1、第 49 卷 第 2 期2023年 3 月吉林大学学报（医学版）Journal of Jilin University（Medicine Edition）Vol.49 No.2Mar.2023DOI：10.13481/j.1671587X.20230227不同血清抗苗勒管激素水平对多囊卵巢综合征患者助孕结局的影响叶雅萍1,2,范岩峰3,丁露1,2,王龙梅1,2,李萍1,2（1.厦门大学附属妇女儿童医院 厦门市妇幼保健院生殖医学科，福建 厦门 361000；2.福建省厦门市生殖与遗传重点实验室，福建 厦门 361000；3.厦门大学附属妇女儿童医院 厦门市妇幼保健院营养门诊，福建 厦门 3610
2、00）摘要 目的目的：探讨多囊卵巢综合征（PCOS）不孕患者不同血清抗苗勒管激素（AMH）水平与卵巢反应及体外受精-胚胎移植（IVF-ET）助孕结局的关系，阐明血清 AMH 水平对 PCOS 患者助孕结局的影响，为 PCOS 患者助孕治疗方案的选择提供依据。方法方法：选取行 IVF-ET 助孕 2139岁患者1 837 例，根据是否被诊断为 PCOS 分为 PCOS 组（n=910）和非 PCOS 组（n=927）；PCOS 组中有437 例患者进行新鲜单优质囊胚移植，根据其血清AMH水平分为AMH7 g L1组和AMH 7 g L1 组，并根据患者年龄分为 2024 岁组、2529 岁组、3
3、034 岁和 3539 岁组。比较 PCOS 组与非PCOS组患者年龄、血清 AMH 水平、促性腺激素（Gn）用量、人绒毛膜促性腺激素（HCG）日雌二醇（E2）值、获卵数、预防卵巢过度刺激综合征（OHSS）取消移植率和临床妊娠率；分析 PCOS 组不同血清 AMH 水平患者 Gn用量、HCG 日 E2值、获卵数、预防 OHSS取消移植率和临床妊娠率；比较 PCOS 组中不同年龄段妊娠组与非妊娠组患者血清 AMH 水平。结果结果：PCOS 组患者血清 AMH 水平、HCG日 E2值、获卵数和预防 OHSS取消移植率均高于非 PCOS组（P0.05），Gn用量和临床妊娠率则低于非 PCOS 组（P
4、0.05）。PCOS 组患者血清 AMH 水平与 HCG 日 E2 值和获卵数呈正相关关系（r=0.502，P=0.001；r=0.233，P=0.001），与 Gn 用量呈负相关关系（r=0.400，P=0.001）。PCOS 组中 AMH7 g L1组患者 HCG日E2值、获卵数和预防 OHSS取消移植率较AMH7 g L1组增加（Z=3.952，P=0.001；Z=2.858，P=0.004；2=23.154，P=0.001）；Gn用量 和 临 床 妊 娠 率 较 AMH7 g L1组 降 低（Z=6.727，P=0.001；2=6.640，P=0.010）。PCOS 组中妊娠组患者血清
5、 AMH 水平低于非妊娠组（Z=4.192，P=0.001）；在 2529 岁组和3034岁组中妊娠组患者血清 AMH 水平低于非妊娠组（Z=2.197，P=0.028；Z=3.700，P0.01）。结论结论：对血清 AMH7 g L1 PCOS 患者应预处理以降低 AMH 后再行助孕，在 IVF-ET 助孕中应掌握好 Gn 用量，以降低 HCG 日 E2 值，降低预防 OHSS 取消移植率，争取有鲜胚移植机会并提高临床妊娠率，改善助孕结局。关键词 抗苗勒管激素；多囊卵巢综合征；促性腺激素；获卵数；临床妊娠率中图分类号 R711.6文献标志码 A文章编号 1671587X(2023)02050
6、107收稿日期 20220520基金项目 福建省卫健委卫生健康青年课题项目（2020QNB068）；北京白求恩公益基金会白求恩医学科学研究基金项目（QL002DS）作者简介 叶雅萍（1984），女，福建省厦门市人，副主任医师，医学硕士，主要从事辅助生殖临床方面的研究。通信作者 李 萍，主任医师，教授，硕士研究生导师（E-mail：）501第 49 卷 第 2 期 2023 年 3 月吉林大学学报（医学版）Effects of different serum levels of anti-mullerian hormone on pregnancy outcome of patients wit
7、h polycystic ovary syndromeYE Yaping1,2,FAN Yanfeng3,DING Lu1,2,WANG Longmei1,2,LI Ping1,2（1.Department of Reproductive Medicine，Xiamen Maternal and Child Health Hospital，Affiliated women s and Children s Hospital，Xiamen University，Xiamen 361000，China；2.Xiamen Key Laboratory of Reproduction and Gene
8、tics，Fujian Province，Xiamen 361000，China；3.Department of Nutrition，Xiamen Maternal and Child Health Hospital，Affiliated Women s and Children s Hospital，Xiamen University，Xiamen 361000，China）ABSTRACT Objective：To discuss the relationship between the different serum levels of anti-mullerian hormone（AM
