抗苗勒氏管激素水平对IVF-ET妊娠结局的预测价值评估

陈艺，刘海鹏，李苏萍，贺平，杨帆

(湖南省郴州市第一人民医院南院生殖医学中心，郴州　423000)

抗苗勒氏管激素水平对IVF-ET妊娠结局的预测价值评估

陈艺，刘海鹏*，李苏萍，贺平，杨帆

(湖南省郴州市第一人民医院南院生殖医学中心，郴州423000)

【摘要】目的评估抗苗勒氏管激素(AMH)水平对于体外受精-胚胎移植(IVF-ET)临床妊娠结局的预测价值。方法选择在本中心行IVF/ICSI治疗的患者150例，按年龄将其分为<35岁组(n=90)和≥35岁组(n=60)。于月经第2～4 d测定患者的血清基础卵泡刺激素(bFSH)和基础AMH(bAMH)水平，同时进行阴道B超窦卵泡计数(AFC)；于患者接受促性腺激素(Gn)刺激卵巢第6天测定血清AMH水平(Gn6AMH)及取卵日测定其卵泡液中AMH水平(FFAMH)。评估各检测指标与IVF-ET临床妊娠结局的相关性，并绘制患者受试工作曲线(ROC)，分析并寻找各检测指标预测IVF-ET临床妊娠结局的临界点。结果患者年龄<35岁时，卵泡液中AMH水平(FFAMH)与IVF-ET临床妊娠结局有显著正相关性(r=0.468，P<0.01)，当FFAMH水平≥6.590 ng/ml时其预测IVF-ET临床妊娠结局的敏感度为78.8%，特异性为81.6%，曲线下面积ROC-AUC为0.859(P<0.01)，具有良好的预测价值；患者年龄≥35岁时，各个测定指标与临床妊娠结局均无显著相关性(P>0.05)。结论对于年轻患者(年龄<35岁)，卵泡液中AMH水平对IVF-ET临床妊娠结局有较高的预测价值；当患者年龄≥35岁时，AMH水平无法预测其临床妊娠结局。

【关键词】抗苗勒氏管激素；体外受精-胚胎移植；妊娠结局

Methods： A total of 150 women undergone IVF/ICSI in our reproductive center were divided into two groups：groupⅠ(age<35，n=90) and groupⅡ(age≥35，n=60). Basal serum levels of AMH & FSH and antral follicle count (AFC) were measured on Day 2 to Day 4. AMH level was measured on Day 6 after administration of gonadotrophin (Gn). AMH level was also measured in follicle fluid on the day of oocytes picked-up. The correlation between AMH level and the pregnancy outcome of IVF-ET were evaluated. Receiver operating characteristic (ROC) curves were constructed to find the cut-off value of AMH and other parameters in predicting clinical pregnancy rate (CPR).

Results： When the patients’ age were less than 35 years，clinical pregnancy rate was correlated with AMH levels in follicle fluid (r=0.468，P<0.01). When AMH levels in follicle fluid were≥6.590 ng/ml，the sensitivity in predicting clinical pregnancy rate was 78.8% & the specificity 81.6%，and the ROC-AUCwas 0.859 (P<0.01). When patients aged≥35 years，no associations were found between AMH and CPR (P>0.05).

Conclusions： AMH level in follicle fluid is significantly correlated with clinical pregnancy rate in patients aged<35 years. There is no association between AMH and CPR in patients aged≥35 years.

(JReprodMed2016，25(6)：522-527)

抗苗勒氏管激素(AMH)属转化生长因子β超家族，由二硫键连接成二聚体糖蛋白，分子量14 KD。人类AMH基因定位于19号染色体短臂P13.2-13.3，仅表达于性腺。对于女性而言，AMH的作用主要体现在参与卵泡形成过程中两次重要募集，即调控卵泡起始募集和参与调控生长卵泡发育至成熟卵泡的周期募集，通过影响卵泡对卵泡刺激素(FSH)的反应性而影响卵泡的选择。因而AMH水平可以反映女性原始卵泡的库存情况，在辅助生殖技术应用过程中，AMH水平已经被证明能够较好地评估患者的卵巢储备功能。但AMH与IVF-ET临床妊娠结局的相关性研究却存在着争议及矛盾。本研究将患者按年龄分组后分别测定了基础FSH和窦卵泡计数(AFC)，以及基础AMH水平(bAMH)、接受促性腺激素(Gn)刺激卵巢第6天血清AMH水平(Gn6AMH)及取卵日卵泡液中AMH水平(FFAMH)等各阶段AMH水平。分析评估各检测指标对于IVF-ET临床妊娠结局的预测价值，试图为AMH与IVF-ET临床妊娠结局的相关性研究提供新的思路。

资料与方法