摘要
目的探讨多囊卵巢综合征(polycystic ovary syndrome, PCOS)不孕患者血清抗苗勒管激素(anti-Müllerian hormone, AMH)水平对促排卵治疗后排卵结局的影响。方法 PCOS不孕患者216例,依据基础血清AMH四分位数分为<6.74μg/L组54例,6.74~9.61μg/L组54例,>9.61~13.31μg/L组54例,>13.31μg/L组54例。4组均行阴道超声检查,记录基础直径≤10 mm窦卵泡数;4组均给予枸橼酸克罗米芬或来曲唑促排卵,治疗1个月经周期时,记录排卵率,比较排卵者与未排卵者基础血清AMH差异;多因素logistic回归分析基础血清AMH与PCOS不孕患者促排卵治疗后排卵结局的关系;ROC曲线分析基础血清AMH对PCOS不孕患者促排卵治疗后未排卵的预测价值。结果216例促排卵治疗后排卵167例,未排卵49例。>13.31μg/L组基础直径≤10 mm窦卵泡数[(12.9±3.5)个]较<6.74μg/L组[(10.9±2.2)个]、6.74~9.61μg/L组[(11.4±2.0)个]多(P<0.05),排卵率(64.8%)较6.74~9.61μg/L组(88.8%)低(P<0.05),<6.74μg/L组、6.74~9.61μg/L组、>9.61~13.31μg/L组基础直径≤10 mm窦卵泡数、排卵率比较差异无统计学意义(P>0.05)。排卵者基础血清AMH[(9.61±4.21)μg/L]低于未排卵者[(11.67±5.45)μg/L](P<0.05)。基础血清AMH增高是PCOS不孕患者促排卵治疗后未排卵的危险因素(OR=1.085,95%CI:1.01~1.76,P=0.047)。基础血清AMH以14.50μg/L为最佳截断值,预测PCOS不孕患者促排卵治疗后未排卵的AUC为0.620(95%CI:0.521~0.718,P=0.011),准确率为77.2%,灵敏度为48.8%,特异度为88.6%。结论高血清AMH的PCOS不孕患者促排卵治疗后排卵率降低,血清AMH>14.50μg/L可有效预测PCOS不孕患者促排卵治疗后排卵障碍。
Objective To evaluate the role of anti-Müllerian hormone(AMH) concentration in predicting the ovulation outcomes after treatment in patients with polycystic ovary syndrome(PCOS). Methods Totally 216 infertility patients with PCOS were divided into four groups according to the interquartile range of AMH: AMH<6.74 μg/L group, AMH 6.74-9.61 μg/L group, AMH >9.61-13.31 μg/L group and AMH >13.31 μg/L group, with 54 patients in each group. The antral follicle count(≤10 mm in diameter) was measured on transvaginal ultrasound. All patients received either clomiphene or letrozole. And the ovulation rate was recorded after 1 menstrual cycle. The AMH difference was compared between the patients with and without ovulation. Multivariate logistic regression analysis was used to analyze the relationship between AMH and ovulation outcome after treatment and ROC was used to analyze the value of AMH to predicting ovulatory dysfunction. Results In 216 patients, 167 got ovulation and 49 got no ovulation. The count of antral follicle ≤10 mm in diameter was more in AMH>13.31 μg/L group(12.9±3.5) than that in AMH<6.74 μg/L group(10.9±2.2) and AMH 6.74-9.61 μg/L group(11.4±2.0)(P<0.05). The ovulation rate was lower in AMH>13.31 μg/L group(64.8%) than that in AMH 6.74-9.61 μg/L group(88.8%)(P<0.05). There were no significant differences in the count of antral follicle ≤10 mm in diameter and ovulation rate among AMH<6.74 μg/L,AMH 6.74-9.61μg/L and AMH>9.61-13.31μg/L groups(P>0.05).The value of AMH was lower in patients with ovulation((9.61±4.21)μg/L)than that in patients without ovulation((11.67±5.45)μg/L)(P<0.05).The elevated AMH concentration was the risk factor for ovulatory dysfunction after treatment(OR=1.085,95%CI:1.01-1.76,P=0.047).When the optimal cut-offof AMH was 14.50μg/L,the AUCfor ovulatory dysfunction was 0.620(95%CI:0.521-0.718,P=0.011),with the accuracy of 77.2%,sensitivity of 48.8%and specificity of 88.6%.Conclusion The ovulation rate is lowered after treatment in infertility PCOS patients with high serum AMH concentration,and AMH >14.50μg/L could predict ovulatory dysfunction.
作者
李红然
张育婧
李春美
李珊珊
李雪言
王瑜
LI Hongran;ZHANG Yujing;LI Chunmei;LI Shanshan;LI Xueyan;WANG Yu(Department of Obstetrics,Henan University People's Hospital,Henan Provincial People's Hospital,Zhengzhou450003,China)
出处
《中华实用诊断与治疗杂志》
2020年第3期308-311,共4页
Journal of Chinese Practical Diagnosis and Therapy
基金
河南省医学科技攻关计划项目(162102310279)。
关键词
多囊卵巢综合征
不孕
抗苗勒管激素
促排卵
polycystic ovary syndrome
infertility
anti-Müllerian hormone
ovulation induction
