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[1]杨 芳,石冬梅,刘永杰,等.卵巢多囊样改变患者抗苗勒氏管激素水平对卵巢过度刺激综合征发生的预测价值[J].宁夏医科大学学报,2018,(12):1384-1389.[doi:10.16050/j.cnki.issn1674-6309.2018.12.005]
 YANG Fang,SHI Dongmei,LIU Yongjie,et al.The Predictive Value of AMH in PCO Patients on the Occurrence of OHSS[J].Ningxia Medical University,2018,(12):1384-1389.[doi:10.16050/j.cnki.issn1674-6309.2018.12.005]
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卵巢多囊样改变患者抗苗勒氏管激素水平对卵巢过度刺激综合征发生的预测价值(PDF)
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《宁夏医科大学学报》[ISSN:1005-8486/CN:64-1029/R]

卷:
期数:
2018年12期
页码:
1384-1389
栏目:
论 著
出版日期:
2018-12-30

文章信息/Info

Title:
The Predictive Value of AMH in PCO Patients on the Occurrence of OHSS
文章编号:
1674-6309(2018)12-1384-06
作者:
杨 芳12 石冬梅2 刘永杰2 马文叶2 常 青1
(1. 宁夏医科大学,银川 750004; 2. 银川市妇幼保健院生殖中心,银川 750001)
Author(s):
YANG Fang12 SHI Dongmei2 LIU Yongjie2 MA Wenye2 CHANG Qing1
(1. Ningxia Medical University,Yinchuan 750004; 2. The Center for Reproductive Medicine, Women and Children Health Care Hospital, Yinchuan 750001)
关键词:
抗苗勒氏管激素卵巢多囊样改变卵巢过度刺激综合征
Keywords:
anti-mullerian hormone ovarian polycystic change ovarian hyperstimulation syndrome
分类号:
R711.75
DOI:
10.16050/j.cnki.issn1674-6309.2018.12.005
文献标志码:
A
摘要:
目的 对比研究辅助生殖技术 (ART) 治疗过程中卵巢储备功能正常与卵巢多囊样改变(PCO)患者血清、卵泡液抗苗勒氏管激素(AMH)水平在控制性超排卵(COH)治疗前后的变化与发生卵巢过度刺激综合征(OHSS)的相关性。方法 研究2016年10月-2017年11月期间就诊于银川市妇幼保健院生殖中心,按入组标准纳入患者42例,按照卵巢储备情况分为对照组(20例)和PCO组(22例)。比较两组患者AMH及性激素水平、助孕周期的促排情况、OHSS的发生情况以及实验室各项指标。结果 ①一般情况比较:PCO组基础窦卵泡数(AFC)、AMH均高于对照组(P<0.01或P<0.05);年龄、不孕年限、体重指数(BMI)、卵泡生成素(FSH)、黄体生成素(LH)、雌二醇(E2)、睾酮(T)水平比较差异均无统计学意义(P均>0.05)。② COH周期情况比较:降调后AFC、LH水平、HCG日卵泡数(FC)、卵泡液T水平PCO组高于对照组(P<0.01或<0.05);促性腺激素(Gn)总量、Gn天数,降调后AMH、FSH、E2、T水平,HCG日AMH、E2、LH、T水平,卵泡液AMH、E2水平,OHSS发生率比较差异无统计学意义(P均>0.05)。③获卵、胚胎指标比较:PCO组优胚率比对照组高(P<0.01);获卵数、MII 卵数、受精率、正常受精率、卵裂率比较差异均无统计学意义(P均>0.05)。④PCO患者血清降调后AMH的曲线下面积AUC为0.784,cut-off值 2.32 ng·mL-1,敏感度0.875,特异度0.727;正常人群血清基础AMH 的AUC为0.917,cut-off值5.2 ng·mL-1,敏感度1.0,特异度0.857。结论 高AMH、AFC是发生OHSS的高危因素; PCO患者降调后AMH(cut-off值:2.32ng·mL-1)、正常人群基础AMH(cut-off值:5.2ng·mL-1)水平可用来预测OHSS的发生;COH治疗过程中优势化卵泡数量越多,发生OHSS 的风险越高;适度的降调可以减少卵巢低反应或高反应等相应并发症的发生。
Abstract:
Objective Comparative studies on the correlation between normal ovarian reserve function and polycystic ovarian change(PCO) patients' serum and follicular anti-mullerian hormone(AMH) levels before and after the control super ovulation(COH) treatment and the occurrence of ovarian hyper stimulation syndrome (OHSS). Methods From October 2016 to November 2017,a prospective study was conducted in the reproductive center of Yinchuan Maternal and Child Health Care Hospital. Forty-two cases of assisted pregnancy patients who were treated with luteal long-term program were included according to the inclusion criteria, and divided into 2 groups according to the ovarian reservation: 20 cases in the normal control group and 22 cases of PCO. The levels of basic AMH and sex hormones in the two groups were compared, and the pro-row status, AMH and sex hormones, the occurrence of OHSS and various laboratory indicators were compared. Results ①Comparison of the general situation: The level of antral follicle count(AFC) and AMH were significantly higher in PCO group than those of control group(P<0.01 or <0.05).Age, infertility years, BMI,FSH,LH,E2 and T levels were not statistically significant in two groups(P>0.05). ②Comparisons of COH cycles: AFC, LH levels, follicular number (FC) per day of HCG, follicular fluid T levels in PCO group were higher than those in control group (P<0.01 or <0.05). Total gonadotropin (Gn) and days of Gn,AMH,FSH,E2,T levels,AMH, E2, LH on HCG day, the incidence of OHSS, AMH and E2 in follicular fluid were not statistically significant in two groups(P>0.05). ③Comparing the indexes of oocyte and embryo: The rate of excellent embryo in PCO group was higher than that in control group(P<0.01); there was no significant difference in the number of oocyte, MII oocyte, fertilization rate, normal fertilization rate and cleavage rate between PCO group and control group(P>0.05). ④The area under curve of AMH in PCO patients was 0.784, cut-off-off value was 2.32 ng·mL-1, sensitivity was 0.875,specificity was 0.727; the AUC of serum-based AMH in normal population was 0.917,cut-off-off value was 5.2 ng·mL-1,sensitivity was 1.0,specificity was 0.857. Conclusion High AMH and AFC are the high risk factors for OHSS; AMH(cut-off-off value: 2.32ng ·mL-1) in PCO patients and basic AMH(cut-off value: 5.2ng·mL-1) in normal population can be used to predict the occurrence of OHSS; the more preponderant follicles in COH treatment,the higher the risk of OHSS;moderate down-regulation can reduce the occurrence of corresponding complications such as low response or high response.

参考文献/References:


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备注/Memo

备注/Memo:
收稿日期:2018-09-23
基金项目:宁夏自然科学基金(NZ-16227)
作者简介:杨芳(1975-),女,副主任医师,在读硕士研究生,从事生殖医学临床工作。
通信作者:常青,教授,硕士研究生导师。
更新日期/Last Update: 2018-12-30