摘要
【目的】探讨两种剂型(长效/短效)促性腺激素释放激素激动剂(GnRH-a)降调节对血清抗苗勒管激素(AMH)的影响是否相同。【方法】选择2012年2月到9月在我中心行体外受精/胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)共869个治疗周期,符合入选标准患者随机进入长效组(使用长效GnRH-a)128例患者128周期;短效组(使用短效GnRH-a)116例患者116周期。降调前月经来潮第3天和降调第14天抽取空腹静脉血检测血清AMH,观察患者用药前后血清AMH变化。【结果】①长效组血清AMH降调后略下降,但P>0.05;短效组降调后下降约0.63μg/L,P<0.05。②两组基础血清AMH降调后均呈现归中趋势。以上升或下降为标准的ROC曲线,寻找切割点。长效组基础血清AMH切割点是2.15μg/L,短效组切割点是2.16μg/L。③长效组切割点以下组52例,降调后AMH(μg/L)由1.39±0.54上升为2.73±1.83,P<0.01;切割点以上组76例,降调后血清AMH(μg/L)为4.40±1.95下降为3.27±1.78,P<0.01。短效组切割点以下组51例,降调后血清AMH(μg/L)由1.21±0.50上升为1.96±1.57,P<0.01;切割点以上组65例,降调后血清AMH(μg/L)由4.26±1.93下降为2.55±1.48,P<0.01。④长效切割点以下组内,血清AMH上升者与下降者基础AMH均值无统计学差异,P>0.05,但上升者获卵数多于下降者(13.4±5.1 vs 7.4±2.5,P<0.05);长效切割点以上组内,血清AMH上升者基础血清AMH均值小于下降者,但获卵数上升组反而多于下降组(17.73±6.13 vs 13.79±4.60)个(P<0.05)。短效组按切割点分组后,结果类似。【结论】无论是使用长效还是短效GnRH-a,降调节前后血清AMH变化规律是一样的:基础AMH低于切割点的呈现上升趋势,高于切割点的呈现下降趋势。符合这一变化规律的患者获卵数的预期结果更好。
[ Objective ] To investigate whether the influence of two forms （long-acting / short-acting） of gonadotrophin-releasing hormone agonist （GnRH-a） on anti-Mullerian hormone （AMH） is the same. [Methods] The study included 869 cycles that underwent in vitro fertilization （IVF） /intracytoplasmic sperm injection （ICSI） from February 2012 to September 2012. Patients who met the inclusion criteria were randomly divided into two groups： long-acting group （using long-acling GnRH-a, Diphereline ） which including 128 women with 128 cycles, and short-acting group （useing short-acting GnRH-a, Diphereline ） which including 116 women with 116 cycles. Serum AMH levels were measured at baseline and Day 14 following GnRH-a. [Results] （1） After down- regulation in long-acting group, baseline serum AMH slightly reduced, P 〉 0.05; In short-acting group, serum AMH fell from （2.92 ± 2.12） μg/L to （2.29 ± 1.54）μg/L （P 〈 0.05）. （2） After GnRH-a treatment higher basal AMH level fell down, and lower basal AMH level grew up in both groups. Using rising or failing AMH level as the standard to the ROC curve, we found the cutoff point of serum AMH：2.15 μg/L in long-acting group, and 2.16 μg/L in short-acting group. （3）In long-acting group, based on the cutoff points, basal AMH level of 52 women was less than 2.15 μg/L, and their basal serum AMH was （1.39 ±0.54） μg/L, after down- regulation AMH was （2.73± 1.83） μg/L（P 〈0.01 ） ; 76 women with basal serum AMH 1〉2.15 μg/L, their basal serum AMH was （4.40 ± 1.95）μg/L, after down-regulation was （3.27 ± 1.78） μg/L（P 〈 0.01 ）. In short-acting group, 51 women with basal serum AMH 〈 2.16 μg/L, AMH before down-regulation was （1.21 ± 0.50） μg/L, after down-regulation was （1.96 ±1.57） μg/L （P 〈 0.01 ） ; 65 women with basal serum AMH 〉12.16 μg/L, their basal serum AMH was （4.26 ± 1.93） μg/L, after down-regulation was （2.55± 1.48） μg/L （P 〈 0.01 ）. （4）In long-acting group, for those whose AMH level 〈 2.15 I.L g/L, there was no significant difference of basal serum AMH between AMH increased group （1.39 ±0.55） μg/L and decreased group （1.41 ± 0.38） μg/L, but the number of retrieved oocytes was less in falling group （13.40 ±5.08 vs 7.40 ±2.51, P 〈 0.05）. For those whose AMH level 〉t 2.15μg/L, AMH increased group had lower basal AMH level （3.39±0.89） μg/L than decreased group （4.65 ± 2.06） μg/L, but had more retrieved oocytes （ 17.73 ± 6.13 vs 13.79 ± 4.60, P 〈 0.05）. In short-acting group, we had the same results. [Conclusion] Whether using long-acting or short-acting GnRH-a, AMH dynamics after down regulation was the same： for those with basal serum AMH below the cutoff point, AMH had upward trend; for those with basal serum AMH higher than the cutoff point, AMH showed downward trend. Consistent with this variation trend, the expected number of oocytes retrieved would be better.
出处
《中山大学学报（医学科学版）》
CAS
CSCD
北大核心
2013年第4期578-584,共7页
Journal of Sun Yat-Sen University:Medical Sciences
基金
广东省医学科研基金(A2011747)
关键词
抗苗勒管激素
垂体降调节
控制性超排卵
anti-Mullerian hormone （AMH）
pituitary down-regulation
controlled ovarian stimulation
