AMH联合FSH检测对拟行辅助生殖技术高龄妇女卵巢储备功能的评估价值

潘维君; 叶希平; 黄存; 艾风连

doi:10.13898/j.cnki.issn.1000-2200.2021.01.020

AMH联合FSH检测对拟行辅助生殖技术高龄妇女卵巢储备功能的评估价值

The value of AMH combined with FSH detection in the evaluation of ovarian reserve function in elderly women scheduled by assisted reproductive technology

摘要

摘要:
目的探讨抗苗勒氏管激素(AMH)联合促卵泡刺激素(FSH)检测对高龄拟行辅助生殖技术病人的卵巢储备功能的评估价值。
方法回顾性分析高龄拟行辅助生殖技术病人139例的临床资料，所有病人年龄>35岁。参照2017年波塞冬卵巢低反应分组标准，按照卵巢储备功能检查结果将病人分为正常组51例、卵巢功能减退(DOR)组46例及卵巢早衰(POF)组42例；根据1年内是否成功受孕将正常组病人分为妊娠组37例及未妊娠组14例。比较各组病人卵巢功能相关评定指标，采用受试者工作特征曲线评价病人年龄、AMH、FSH单独或联合诊断对卵巢储备功能异常的评估价值。
结果DOR组和POF组年龄、FSH及促黄体生成素(LH)均明显高于正常组，AMH、窦卵泡计数(AFC)及雌二醇(E2)均明显低于正常组(P < 0.01)；POF组年龄、FSH及LH均高于DOR组，AMH、AFC及E2均低于DOR组(P < 0.05~P < 0.01)；3组催乳素、孕酮水平间差异均无统计学意义(P>0.05)。相关分析结果显示，AMH与AFC、E2均呈明显正相关关系(P < 0.01)，与年龄、FSH、LH均呈明显负相关关系(P < 0.01)；FSH与年龄、LH均呈正相关关系(P < 0.05和P < 0.01)，与AFC、E2均呈明显负相关关系(P < 0.01)；而AMH、FSH与催乳素、孕酮均无明显相关关系(P>0.05)。年龄、AMH及FSH诊断卵巢储备功能异常的临界值分别为36.25岁、1.27 ng/mL、8.11 U/L，三项联合诊断卵巢储备功能异常的AUC值为0.932，灵敏度93.18%，特异度94.11%，阳性似然比为96.47%，阴性似然比为88.89%，检出率96.59%，均高于单项检测(P < 0.05)。按照1年内是否成功受孕，将卵巢储备功能正常组病人分为妊娠组37例及未妊娠组14例。结果显示，妊娠组AMH、E2均明显高于非妊娠组(P < 0.01和P < 0.05)，FSH、LH均明显低于未妊娠组(P < 0.01)。
结论AMH、FSH是评估高龄拟行辅助生殖技术病人卵巢储备功能的有效指标，AMH联合FSH检测技术有望替代传统的卵巢储备功能评估体系。

Abstract:
ObjectiveTo investigate the value of anti-Miillerian hormone(AMH) combined with follicle stimulating hormone(FSH) in the evaluation of ovarian reserve function in elderly women scheduled by assisted reproductive technology.
MethodsThe clinical data of 139 elderly patients(aged >35 years old) scheduled by assisted reproductive technology were retrospectively analyzed.According to the 2017 Poseidon poor ovarian response grouping criteria and ovarian reserve function test results, the patients were divided into normal group(n=51), diminished ovarian reserve(DOR) group(n=46) and premature ovarian failure(POF) group(n=42).According to the success of pregnancy within 1 year, the normal group was subdivided into the pregnant group(n=37) and non-pregnant group(n=14).The ovarian function-related assessment indexes were compared among all groups.The receiver operating characteristic curve(ROC) was used to evaluate the value of age, AMH and FSH alone or combined in the diagnosis of ovarian reserve dysfunction.
ResultsThe age, FSH and LH in DOR and POF groups were significantly higher than those in normal group, while the AMH, AFC and E2 were significantly lower than those in normal group(P < 0.01).The age, FSH and LH in POF group were higher than those in DOR group, and the AMH, AFC and E2 in POF group were lower than those in DOR group(P < 0.05 to P < 0.01).The differences of the levels of PRL and P among three groups were not statistically significant(P>0.05).The results of correlation analysis showed that the AMH was positively correlated with AFC and E2(P < 0.01), and negatively correlated with the age, FSH and LH(P < 0.01).The FSH was positively correlated with age and LH(P < 0.01 and P < 0.05), and negatively correlated with AFC and E2(P < 0.01).There was not significant correlation among AMH, FSH, PRL and P(P>0.05).The critical values of age, AMH and FSH in the diagnosis of ovarian reserve dysfunction were 36.25 years old, 1.27 ng/mL and 8.11 U/L, respectively.The AUC value, sensitivity, specificity, PPV and NPV of three combination detection in the diagnosis of ovarian reserve dysfunction were 0.932, 93.18%, 94.11%, 96.47%, 88.89% and 96.59%, respectively, which were higher than those of single detection(P < 0.05).The levels of AMH and E2 in pregnant group were significantly higher than those in non-pregnant group(P < 0.01 and P < 0.05), while the levels of FSH and LH in pregnant group were significantly lower than those in non-pregnant group(P < 0.01).
ConclusionsThe AMH and FSH are the effective indexes to evaluate the ovarian reserve function in elderly patients scheduled by assisted reproductive technology.The AMH combined with FSH detection technology can effectively replace the traditional evaluation system of ovarian reserve function.

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