HLA-DR联合AMH评估年轻不孕妇女卵巢功能的临床价值

The clinical value of HLA-DR combined with AMH in evaluating ovarian function in young infertile women

目的探讨人白细胞DR抗原(human leukocyte antigen-DR,HLA-DR)与抗缪勒管激素(anti-mullerian hormone,AMH)联合检测在评估年轻不孕妇女卵巢功能中的临床价值。方法选取2019年9月至2020年8月在保定市第一中医院就诊的年轻不孕女性患者110例作为研究对象,将其分为卵巢储备功能低下组(观察组)48例和卵巢储备功能正常组(对照组)62例。所有受试者进行促卵泡生成激素(follicle-stimulating hormone,FSH)、促黄体生成激素(luteinizing hormone,LH)、雌二醇(estradiol,E)和AMH、HLA-DR和免疫细胞水平测定,绘制ROC曲线并分析HLA-DR联合AMH检测的诊断价值。结果观察组中FSH、LH水平明显高于对照组,E_(2)、AMH水平明显低于对照组,差异有统计学意义(P<0.05);观察组外周血中CD3^(+)和CD8^(+)细胞、HLA-DR的表达水平明显高于对照组,CD4^(+)和CD4^(+)/CD8^(+)水平明显低于对照组,差异有统计学意义(P<0.05);HLA-DR与AMH联合诊断的灵敏度为89.58%,高于二者单独检测时的灵敏度(75.00%,70.83%),同时准确度(78.18%)也高于单一检测方法。ROC曲线图显示:HLA-DR联合AMH联合诊断的ROC曲线下面积为0.839(95%CI:0.793-0.885),显著高于HLA-DR、AMH单独检测,差异有统计学意义(P<0.05)。结论HLA-DR与AMH联合可提高对年轻不孕女性卵巢功能的评估诊断效能。

Objective To explore the clinical value of combined detection of human leukocyte antigen-DR(HLA-DR) and anti-mullerian hormone(AMH) in evaluating ovarian function in young infertile women.Methods A total of 110 young infertile female patients who were treated in Baoding First Traditional Chinese Medicine Hospital from September 2019 to August 2020 were selected as the research objects.They were divided into low ovarian reserve group(observation group) with 48 cases and normal ovarian reserve group(control group) with 62 cases.Their follicle-stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E_(2)) and AMI,HLA-DR and immune cell levels were measured, the ROC curve was drawn, and the diagnostic value of HLA-DR combined with AMH detection was analyzed.Results The FSH and LH levels in the observation group were significantly higher than those in the control group, and the E;and AMH level was significantly lower than that in the control group, the difference was statistically significant(P<0.05).The expression levels of CD3^(+) and CD8^(+) cells in the peripheral blood of the observation group were significantly higher than those in the control group, CD4^(+),CD4^(+)/CD8^(+) and HLA-DR levels were significantly lower than the control group, the difference was statistically significant(P<0.05);the sensitivity of the combined diagnosis of HLA-DR and AMH was 89.58%,which was higher than the sensitivity of the two separate detection(75.00%,70.83%),and the accuracy(78.18%) was also higher than other single detection methods.The ROC curve chart showed that the area under the ROC curve for the combined diagnosis of HLA-DR combined with AMH was 0.839(95% CI:0.793-0.885),which was significantly higher than that of HLA-DR and AMH alone, and the difference was statistically significant(P<0.05).Conclusion The combination of HLA-DR and AMH can improve the diagnostic performance for evaluating ovarian function in young infertile women.