血清促代谢因子联合AMH评估年轻不孕女性卵巢功能的临床价值

目的 探讨血清促代谢因子联合抗苗勒管激素(AMH)评估年轻不孕妇女卵巢功能的临床价值.方法 选取2017年10月至2019年12月延安大学附属医院妇产科就诊的220例不孕症患者作为研究对象,年龄范围为25～40岁,根据卵巢储备功能,将患者分成卵巢正常反应组(n=166)和卵巢低反应组(n=54).比较两组患者血清促代谢因子和AMH水平,通过受试者工作特征(ROC)曲线分析血清促代谢因子和AMH联合诊断价值.结果 卵巢正常反应组血清促代谢因子水平低于卵巢低反应组;而卵巢正常反应组血清AMH水平高于卵巢低反应组,差异均有统计学意义(P<0.05).根据ROC曲线可得,血清促代谢因子诊断的临界值为123.45 pg/mL,其对应的灵敏度为57.41％,特异度为62.65％,ROC曲线下面积(AUC)为0.619(95％CI:0.545～0.693);血清AMH诊断的临界值为4.12 ng/mL,其对应的灵敏度为59.26％,特异度为63.25％,AUC为0.718(95％CI:0.650～0.786).在最佳临界切点时,平行联合检测的灵敏度为81.48％,特异度为60.84％,AUC为0.791(95％CI:0.735～0.847).平行联合检测灵敏度明显高于各指标单独检测(P<0.05),且联合诊断的AUC明显高于各项指标单独检测(P<0.05),平行联合诊断时,当任一指标为阳性即可确诊卵巢低反应.结论 血清促代谢因子和AMH二者单独检测对卵巢储备功能临床诊断具有重要意义,而联合检测可提高卵巢储备功能诊断的灵敏度,为临床评估年轻女性卵巢储备功能降低提供新的参考.

The clinical value of serum betatrophin combined with AMH in evaluation of ovarian function in young infertile women

Objective To investigate the clinical value of serum betatrophin combined with AMH in the evaluation of ovarian function in young infertile women. Methods A total of 220 patients with infertility who underwent IVF/ICSI therapy in the Affiliated Hospital of Yan''an University from October 2017 to December 2019 were divided into normal ovarian response group (n=166) and low ovarian response group (n=54) according to ovarian reserve function. The levels of serum betatrophin and AMH were compared between the two groups. The indicators and combined diagnostic value were analyzed by receiver operating characteristic (ROC) curve. Results The serum betatrophin level in the normal ovarian response group was significantly lower than that of the low ovarian response group (P<0.05), while the serum AMH level in the normal ovarian response group was significantly higher than that of the low ovarian response group (P<0.05). According to the ROC curve, the critical value of serum betatrophin diagnosis was 123.45 pg/mL, the corresponding sensitivity was 57.41%, the specificity was 62.65%, and area under curve (AUC) was 0.619 (95%CI 0.545~0.693); the critical value of serum AMH diagnosis was 4.12 ng/mL, the corresponding sensitivity was 59.26%, the specificity was 63.25% and the AUC was 0.718 (95%CI 0.650~0.786). At the optimal critical tangent point, the sensitivity, specificity and AUC of parallel joint detection was 81.48%, 60.84% and 0.791 (95%CI 0.735~0.847), respectively. The sensitivity of parallel combined detection was significantly higher than that of each index alone, and the AUC of combined diagnosis was significantly higher than that of each index alone (P<0.05). In parallel combined diagnosis, low ovarian response could be diagnosed when any index was positive. Conclusions The detection of serum betatrophin and AMH alone is of great significance for the clinical diagnosis of ovarian reserve function, while the combined detection can improve the sensitivity of the diagnosis of ovarian reserve function and provide a new idea for evaluation of decreased ovarian reserve in young woman.