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目的:探讨抗苗勒氏管激素(AMH)对卵巢储备功能及卵巢反应性的预测价值。方法:利用ELISA法对228例不孕症患者基础血清AMH蛋白水平(bAMH)进行检测,其中71例初次接受IVF-ET治疗的患者,分别检测IVF周期中FSH注射后各阶段的血清及卵泡液中AMH蛋白水平,分离并采用RT-PCR检测卵巢颗粒细胞AMH mRNA相对含量。结果:①228例不孕症患者bAMH水平与窦卵泡计数成正相关(r=0.907,P<0.01),与患者年龄、初潮年龄、初潮至就诊的年数成负相关(r=-0.833,P<0.01;r=-0.580,P<0.01;r=-0.783,P<0.01)。②71例接受IVF-ET治疗的患者,bAMH与在FSH注射后各阶段血清AMH水平无明显差异(t=0.042,P>0.05;t=0.278,P>0.05;t=0.255,P>0.05)。③血清、卵泡液AMH蛋白表达及颗粒细胞AMH mRNA相对含量与卵巢反应性有关,卵巢低反应组(获卵数≤5个)与正常组(获卵数>5个)比较,差异有统计学意义(P<0.05)。④获卵数与bAMH水平均呈显著正相关(r=0.527,P<0.01)。颗粒细胞AMH mRNA相对含量与成熟卵数、受精卵数显著相关(r=0.479,P<0.01,r=0.529,P<0.01)。⑤发生卵巢过度刺激综合征患者的bAMH蛋白水平较其他患者显著增高(t=3.173,P<0.01)。结论:AMH的表达不受促性腺激素作用的影响,bAMH水平与患者卵巢的储备功能及卵巢反应性有关,可以作为评价卵巢储备功能及预测促排卵中卵巢反应性的血清学标记物。
Objective: To investigate the predictive value of anti-Müllerian hormone (AMH) on ovarian reserve and ovarian response. Methods: The basal serum AMH protein level (bAMH) was detected in 228 cases of infertility patients by ELISA. Among the 71 patients who were treated with IVF-ET for the first time, the levels of serum and follicular fluid AMH protein levels in ovarian granulosa cells, and the relative content of AMH mRNA in ovarian granulosa cells was isolated and detected by RT-PCR. Results: (1) There was a positive correlation between bAMH levels and antral follicle count (r = 0.907, P <0.01) in 228 infertility patients and negative correlation with age, age of menarche, ; r = -0.580, P <0.01; r = -0.783, P <0.01). There was no significant difference in serum AMH levels between the bAMH group and the control group (P> 0.05). There was no significant difference in serum AMH levels between the bAMH group and the control group (P> 0.05). (3) Serum and follicular fluid AMH protein expression and granulosa cells AMH mRNA relative content and ovarian response, low ovarian response group (number of oocytes ≤ 5) and normal group (number of oocytes> 5), the difference was statistically significant Significance (P <0.05). ④ The number of oocytes and bAMH levels were significantly and positively correlated (r = 0.527, P <0.01). The relative content of AMH mRNA in granulosa cells was significantly correlated with the number of mature eggs and fertilized eggs (r = 0.479, P <0.01, r = 0.529, P <0.01). ⑤ patients with ovarian hyperstimulation syndrome bAMH protein levels were significantly higher than other patients (t = 3.173, P <0.01). CONCLUSION: The expression of AMH is not affected by gonadotrophin. The level of bAMH is related to the ovarian reserve function and ovarian response, which may serve as a serological marker for evaluating ovarian reserve and predicting ovarian response during ovulation induction.