AMH对辅助生殖妊娠结局预测价值的Meta分析

目的:系统评价抗苗勒管激素(anti-Mullerian hormone,AMH)对接受辅助生殖技术(assisted reproductive technology,ART)治疗,如体外受精-胚胎移植(in vitro fertilization-embryo transfer,IVF-ET)或胞浆内单精子注射(intracytoplasmic sperm injection,ICSI)等不同助孕方式患者卵巢反应性和妊娠结局的预测价值。方法:检索Pubmed、Medline、Cochrane Library、CNKI等相关中英文数据库,按纳入与排除标准对文献进行筛选,收集血清AMH用于预测接受IVF/ICSI治疗的不孕症患者卵巢反应性及妊娠结局的研究数据。采用Stata 12.0软件,通过合并诊断效应量,汇总受试者工作特征(summary receiver operating characteristic,SROC)曲线,进而综合评价AMH对卵巢反应性及妊娠结局的预测价值。结果:本研究最终纳入文献15篇,累计病例3 475例。AMH预测卵巢反应性及妊娠结局的合并敏感度分别为0.814和0.661,合并特异度分别为0.826和0.768,合并阳性似然比分别为3.900和2.848,合并阴性似然比分别为0.229和0.357,合并诊断比值比分别为21.334和9.403。SROC曲线显示,AMH预测卵巢反应性及妊娠结局的曲线下面积(AUC)分别为0.890 8和0.822 1,Q指数分别为0.821 6和0.755 5,但差异无统计学意义。结论:AMH对妊娠结局的预测价值与其对卵巢反应性的预测价值相近,可作为妊娠结局的预测指标,但其敏感度较低,仍存在一定的局限性。

Prediction of Pregnancy Outcome of ART by AMH: A Meta-analysis

Objective:To evaluate systematically the predictive value of anti-Mullerian hormone (AMH) on the ovarian response and pregnancy outcome for the women undergoing the different assisted reproductive technology (ART),such as in vitro fertilization-embryo transfer (IVF-ET) and intracytoplasmic sperm injection (ICSI).Methods:The articles were searched electronically from the databases in both English and Chinese including Pubmed,Medline,Cochrane Library and CNKI.The articles were selected according to the inclusion and exclusion criteria,and data coming AMH predicting the ovarian response and pregnancy outcome for women undergoing IVF-ET and ICSI were selected.Then Stata 12.0 software was used for Meta analysis.By combining the diagnostic effect and fitting the SROC,the predictive value of AMH on ovarian response and pregnancy outcome was evaluated comprehensively.Results:The study included 15 effective papers and 3 475 cumulative cases.The pooled sensitivity,specificity,positive likelihood ratio,negative likelihood ratio and diagnostic odds ratio of AMH in the prediction of ovarian response were 0.814,0.826,3.900,0.229 and 21.334,and the pregnancy outcomes were 0.661,0.768,2.848,0.357 and 9.403,respectively.The area under curve,and Q values of ovarian response and pregnancy outcome,were 0.890 8,0.821 6 and 0.822 1,0.755 5,respectively.There was no statistical significance between the two.Conclusions:The predictive value of AMH for pregnancy outcome is similar to that for ovarian response.AMH can be used as a predictor of pregnancy outcome.However,its sensitivity is low,there are still some limitations for its clinical application.