摘要
目的探讨促性腺激素释放激素激动剂（GnRH-a）降调节后，血清抑制素B（INHB）对体外受精-胚胎移植（IVF-ET）中卵巢反应性和IVF-ET结局的预测价值。方法前瞻性观察124例行IVF-ET患者，超促排卵均采朋GnRH-a＋重组卵泡刺激素（rFSH）＋人绒毛膜促性腺激素（hCG）黄体期长方案。观察指标：年龄、基础卵泡刺激素（bFSH）水平、卵泡刺激素（FSH）与黄体生成素（LH）比值、GnRH-a降调节后INHB水平、双侧卵巢内总窦卵泡数（AFC）及双侧卵巢体积。卵巢反应性评价指标为获卵数。通过多元线性回归分析、logistic回归分析评价各激素水平与卵巢反应性及IVF-ET结局的关系，计算受试者工作特征（ROC）曲线下面积（AUC），评价INHB水平预测获卵数的准确率，通过敏感度、特异度计算并确定其诊断临界值。结果INHB水平与AFC呈显著正相关关系（r=0．435，P〈0．01）；多元回归分析显示，INHB水平与bFSH水平呈显著负相关关系（r=-0．239，P〈0．01），与AFC（r=0．435，P〈0．01）、获卵数（r=0．861，P〈0．01）呈显著正相关关系，而与年龄、FSH／LH比值、卵巢体积无相关性（P〉0．05）。ROC曲线分析显示，GnRH-a降调节后，INHB水平的最大AUC为0．933（95％CI为0．878-0．988），将INHB水平为15ng／L作为临界值时，其预测卵巢反应性的敏感度为95．5％，特异度为50．0％。结论INHB水平是预测IVF-ET中卵巢反应性的最佳指标之一，INHB水平下降是卵巢储备功能下降的早期指标，但对IVF-ET结局无预测价值。
Objective To evaluate the decreased level of serum inhibin B （ INHB ） treated by gonadotropin releasing hormone agonist （GNRH-a） in predicting ovarian response and pregnancy in in vitro fertilization-embryo transfer （IVF-ET）. Methods The prospective study enrolled 124 women given by GnRH-a ＋ recombine follicle stimulating hormone （rFSH） ＋ human chorionic gonadotrophin （hCG） long term stimulation protocol undergone their first cycle of IVF-ET treatment. The following predictive factors were collected and analyzed, such as age ,basal level of follicle stimulating hormone （ FSH）, the ratio of FSH/ luteinizing hormone （LH）, the concentration of INHB after down-regulation, total number of antral follicle count （AFC） and mean ovarian volume. Ovarian response was evaluated by the number of oocytes obtained. A muhiple regression analysis and logistic regression model were used for all possible prognostic variables to evaluate the value of different hormones in predicting ovarian response and pregnancy after IVF-ET. Receiver operating characteristic （ROC） analysis was used to evaluate the level of INHB in predicting the number of oocytes obtained. The sensitivity and specificity were calculated at the discriminating cut-off point. Results The concentration of INHB after down-regulation showed a highly significant positive correlations with the number of oocytes obtained （ r = 0. 435,P 〈 0. 01 ）. The multiple regression analyses showed INHB was the most significant predictor of the number of retrieved oocytes, but INHB was not associated with IVF-ET outcome significantly （P 〉 0. 05 ）. ROC analyses showed INHB after down-regulation had the largest area under curve （AUC） 0. 933 （95% CI： 0. 878-0. 988 ） . When a threshold of 15 ng/L of INHB was established, 95.5% sensitivity and 50. 0% specificity in ovarian response were observed. Conclusions The level of INHB was the best factor in predicting ovarian response in IVF-ET. Decreased level of INHB was the early sign of ovarian reserve function failure, however, useless in predicting IVF-ET outcome.
出处
《中华妇产科杂志》
CAS
CSCD
北大核心
2009年第4期260-262,共3页
Chinese Journal of Obstetrics and Gynecology
关键词
受精
体外
胚胎移植
促性腺素释放激素
抑制素类
Fertilization in vitro
Embryo transfer
Gonadotropin-releasing hormone
Inhibins
