患者分为卵巢正常反应组78例,患者获卵数<20个且hCG日E2水平<18 350 pmol/L;卵巢高反应组86例,患者获卵数≥20个或hCG日E2水平≥18 350 pmol/L。比较两组患者各项指标的差异性,并对检测结果进行逐步Logistic回归分析并作图绘制ROC曲线。结果卵巢高反应组的AMH、基础LH均明显高于卵巢正常反应组,BMI、Gn启动剂量均显著低于卵巢正常反应组,差异均有统计学意义(P<0.05);其他指标在两组间差异无统计学意义(P>0.05)。Logistic回归分析结果显示,BMI、AMH对PCOS患者发生卵巢高反应有影响(P<0.05),其中BMI为保护因素OR值为0.895,AMH为危险因素OR值为1.109。基础LH和启动剂量对PCOS患者发生卵巢高反应无影响(P>0.05);联合诊断(Pre-1)的诊断符合率最高为78.0%,ROC曲线下面积:pre-1(0.825)>BMI(0.753)>AMH(0.725)。结论联合检测指标对卵巢高反应的预测有较好的准确性,优于单一指标预测价值。建议采用AMH 8.46ng/ml,BMI 20.95作为PCOS患者长方案超促排卵中预测卵巢高反应的临床最佳临界值。

Objective To explore the predictive value of age,body mass index (BMI),antral follicle count (AFC),serum luteinizing hormone (LH),and anti-Müllerian hormone (AMH) for high ovarian response in patients with polycystic ovary syndrome (PCOS) treated by long protocol controlled ovarian hyperstimulation. Methods A total of 164 PCOS patients treated by IVF/ICSI were analyzed retrospectively. The types and duration of infertility,age,BMI,AFC by transvaginal ultrasound during early follicular phase were recorded. Before controlled ovarian hyperstimulation,fasting blood samples were obtained on the third day of menstruation to detect basic sex hormones and AMH levels. The initial dose of Gn,time of Gn,the total dose of Gn,the level of E2 on the day of hCG injection,the number of retrieved oocytes were recorded. Long protocol controlled ovarian hyperstimulation was conducted,the patients were divided into normal ovarian response group (78 cases,the number of retrieved oocytes<20,the level of E2 on the day of hCG injection<18 350 pmol/L) and high ovarian response group (86 cases,the number of retrieved oocytes≥20,the level of E2 on the day of hCG injection≥18 350 pmol/L). The differences of various indicators in the two groups were compared,the results were analyzed by stepwise Logistic regression analysis,ROC curve was plotted. Results The levels of AMH and basic LH in high ovarian response group were statistically significantly higher than those in normal ovarian response group,BMI and initial dose of Gn in high ovarian response group were statistically significantly lower than those in normal ovarian response group (P<0. 05),there was no statistically significant difference in the levels of other indicators between the two groups (P>0. 05). Logistic regression analysis showed that BMI and AMH had impact on high ovarian response in PCOS patients (P <0. 05),BMI was protective factor,OR value was 0. 895,AMH was risk factor,OR value was 1. 109. Basic LH and initial dose had no impact on high ovarian response in PCOS patients (P > 0. 05). The coincidence rate of combined diagnosis was the highest,which was 78. 0%. The area under ROC curve: pre-1 (0. 825) >BMI (0. 753) >AMH (0. 725). Conclusion The accuracy of joint detection in predicting high ovarian response is high,which is better than single indicator detection. AMH 8. 46 ng/ml and BMI 20. 95 kg/m2 are recommended as the clinically optimal cut-off values in predicting high ovarian response in PCOS patients treated by long protocol controlled ovarian hyperstimulation.