9、H）and ovarian response and in vitro fertilization-embryo transfer（IVF-ET）-assisted pregnancy outcome of the infertile patients with polycystic ovary syndrome（PCOS），and to clarify the influence of serum AMH level on assisted pregnancy outcome of the PCOS patients，and to provide the basis for the sele
10、ction of assisted pregnancy treatment in the PCOS patients.Methods：A total of 1 837 patients aged 2139 years old who underwent IVF-ET-assisted pregnancy were selected and divided into PCOS group（n=910）and non-PCOS group（n=927）according to whether they were diagnosed as PCOS；a total of 437 patients i
11、n PCOS group received fresh single high-quality blastocyst transfer，and they were divided into AMH 7 g L1 group and AMH7 g L1 group according to their serum AMH levels；the patients were divided into 2024 years old group，2529 years old group，3034 years old and 3539 years old group according to their
12、ages.Age，serum levels of AMH，gonadotropin（Gn）dosages，estradiol（E2）values on the human chorionic gonadotropin（HCG）day，number of retrieved oocytes，cancellation transfer rates for preventing ovarian hyperstimulation syndrome（OHSS）and clinical pregnancy rates of the patients in PCOS group and non-PCOS g
13、roup were compared；the Gn dosages，E2 values on the HCG day，number of retrieved oocytes，cancelation transfer rates of preventing OHSS and clinical pregnancy rates of the patients with different AMH levels in PCOS group were analyzed；the serum AMH levels of the patients with different ages in pregnant
14、 group and non-pregnant group were compared.Results：The level of serum AMH and E2 value on the HCG day，number of retrieved oocytes and cancelation transfer rate for preventing OHSS of the patients in PCOS group were higher than those in non-PCOS group（P0.05），while the Gn dosage and clinical pregnanc
15、y rate were lower than those in non-PCOS group（P0.05）.The serum AMH level of the patients in PCOS group was positively correlated with the E2 value on the HCG day and number of retrieved oocytes（r=0.502，P=0.001；r=0.233，P=0.001），and negatively correlated with Gn dosage（r=0.400，P=0.001）.In PCOS group，
16、compared with AMH 7 g L1 group，the E2 value on the HCG day，number of retrieved oocytes，and cancelation transfer rate for preventing OHSS of the patients in PCOS group were increased（Z=3.952，P=0.001；Z=2.858，P=0.004；2=23.154，P=0.001）；the Gn dosage and clinical pregnancy rate were decreased（Z=6.727，P=0.001；2=6.640，P=0.010）.The serum AMH level of the patients in pregnant group in PCOS group was lower than that in non-pregnant group（Z=4.192，P=0.001）；in 2529 years old group and 3034 years old group，th
