本文關(guān)鍵詞：抗苗勒氏管激素在多囊卵巢綜合征患者控制性卵巢刺激過程中的變化及與IVF-ET結(jié)局的關(guān)系　出處：《河北醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

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【摘要】：目的：研究血清抗苗勒氏管激素（AMH）在多囊卵巢綜合征（PCOS）患者控制性卵巢刺激（COS）過程中的變化；分析血清基礎(chǔ)AMH水平與COS過程中促性腺激素（Gn）劑量的關(guān)系；探討血清和卵泡液中AMH水平與體外受精-胚胎移植(IVF-ET)結(jié)局的關(guān)系及血清AMH水平對(duì)卵巢過度刺激綜合征(OHSS)的預(yù)測(cè)價(jià)值。 方法：選取2012.12～2013.10于河北醫(yī)科大學(xué)第二醫(yī)院生殖中心因輸卵管因素和/或男方因素接受IVF/ICSI-ET助孕的患者為研究對(duì)象，其中包括PCOS患者共70例（試驗(yàn)組），，非PCOS患者共20例（對(duì)照組）。所有研究對(duì)象分別于月經(jīng)周期的第3天（Day3）、垂體降調(diào)節(jié)后即啟動(dòng)外源性促性腺激素日(Gn日)、注射絨毛膜促性腺激素日（HCG日）收集血清，取卵日(OPU日)清晨收集卵泡液。比較兩組患者Day3、Gn日、HCG日血清AMH水平、OPU日卵泡液AMH水平，記錄每位患者的基礎(chǔ)卵泡刺激素（FSH）水平、Gn的用量、COS天數(shù)、獲卵數(shù)、可移植胚胎數(shù)、臨床妊娠情況以及中重度OHSS的發(fā)生情況。按照Day3的血清AMH水平將PCOS患者分為低AMH組、中AMH組和高AMH組，比較三組的基礎(chǔ)FSH水平、Gn的用量、COS天數(shù)、獲卵數(shù)、可移植胚胎數(shù)、妊娠率以及中重度OHSS的發(fā)生情況。分析PCOS組的血清AMH(Day3、Gn日及HCG日)以及卵泡液AMH水平與中重度OHSS的關(guān)系。 結(jié)果：PCOS組Day3、Gn日、HCG日血清AMH以及OPU日卵泡液中AMH均高于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P0.05）；兩組患者Gn日的血清AMH水平均較Day3水平升高，差異有統(tǒng)計(jì)學(xué)意義（P0.05）;HCG日血清AMH水平較Day3水平降低，差異有統(tǒng)計(jì)學(xué)意義（P0.05）。PCOS組Gn的用量高于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P0.05），PCOS組與對(duì)照組的COS天數(shù)、可移植胚胎數(shù)、妊娠率、中重度OHSS發(fā)生率均無統(tǒng)計(jì)學(xué)差異（P0.05）。PCOS組中高AMH組的Gn用量高于低AMH組及中AMH組，但低AMH組與中AMH組相比Gn用量無統(tǒng)計(jì)學(xué)差異（P0.05），高AMH組與低AMH組及中AMH組比Gn用量均有統(tǒng)計(jì)學(xué)差異（P0.05）。對(duì)照組中妊娠患者與未妊娠患者相比血清與卵泡液中的AMH水平顯著增高，差異均有統(tǒng)計(jì)學(xué)意義（P0.05）。在PCOS患者中妊娠組與未妊娠組相比血清以及卵泡液中的AMH水平均無統(tǒng)計(jì)學(xué)差異（P0.05）。PCOS組中中重度OHSS患者Day3、Gn日、HCG日AMH水平以及卵泡液中的AMH水平與未發(fā)生OHSS患者比均無統(tǒng)計(jì)學(xué)差異（P0.05），但發(fā)生中重度OHSS患者HCG日血清AMH較Day3的下降水平比未發(fā)生者升高，差異有統(tǒng)計(jì)學(xué)意義（P0.05）。 結(jié)論：血清AMH水平在進(jìn)行COS的過程中有顯著變化：血清AMH水平經(jīng)過垂體降調(diào)節(jié)后升高，經(jīng)過Gn促排卵后降低；基礎(chǔ)AMH水平較高的PCOS患者進(jìn)行控制性超排卵的過程中需要的Gn劑量增加；血清及卵泡液AMH水平能預(yù)測(cè)非PCOS患者的妊娠結(jié)局；血清HCG日AMH水平較Day3的下降水平可以用于預(yù)測(cè)PCOS患者中重度OHSS的發(fā)生。
[Abstract]:Objective: to study the changes of serum anti-Mullerian tube hormone (AMH) in patients with polycystic ovary syndrome (PCOS) treated with controlled ovarian stimulation (COSs). The relationship between serum basal AMH level and gonadotropin Gnn dose during COS was analyzed. To investigate the relationship between the levels of AMH in serum and follicular fluid and the outcome of IVF-ETS and the predictive value of serum AMH level in ovarian hyperstimulation syndrome (OHSS). Methods:. The patients who received IVF/ICSI-ET for pregnancy in the reproductive center of the second Hospital of Hebei Medical University on February 12, 2013.10 were selected as the study subjects because of fallopian tube factors and / or male factors. These included 70 patients with PCOS (trial group, 20 patients without PCOS) (control group, all subjects were studied on the 3rd day of menstrual cycle). The serum was collected immediately after hypophysis regulation and HCG was injected into the human chorionic gonadotropin (HCG). Follicular fluid was collected early in the morning. The serum AMH level was compared between the two groups on the day of Day3 Gn and the level of AMH in the follicular fluid on the day of OPU. The basal follicle stimulating hormone (FSH) level of