南方医科大学学报

南方医科大学学报 ›› 2013, Vol. 33 ›› Issue (02): 216-.

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在体外受精-胚胎移植中应用多项卵巢储备功能评估指标预测卵巢反应性

何于夏，夏容，陈薪，叶德盛，唐妍，黎璞，牛静，陈士岭   

  • 出版日期:2013-02-20 发布日期:2013-02-20

Estimation of ovarian response using multiple predictors of ovarian reserve in women undergoing in vitro fertilization-embryo transfer

  • Online:2013-02-20 Published:2013-02-20

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摘要： 目的分析卵巢储备功能评估指标与卵巢反应性的关系及对卵巢反应性的预测效能。方法队列研究分析行体外受精（IVF）/
单精子卵母细胞内注射(ICSI) 的331个取卵周期病例，并将病例分为正常反应组、低反应组以及高反应组3组，采用ELISA方法检
测患者月经第3天的血清抗苗勒氏激素（AMH）水平，同时超声测量双侧卵巢内基础窦状卵泡数（AFC），血清基础卵泡刺激素
（FSH）、黄体生成素（LH）及雌激素（E2）采用化学免疫发光法检测。结果血清AMH水平、AFC、血清FSH水平、FSH与LH比值
（FSH/LH）、年龄均与获卵数×1000/促性腺激素（Gn）总安瓿数相关（P<0.001）；而基础E2与其不相关（P>0.05）。AFC及血清AMH
水平作为单一指标对于卵巢低反应的预测价值最好，其ROC曲线下面积分别为0.855（0.787~0.924）和0.832（0.764~0.900），对卵
巢低反应的最佳预测界值点分别为AFC≤9个，AMH≤1.88 ng/ml。AFC是预测卵巢高反应的最好单一指标，其ROC曲线下面积
为0.787（0.728~0.847），最佳预测界值点为AFC≥15个。Logistic逐步回归分析显示联合AFC、血清AMH水平以及血清FSH水
平指标能更好地预测卵巢低反应，但联合各指标并不能提高对卵巢高反应的预测效能。结论AFC、血清AMH水平、血清FSH水
平、FSH/LH、年龄均是卵巢反应性的预测指标，但是其敏感性、特异性不同。AFC作为单一指标对于卵巢反应的预测价值最好。联
合AFC、血清AMH水平及血清FSH水平能提高对于卵巢低反应的预测效能。而对于卵巢高反应，联合多指标不能提高预测效能。

Abstract: Objective To analyze the value of ovarian reserve markers for predicting ovarian response in women undergoing in
vitro fertilization-embryo transfer. Methods According to the ovarian response, 331 patients undergoing oocyte retrieval cycles
were divided into of normal, poor, and high response groups. Serum anti-Müllerian hormone (AMH) was determined using
AMH ELISA kit on day 3 of the menstrual cycle, antral follicle count (AFC) was measured using vaginal ultrasound, and basal
serum follicle-stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E2) levels were detected using
chemiluminescence method. Results Serum AMH and FSH levels, FSH/LH ratio, AFC, and the patient’s age, but not the basal
E2 level (P>0.05), were correlated with the number of oocytes collected (×1000/ampules of Gn) (P<0.001). AFC and serum AMH
were the strongest single predictors for low ovarian response, with the areas under curve (AUC) of 0.855 (0.787-0.924) and
0.832 (0.764-0.900) (P<0.05), and cutoff values of ≤9 and ≤1.88 ng/ml, respectively. AFC was the strongest single predictor for
high ovarian response, with an AUC of 0.787 (0.728-0.847) and the cutoff value of ≥15. Logistic regression model found that
the combination of AFC, serum AMH and FSH improved the predictive power for poor ovarian response, but not for high
ovarian response. Conclusions AFC, serum AMH, FSH, FSH/LH, and age are all predictors of ovarian response, among which
AFC is the strongest single predictor. A multivariable model can improve the predictive power for low ovarian response but
not for high ovarian response.