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目的探讨血清抑制素水平在体外受精-胚胎移植(IVF-ET)超排卵周期中与卵巢反应性的相关性及其预测价值。方法对37例初次接受IVF-ET、基础卵泡刺激素(FSH)水平<12U/L的患者,于IVF前1周期月经第2~4天及黄体中期、IVF周期重组rFSH注射第5天、人绒毛膜促性腺激素(hCG)注射日、取卵日及黄体中期,分别检测血清雌二醇、孕酮、抑制素(INH)A及INHB水平。根据IVF周期中的获卵数、雌二醇峰值水平、是否发生卵巢过度刺激综合征(OHSS)的情况,将37例患者分为卵巢低反应者8例(A组)、卵巢正常反应者及卵巢高反应者29例(B组),比较两组IVF-ET临床效果及注射rFSH前后INH、雌二醇及孕酮水平的变化。通过多重逻辑回归分析、受试者工作特征曲线分析,评价各激素水平预测卵巢反应性的准确性;通过敏感度、特异度的计算确定INHB诊断的临界值。结果(1)A、B组IVF前1周期月经第2~4天INHB水平分别为(37±35)、(91±90)ng/L;IVF周期注射rFSH第5天的INHB水平分别为(194±157)、(2254±4765)ng/L,INHA水平分别为(36±35)、(91±90)ng/L,两组比较,差异有统计学意义(P<0·05)。(2)获卵数与IVF前1周期月经第2~4天INHB水平、IVF周期rFSH注射后各阶段的INHB、INHA及雌二醇水平呈显著正相关(INHB:r=0·39~0·67,P<0·05;INHA:r=0·43~0·59,P<0·01;雌二醇:r=0·50~0·60,P<0·01)。(3)受试者工作特征曲线分析显示,注射rFSH第5天的INHB水平的最大的曲线下面积为0·948(95%可信限为0·871~1·025),将INHB为400ng/L作为临界值时,其对卵巢反应性的预测敏感度为82·8%,特异度为99·1%。结论基础INHB水平、IVF周期rFSH注射第5天的INHB水平均是预测卵巢反应性较好的标记物;IVF周期rFSH注射第5天的INHB水平对卵巢反应性具有最佳的预测价值。
Objective To investigate the correlation between the level of serum inhibin and ovarian response during the IVF-ET superovulation cycle and its predictive value. Methods 37 patients with initial IVF-ET and basic follicle-stimulating hormone (FSH) level <12U / L were enrolled in the first menstrual cycle of IVF on the 2nd to 4th days and in the mid luteal phase on the 5th day after IVF cycle rFSH injection Serum estradiol, progesterone, inhibin (INH) A and INHB levels were detected on the day of ovulation, ovulation and mid luteal phase on the day of human chorionic gonadotropin (hCG) injection. According to the number of oocytes in the IVF cycle, the peak level of estradiol and the occurrence of ovarian hyperstimulation syndrome (OHSS), 37 patients were divided into 8 cases (group A) with low ovarian response, normal ovarian response and 29 cases of ovarian hyperresponsiveness (group B). The clinical effects of IVF-ET and INH, estradiol and progesterone levels before and after injection of rFSH were compared. Through multiple logistic regression analysis, the working curve of the subjects was analyzed to evaluate the accuracy of each hormone level in predicting the ovarian response. The critical value of INHB diagnosis was determined by the sensitivity and specificity calculation. Results (1) The INHB levels in the first two cycles of menstrual cycle in group A and group B were (37 ± 35) and (91 ± 90) ng / L on the first to fourth days of IVF respectively. The levels of INHB on day 5 after IVF injection of rFSH were 194 ± 157 and 2254 ± 4765 ng / L, respectively. The levels of INHA were (36 ± 35) and (91 ± 90) ng / L, respectively. There was significant difference between the two groups (P <0.05). (2) The number of oocytes retrieved had a significant positive correlation with INHB level, INHB, INHA and estradiol levels at all stages after IVF cycle rFSH injection (INHB: r = 0.39 ~ 0 · 67, P <0 · 05; INHA: r = 0 · 43 ~ 0 · 59, P <0 · 01; estradiol: r = 0 · 50 ~ 0 · 60, P <0.01). (3) The working curve of the subjects showed that the area under the curve of INHB at the 5th day after injection of rFSH was 0.948 (95% confidence interval was 0.87-1.025), INHB was 400ng / L as a cutoff value, its sensitivity to ovarian response was 82.8% and its specificity was 99.1%. Conclusions INHB level and INHB level on day 5 of rFSH injection are the best predictors of ovarian response. The level of INHB on day 5 after rFSH injection has the best predictive value for ovarian response.