抗苗勒管激素对多囊卵巢综合征不孕患者促排卵结局的影响

Effect of anti-mullerian hormone on ovulation induction outcome in infertile patients with polycystic ovary syndrome

目的探讨抗苗勒管激素(AMH)对多囊卵巢综合征(PCOS)不孕患者促排卵结局的影响。方法连续纳入2019年1月至2020年5月湖南省妇幼保健院妇产科收治的280例PCOS不孕患者,按照血清AMH水平四分位数将患者分为A组(<6.32μg/L)、B组(6.32~9.58μg/L)、C组(9.58~13.24μg/L)、D组(>13.24μg/L),每组70例。所有患者给予同一药物促排卵方案。比较四组患者的排卵率及临床妊娠率,采用多因素Logistic回归分析血清AMH水平对促排卵结局的影响,采用ROC曲线分析血清AMH水平对促排卵结局的预测效能。结果四组患者的临床妊娠率比较差异无统计学意义(P>0.05);D组患者的排卵率为64.29%,明显低于B组的88.57%,差异有统计学意义(P<0.05),但D组分别与A组、C组患者的排卵率比较以及A、B、C组患者间的排卵率比较差异均无统计学意义(P>0.05);经多因素Logistic回归分析结果显示,血清AMH水平升高是促排卵结局的危险因素(OR=1.090,95%CI:1.006~1.875,P=0.032);以14.65μg/L为最佳截断值时,血清AMH水平预测促排卵结局的AUC为0.675(95%CI:0.550~0.729,P=0.014),准确率、灵敏度及特异度分别为80.44%、82.35%、89.70%。结论血清AMH水平升高会降低PCOS不孕患者促排卵后的排卵率,血清AMH水平>14.65μg/L能够对促排卵结局进行有效的预测。

Objective To investigate the effect of anti-mullerian hormone(AMH)on ovulation induction outcome in infertile patients with polycystic ovary syndrome(PCOS).Methods From January 2019 to May 2020,280 infertility patients with PCOS were enrolled in the Department of Obstetrics and Gynecology,Hunan Maternal and Child Health Hospital.According to the quartile of serum AMH level,the patients were divided into group A(<6.32μg/L),group B(6.32-9.58μg/L),group C(9.58-13.24μg/L)and group D(>13.24μg/L),with 70 patients in each group.All patients were given the same ovulation induction regimen.The ovulation rate and clinical pregnancy rate was compared between four groups.Multivariate logistic regression was used to analyze the influence of serum AMH level on ovulation induction outcome.The ROC curve was used to analyze the predictive efficacy of serum AMH level on ovulation induction outcome.Results There was no significant difference on clinical pregnancy rate between four groups(P>0.05).The ovulation rate in group D was 64.29%,which was significantly lower than 88.57%in group B(P<0.05),but it showed no statistically significant difference between group D,and group A or group C,and also among group A,B and C(P>0.05).Multivariate logistic regression analysis showed that serum increase of AMH level was the risk factor for ovulation induction outcome(OR=1.090,95%CI:1.006-1.875,P=0.032).When the optimal cutoff value was 14.65μg/L,the AUC of serum AMH level predicting the ovulation induction outcome was 0.675(95%CI:0.550-0.729,P=0.014),and the accuracy,sensitivity and specificity was 80.44%,82.35%,and 89.70%,respectively.Conclusion The increase of serum AMH level could reduce the ovulation rate after ovulation induction in infertile patients with PCOS.The serum AMH level>14.65μg/L could effectively predict the ovulation induction outcome.