降调节后血清及尿液FSH、LH水平及其比值对卵巢反应性的预测价值研究

发布时间：2018-06-07 10:17

本文选题：卵泡刺激素 + 黄体生成素　；参考：《昆明医科大学》2014年硕士论文

【摘要】：[研究目的] 通过测定促性腺激素释放激素激动剂(GnHR-a)降调节后Gn启动日血清和尿液卵泡刺激素(FSH)水平、黄体生成素(LH)水平、以及FSH/LH来探讨垂体降调节后FSH、LH测定预测卵巢反应性的价值,以及快速全定量尿FSH和LH测定的应用价值。 [资料与方法] 回顾性分析2012年10月至2014年1月在昆明医科大学第二附属医院生殖医学科接受长方案体外受精-胚胎移植(IVF-ET)或卵胞浆内单精子注射(ICSI)治疗的752例取卵周期,促性腺激素(Gn)启动当天测定血清FSH、LH水平并计算其比值。2012年10月至2013年5月对其中208个周期同时测定了血清及尿液FSH、LH水平,血、尿FSH各分为三组,分析两种测量方法的相关性以及血、尿FSH、LH与获卵数及妊娠结局的关系。分析各组间年龄、获卵数、正常受精数、卵裂数、Gn使用总量、妊娠率等的差异。记录752例患者的年龄、体重指数(BMI)、不孕年限、Gn总量、获卵数、正常受精数及优质胚胎数等指标。根据获卵数分组,获卵数≤3个为卵巢低反应、获卵数4-19为卵巢正常反应,获卵数≥20个为卵巢高反应组,比较3组间各指标的差异。年龄分三组,Ⅰ组：年龄≤30岁；Ⅱ组：年龄30-35岁；Ⅲ组：年龄≥35岁。采用SPSS17.0软件包进行数据处理,数据用均数土标准差(x±s)表示,3组间计量资料采用One-way ANOVA或者Welch近似方差分析；组间率的比较采用RxC列联表x2检验；采用ROC曲线分析各指标对卵巢反应性的预测价值及判定最佳诊断界值点,采用Spearman相关、Logistic回归分析各项卵巢储备功能评估指标与卵巢反应性之间的关系。P0.05有统计学意义。 [结果]1.年龄未分组的情况下,卵巢不同反应性各组之间患者年龄、Gn启动日血FSH、Gn总量、获卵总数、正常受精数、优质胚胎数都有显著性差异,P0.01,三组间血FSH/LH也有显著性差异,P0.05。 2.年龄分组后,卵巢不同反应性各组之间患者血FSH有显著性差异,血LH及FSH/LH无显著性差异。 3.不同年龄组中,血FSH与获卵数呈负相关,相关系数Ⅰ-Ⅲ组分别为-0.183、-0.196、-0.258,P值均0.01。Ⅱ组和Ⅲ组血FSH/LH与获卵数呈负相关,相关系数分别为-0.136、-0.143,P0.05。 4.运用ROC曲线分析多项指标对卵巢反应性的预测价值,结果显示：Ⅰ组中血FSH对卵巢高反应有预测价值；Ⅱ组中各指标对卵巢反应性的预测价值有限；Ⅲ组中血FSH对卵巢低反应和卵巢高反应的预测价值相对较好,血FSH/LH对卵巢低反应有预测价值。 5.用Logistic逐步回归法分析患者的年龄、Gn日血清FSH、LH水平以及FSH/LH值对于卵巢反应性的影响,患者年龄、血FSH存在于回归模型,且二者对卵巢低反应的影响均为保护性因素,年龄越小,FSH越低,发生卵巢低反应的可能性降低。患者年龄、血FSH也是卵巢高反应的影响因素。年龄分组后,在Ⅰ组中,血FSH是卵巢高反应的影响因素；Ⅱ组中患者年龄和血FSH都是卵巢低反应的影响因素；Ⅲ组中患者年龄、血FSH对卵巢低反应和高反应都有影响,二者对低反应是保护性因素,对高反应是危险性因素。 6.尿FSH与获卵数相关,相关系数r为0.152,P0.05; Logistic回归法分析尿FSH对卵巢低反应有影响,尿FSH/LH对卵巢高反应的有预测价值。 7.尿FSH与血FSH高度正相关(r=0.508,P0.01),尿LH与血LH正相关(r=0.328,P0.05)。 [结论]1.垂体降调节后Gn启动日血FSH水平对卵巢低反应和高反应都有预测价值,尤其对于年龄≤30岁和≥35岁者预测价值较高。 2.垂体降调节后Gn启动日血FSH/LH对年龄≥35岁者的卵巢反应性有预测价值。 3.全定量尿FSH、LH与血清FSH、LH呈正相关。 4.全定量尿FSH可作为预测卵巢反应性的一个手段,在临床上具有应用价值。
[Abstract]:[research purposes]
The value of serum and urine follicular stimulating hormone (FSH) level, luteinizing hormone (LH) level, and FSH/LH to determine the value of FSH, LH in predicting ovarian responsiveness after pituitary descending regulation, and the value of rapid full quantitative urine FSH and LH determination by the determination of gonadotropin releasing hormone agonist (GnHR-a) on Gn start day.
[information and methods]
A retrospective analysis was made of 752 cases of oocyte withdrawal period from October 2012 to January 2014 in the reproductive medicine department of the Second Affiliated Hospital of Kunming Medical University, which received long program in vitro fertilization embryo transfer (IVF-ET) or intracytoplasmic sperm injection (ICSI). Serum FSH was determined on the day of gonadotropin (Gn), and the ratio of LH was calculated from October to 201. In May 3, the serum and urine FSH, LH level, blood and urine FSH were divided into three groups at the same time. The correlation between the two measurement methods and the relationship between the blood, urine FSH, LH and the number of acquired eggs and pregnancy outcome were analyzed. The age, the number of eggs, the number of normal fertilization, the number of cleavage, the total amount of cleavage, the total amount of Gn and the pregnancy rate were analyzed.
The age, body mass index (BMI), the number of infertility, the number of Gn, the number of eggs, the number of normal fertilization and the number of high quality embryos were recorded. According to the number of acquired eggs, the number of ovum was less than 3 of the ovarian hyper response, the number of ovum 4-19 was normal, the number of ovum was more than 20 as the ovarian hyperreaction group, and the difference between the indexes of the 3 groups was compared. Three groups of age groups were compared. Group I: age less than 30 years; group II: age 30-35 years; group III: age over 35 years.
