抗缪勒管激素（AMH）与免疫性不孕及IVF妊娠结局的相关性研究

发布时间：2018-04-13 09:58

本文选题：抗缪勒管激素 + 免疫性不孕　；参考：《青岛大学》2017年硕士论文

【摘要】：目的探讨血清抗缪勒管激素(AMH)水平与免疫性不孕症及体外受精-胚胎移植(IVF-ET)妊娠结局的相关性。方法(1)选取2014年1月至2016年5月于临沂市妇女儿童医院生殖中心门诊就诊的不孕症患者500例及孕前查体者210例,其中将不孕症患者根据不孕因素进行分组,其中因免疫因素导致不孕者35例(免疫因素组),因输卵管因素不孕者250例(输卵管因素组)、因内分泌因素不孕者165例(内分泌因素组)、因子宫因素导致不孕者50例(子宫因素组),采用化学发光法检测其血清AMH值,比较各组之间AMH的差异;并分析AMH与不孕抗体{抗精子抗体(As Ab)、抗心磷脂抗体(Ac Ab)、抗子宫内膜抗体(Aem Ab)和抗卵巢抗体(Ao Ab)}之间的相关性。(2)另选取因输卵管因素初次行IVF的患者48例,以IVF中获卵数为分组依据,分为低获卵数组共3例为A组、正常获卵数组共22例为B组及高获卵数组共23例为C组,检测其AMH值、不孕抗体、基础内分泌{血清雌二醇(E2)、卵泡刺激素(FSH)}、B超相关指标{基础窦卵泡数(AFC)、卵巢体积、间质动脉收缩期峰值(PSV)及阻力指数(RI)}及妊娠结局{促性腺激素(Gn)用量、获胚数、临床妊娠率},比较各组之间AMH、不孕抗体、基础内分泌、B超相关指标、妊娠结局及一般资料等之间的差异,并分析AMH与不孕抗体及其他各因素之间的相关性。结果(1)内分泌因素组与孕前查体组、免疫因素组、输卵管因素组、子宫因素组之间AMH测定值比较有统计学差异(P0.01);(2)免疫因素组不孕抗体与其它三组之间的有统计学差异,且不同年龄段下AMH患者之间的不孕抗体之间无统计学差异(P0.05);(3)IVF患者三组(低获卵数组、正常获卵数组和高获卵数组)之间一般资料(年龄、BMI等)及不孕抗体比较均无统计学差异(P0.05);(4)IVF患者三组之间AMH、FSH、AFC及妊娠结局(Gn用量、获胚数、临床妊娠率)比较均有显著统计学差异(P0.01);(5)IVF患者三组之间卵巢体积、PSV及RI比较均有统计学差异(P0.05);(6)AMH与获卵数、AFC、卵巢体积、获胚数、临床妊娠率呈正相关;与D2天的FSH呈负相关;与PSV、RI、不孕抗体无相关性。结论(1)血清AMH水平与内分泌性不孕症的发生有一定的相关性;(2)不孕抗体水平的增高与免疫因素不孕症患者有关,但各组患者不孕抗体与AMH水平无相关性;(3)在IVF患者中,AMH与获卵数、获胚数、临床妊娠率等相关;与不孕抗体无相关性。
[Abstract]:Objective to investigate the relationship between serum AMH levels and pregnancy outcomes of immunological infertility and IVF-ETs.Methods from January 2014 to May 2016, 500 patients with infertility and 210 patients with pre-pregnancy were selected from outpatient clinic of Reproductive Center of Linyi Women's and Children's Hospital. Among them, the infertile patients were grouped according to the factors of infertility.Of these, 35 were infertile due to immunological factors (immune factor group), 250 cases were infertility due to fallopian tube factor (tubal factor group), 165 cases were infertile due to endocrine factor (endocrine factor group), and 50 cases were infertility due to uterine factor (50 cases).The serum AMH of uterine factor group was detected by chemiluminescence method.The difference of AMH between groups was compared.To analyze the correlation between AMH and infertility antibody {antisperm antibody as Aban, anticardiolipin antibody ac Aban, anti endometrial antibody Aem Aband anti ovary antibody Ao Ab2}. Another 48 patients who were treated with IVF for the first time because of fallopian tube factors were selected.According to the number of eggs obtained in IVF, they were divided into three groups: group A, group A, group A, group B, group B, group B, group B, and group C, respectively. The AMH value and the antibody against infertility were detected.Basal endocrine, serum estradiol E _ 2, follicle stimulating hormone (FSH)}, B-ultrasound related indexes (basic antral follicle number, ovarian volume, interstitial artery systolic peak PSV), resistance index (RI)}, pregnancy outcome {gonadotropin Gnn], the number of embryos obtained,The clinical pregnancy rate}, the difference of AMH, infertility antibody, basic endocrine, B-ultrasound related index, pregnancy outcome and general data among the groups were compared, and the correlation between AMH and infertility antibody and other factors were analyzed.Results (1) there was a significant difference in AMH between the endocrine factor group and the pre-pregnancy examination group, the immune factor group, the fallopian tube factor group and the uterine factor group. There was a significant difference between the immune factor group and the other three groups.There was no significant difference in infertility antibody among AMH patients in different age groups.There was no significant difference in general data (age BMI, etc.) and infertile antibody between normal and high-acquired egg arrays. There were no significant differences among the three groups (P0.05 / 4), including the AFC of AMH FSHF, the dosage of AFC in pregnancy outcome, the number of embryos obtained, and the number of embryos obtained.There was no correlation between infertility antibody and PSVG RI.Conclusion (1) the level of serum AMH is related to the occurrence of endocrine infertility.However, there was no correlation between infertility antibody and AMH level in patients with IVF, but there was no correlation between AH and egg number, embryo count, clinical pregnancy rate and so on in patients with IVF.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.8

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