不同卵巢反应预测指标对不孕女性卵巢反应功能的评价效果比较

Comparison of evaluation effects of different ovarian response predictors on ovarian response function in infertile women

目的探讨年龄、窦卵泡个数、基础血清促卵泡激素、抗苗勒管激素、基础卵泡刺激素/黄体生成素比值、卵巢反应预测指数评价卵巢反应功能的效果。方法选取我院生殖医学科首次行体外受精/胞浆内精子注射治疗不孕症的490例患者作为研究对象,对以上指标进行测量和计算。用操作者特征曲线分析变量的预测精度,计算截断值及敏感度和特异度。结果490例不孕症患者中卵巢低反应61例(12.45%),卵巢正常反应352例(71.84%),卵巢高反应77例(15.71%)。年龄、窦卵泡个数、基础促卵泡激素、抗苗勒管激素、基础卵泡刺激素/黄体生成素比值和卵巢反应预测指数在卵巢高反应组的曲线下面积分别为0.674、0.964、0.674、0.842、0.716、0.915,敏感度分别为93.5%、92.2%、84.4%、79.2%、63.6%、83.1%,特异度分别为60.5%、97.7%、44.1%、77.0%、73.8%、89.5%;截断值分别为35.5岁、15个、7.75 U/L、4.325 mg/L、1.633、1.985;在卵巢低反应组的曲线下面积分别为0.616、0.844、0.589、0.789、0.573、0.834,敏感度分别为57.4%、75.4%、44.3%、70.5%、62.3%、78.7%,特异度分别为69.0%、99.8%、55.7%、84.8%、59.2%、85.3%,截断值分别为35.5岁、4个、8.945 U/L、1.085 mg/L、2.252、0.207。结论对于不孕女性窦卵泡计数和卵巢反应预测指数在评估卵巢反应性方面优于其他变量,且在预测卵巢过度反应方面表现出更好的效果,在预测卵巢低反应方面还需要进一步探索更有预测价值的指标。

Objective To explore the effects of age,antral follicle count(AFC),basal serum follicle-stimulating hormone,anti-müllerian hormone(AMH),basal follicle-stimulating hormone(FSH)/luteinizing hormone(LH),and ovarian response prediction index(ORPI)on the evaluation of ovarian response function.Methods A total of 490 patients who were treated with in vitro fertilization and intracytoplasmic sperm injection for the first time in the Department of Reproductive Medicine of our hospital were selected as the research subjects.The above indicators were measured and calculated.The receiver operating characteristic(ROC)curve was used to analyze the prediction accuracy of variables,and the cutoff value and the corresponding sensitivity and specificity were calculated.Results Among the 490 infertile patients,61 cases(12.45%)had low ovarian response,352 cases(71.84%)had normal ovarian response,and 77 cases(15.71%)had high ovarian response.The area under the ROC curve(AUC)of age,AFC,basal FSH,AMH,and FSH/LH and ORPI of the patients was 0.674,0.964,0.674,0.842,0.716 and 0.915,respectively,the sensitivity was 93.5%,92.2%,84.4%,79.2%,63.6%and 83.1%,respectively,and the specificity was 60.5%,97.7%,44.1%,77.0%,73.8%and 89.5%,respectively.The cutoff values were 35.5 years of age,15,7.75 U/L,4.325 mg/L,1.633 and 1.985,respectively.The AUC values in the ovarian hyporesponse group were 0.616,0.844,0.589,0.789,0.573,and 0.834,respectively.The sensitivity was 57.4%,75.4%,44.3%,70.5%,62.3%,and 78.7%,the specificity was 69.0%,99.8%,55.7%,84.8%,59.2%,and 85.3%,respectively,and the cutoff values were 35.5 years of age,4,8.945 U/L,1.085 mg/L,2.252,and 0.207,respectively.Conclusion For infertile women,AFC and ORPI are better than other variables in the evaluation of ovarian response,and show a better effect in the prediction of ovarian hyperresponse.Further exploration of more predictive indicators is needed in the prediction of ovarian hyporesponse.