each patient was recorded. The number of days of COS, the number of eggs obtained and the number of embryos transfered were recorded. According to the serum AMH level of Day3, PCOS patients were divided into low AMH group, middle AMH group and high AMH group. The number of days, the number of eggs and the number of embryos transfered were compared among the three groups. The pregnancy rate and the occurrence of moderate and severe OHSS were analyzed in PCOS group. The relationship between AMH level in follicular fluid and moderate to severe OHSS was analyzed. Results the levels of AMH in serum and AMH in follicular fluid on OPU day in the control group were significantly higher than those in the control group (P 0.05). The serum AMH level of the two groups was higher than that of Day3 on the day of Gn, and the difference was statistically significant (P 0.05). The level of serum AMH in HCG group was lower than that in Day3 group, the difference was statistically significant (P 0.05). The dosage of Gn in PCOS group was higher than that in control group, and the difference was statistically significant (P 0.05). Days of COS, number of embryos transferable and pregnancy rate in PCOS group and control group. There was no significant difference in the incidence of moderate and severe OHSS. The dosage of Gn in high AMH group was higher than that in low AMH group and moderate AMH group. However, there was no significant difference in the dosage of Gn between the low AMH group and the middle AMH group (P0.05). There was significant difference in the dosage of Gn between high AMH group, low AMH group and middle AMH group (P0.05). The levels of AMH in serum and follicular fluid in the control group were significantly higher than those in the non-pregnant group. There was no significant difference in AMH levels in serum and follicular fluid between pregnant group and non-pregnant group in PCOS patients (P 0.05). Day3 in moderate and severe OHSS patients in PCOS group. There was no significant difference in the level of AMH and the level of AMH in follicular fluid between patients with OHSS and those without OHSS (P 0.05). However, the level of serum AMH in patients with moderate and severe OHSS on the day of HCG was higher than that in patients without Day3, and the difference was statistically significant (P 0.05). Conclusion: the level of serum AMH has a significant change in the process of COS: the level of serum AMH increases after hypophyseal regulation and decreases after gonadovulatory stimulation. The Gn dose needed by PCOS patients with higher basal AMH level was increased during the process of controlled hyperovulation. AMH levels in serum and follicular fluid can predict pregnancy outcome in non-#en1# patients. The decrease of serum HCG day AMH level compared with Day3 level can be used to predict the occurrence of moderate and severe OHSS in PCOS patients.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R711.75

【引證文獻(xiàn)】

相關(guān)期刊論文 前1條

1 楊碩;尤昭玲;孫曉峰;李靖;林星輝;;抗苗勒氏管激素與多囊卵巢綜合征卵泡發(fā)育相關(guān)性的研究進(jìn)展[J];湖南中醫(yī)藥大學(xué)學(xué)報(bào);2015年09期

相關(guān)碩士學(xué)位論文 前1條

1 趙蓉;腹腔鏡卵巢成熟畸胎瘤剝除術(shù)中不同止血方法對(duì)卵巢儲(chǔ)備功能的影響[D];安徽醫(yī)科大學(xué);2016年

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