The data were processed with SPSS17.0 software package. The data were expressed with the standard difference (x + s) of average soil (x + s). The measurement data of the 3 groups were analyzed by One-way ANOVA or Welch, and the comparison of the inter group rates was carried out by RxC contingency table x2 test; the prediction value of each index to ovarian reactivity and the best diagnostic value point were determined by the ROC curve. Spearman correlation and Logistic regression analysis showed that the relationship between ovarian reserve indexes and ovarian responsiveness was statistically significant (.P0.05).
[results when]1. age was not grouped, the age of the patients with different ovarian responses, the total amount of FSH, the total number of Gn, the total number of eggs, the number of normal fertilization and the number of high quality embryos on the Gn start day were significantly different, P0.01, and there was a significant difference in the blood FSH/LH between the three groups, P0.05.
2. after age group, there was significant difference in serum FSH between different groups of ovarian response, but there was no significant difference in blood LH and FSH/LH.
3. in different age groups, the blood FSH was negatively correlated with the number of acquired eggs. The correlation coefficient I - III group was -0.183, -0.196, -0.258, and P value all 0.01. II and group III of group 0.01. were negatively correlated with the number of acquired eggs, the correlation coefficients were -0.136, -0.143, P0.05., respectively.
4. the ROC curve was used to analyze the predictive value of multiple indexes on ovarian responsiveness. The results showed that FSH in group I was of predictive value for ovarian hyper response, and the predictive value of each index in group II on ovarian reactivity was limited, and the value of FSH in group III was relatively good for ovarian Hyper response and ovarian hyper response, and blood FSH/LH was low on ovarian response. There should be a predictive value.
5. Logistic stepwise regression analysis of patients' age, Gn day serum FSH, LH level and FSH/LH value on ovarian responsiveness, age, blood FSH exist in regression model, and the effects of the two on ovarian response are protective factors, the younger the age, the lower the FSH, the lower possibility of ovarian response. Patients age, blood FS H is also an influential factor in ovarian hyper response. After age group, blood FSH is an influential factor in ovarian hyper response in group I; age and blood FSH in group II are the factors affecting ovarian hyper response; age in group III, blood FSH has an influence on ovarian hyper response and hyperreaction, and the two is a protective factor for low response and a high response to low response. It's a dangerous factor.
6. urinary FSH was associated with the number of acquired eggs, and the correlation coefficient r was 0.152, P0.05. Logistic regression analysis showed that urinary FSH had an effect on ovarian hyper response, and FSH/LH had a predictive value for ovarian hyper response.
7. urine FSH was highly correlated with blood FSH (r=0.508, P0.01), and urine LH was positively correlated with blood LH (r=0.328, P0.05).
[conclusion the serum FSH level of Gn starting day after pituitary descending regulation of]1. has predictive value for ovarian hypophysis and high response, especially for those aged less than 30 years old and over 35 years old.
2. the Gn promoter FSH/LH is predictive of ovarian responsiveness in patients over 35 years of age after pituitary down regulation.
3. full quantitative urine FSH and LH were positively correlated with serum FSH and LH.
4. full quantitative urine FSH can be used as a means of predicting ovarian responsiveness and has clinical application value.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.8

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