血清AMH联合E_2对冻融胚胎移植术后妊娠成功的预测价值分析

Predictive value of serum AMH combined with E_2 for pregnancy success after freeze-thawed embryo transfer

目的分析血清抗苗勒氏管激素(AMH)联合雌二醇(E_2)对冻融胚胎移植术(FET)后妊娠成功的预测价值。方法回顾性分析2017年3月至2018年3月医院收治的105个不孕者,进行FET共110周期的临床资料,设为FET组,检测FET组血清AMH、E_2水平;统计FET术后妊娠成功率,根据结果将其分为成功组和失败组,对比排卵日和移植日两组血清AMH、E_2水平变化,通过绘制工作曲线(ROC),分析并对比AMH、E_2检测及联合检测对FET术后妊娠成功预测价值。结果 FET组排卵日及移植日血清AMH水平分别为(5.36±0.85)ng/mL、(5.30±0.89)ng/mL,E_2水平分别为(3624.31±353.69)pmol/mL、(2508.62±265.67)pmol/mL;110个FET周期中,临床妊娠率为29.09%;失败组患者排卵日及移植日血清AMH水平均显著高于成功组(P<0.05),血清E_2水平均显著低于成功组(P<0.05);移植日失败组和成功组患者血清AMH水平与排卵日比较差异均不显著(P>0.05),移植日失败组和成功组患者血清E_2水平显著低于排卵日(P<0.05);排卵日血清AMH、E_2预测FET术后妊娠成功最佳截断点分别为4.19 ng/mL、3660.30 pmol/mL,移植日最佳截断点为4.17ng/mL、2587.19pmol/mL;排卵日和移植日血清AMH、E_2联合检测预测妊娠成功的灵敏度、特异度和准确度均高于单独检测,且排卵日和移植日联合检测预测妊娠成功的AUC分别为0.851、0.884,高于单独检测。结论与单独应用血清AMH、E_2相比,联合应用2种血清学指标对FET术后妊娠成功预测价值更高。

Objective:To analyze on the predict value of the predictive value of serum anti-Mullerian hormone(AMH)combined with estradiol(E2)in freeze-thawed embryo transfer(FET).Methods:A retrospective analysis of 105 infertile patients admitted to the hospital from March 2017 to March 2018,the clinical data of 110 cycles of FETs,set as FET group.The serum AMH and E2 levels of the FET group on the ovulation day and the transplant day were detected.Pregnancy success rate after FET was counted,and according to the results,they were divided into successful group and failed group.The changes of serum AMH and E2 levels in ovulation day and transplant day were compared.Predictive value of pregnancy success after FET of AMH,E2 detection and combined detection were analyzed and contrasted by plotting working curve(ROC).Results:The serum AMH levels in the FET group were(5.36±0.85)ng/mL and(5.30±0.89)ng/mL,respectively,and the E2 levels were(3624.31±353.69)pmol/mL,(2508.62±265.67)pmol/mL.Among the 110 FET cycles,the clinical pregnancy rate was29.09%.The serum AMH level in the ovulation day and the transplant day was significantly higher than that in the successful group(P<0.05),and the serum E2 level was significantly lower than the successful group(P<0.05).The serum AMH level in the failure group was significantly higher than that in the successful group on ovulation day and transplant day(P<0.05),while the serum E2 level was significantly lower than the successful group(P<0.05).There was no significant difference in serum AMH levels between transplant day and ovulation day of the ailed group and the successful group(P>0.05).The serum E2 level of patients on transplant day was significantly lower than that of ovulation day of the ailed group and the successful group(P<0.05).The best cut-off points for serum AMH and E2 on ovulation day for predicting postoperative FET success were 4.19 ng/mL and 3663.30 pmol/mL,respectively,and the best cut-off point on transplant day was 4.17 ng/mL and 2587.19 pmol/mL.The sensitivity,specificity and accuracy of serum AMH and E2 combined detection on ovulation day and transplant day for pregnancy success were higher than those of single detection,and the AUC of combined detection for pregnancy success prediction on ovulation day and transplant day was 0.851 and 0.884,respectively,which was higher than that of the separate test.Conclusion:Compared with serum AMH and E2 alone,the combined use of two serological indicators has a higher predictive value for postoperative pregnancy outcomes after FET.