本文選題：抗繆勒管激素 + 免疫性不孕��； 參考：《青島大學(xué)》2017年碩士論文

【摘要】：目的探討血清抗繆勒管激素(AMH)水平與免疫性不孕癥及體外受精-胚胎移植(IVF-ET)妊娠結(jié)局的相關(guān)性。方法(1)選取2014年1月至2016年5月于臨沂市婦女兒童醫(yī)院生殖中心門診就診的不孕癥患者500例及孕前查體者210例,其中將不孕癥患者根據(jù)不孕因素進(jìn)行分組,其中因免疫因素導(dǎo)致不孕者35例(免疫因素組),因輸卵管因素不孕者250例(輸卵管因素組)、因內(nèi)分泌因素不孕者165例(內(nèi)分泌因素組)、因子宮因素導(dǎo)致不孕者50例(子宮因素組),采用化學(xué)發(fā)光法檢測其血清AMH值,比較各組之間AMH的差異;并分析AMH與不孕抗體{抗精子抗體(As Ab)、抗心磷脂抗體(Ac Ab)、抗子宮內(nèi)膜抗體(Aem Ab)和抗卵巢抗體(Ao Ab)}之間的相關(guān)性。(2)另選取因輸卵管因素初次行IVF的患者48例,以IVF中獲卵數(shù)為分組依據(jù),分為低獲卵數(shù)組共3例為A組、正常獲卵數(shù)組共22例為B組及高獲卵數(shù)組共23例為C組,檢測其AMH值、不孕抗體、基礎(chǔ)內(nèi)分泌{血清雌二醇(E2)、卵泡刺激素(FSH)}、B超相關(guān)指標(biāo){基礎(chǔ)竇卵泡數(shù)(AFC)、卵巢體積、間質(zhì)動(dòng)脈收縮期峰值(PSV)及阻力指數(shù)(RI)}及妊娠結(jié)局{促性腺激素(Gn)用量、獲胚數(shù)、臨床妊娠率},比較各組之間AMH、不孕抗體、基礎(chǔ)內(nèi)分泌、B超相關(guān)指標(biāo)、妊娠結(jié)局及一般資料等之間的差異,并分析AMH與不孕抗體及其他各因素之間的相關(guān)性。結(jié)果(1)內(nèi)分泌因素組與孕前查體組、免疫因素組、輸卵管因素組、子宮因素組之間AMH測定值比較有統(tǒng)計(jì)學(xué)差異(P0.01);(2)免疫因素組不孕抗體與其它三組之間的有統(tǒng)計(jì)學(xué)差異,且不同年齡段下AMH患者之間的不孕抗體之間無統(tǒng)計(jì)學(xué)差異(P0.05);(3)IVF患者三組(低獲卵數(shù)組、正常獲卵數(shù)組和高獲卵數(shù)組)之間一般資料(年齡、BMI等)及不孕抗體比較均無統(tǒng)計(jì)學(xué)差異(P0.05);(4)IVF患者三組之間AMH、FSH、AFC及妊娠結(jié)局(Gn用量、獲胚數(shù)、臨床妊娠率)比較均有顯著統(tǒng)計(jì)學(xué)差異(P0.01);(5)IVF患者三組之間卵巢體積、PSV及RI比較均有統(tǒng)計(jì)學(xué)差異(P0.05);(6)AMH與獲卵數(shù)、AFC、卵巢體積、獲胚數(shù)、臨床妊娠率呈正相關(guān);與D2天的FSH呈負(fù)相關(guān);與PSV、RI、不孕抗體無相關(guān)性。結(jié)論(1)血清AMH水平與內(nèi)分泌性不孕癥的發(fā)生有一定的相關(guān)性;(2)不孕抗體水平的增高與免疫因素不孕癥患者有關(guān),但各組患者不孕抗體與AMH水平無相關(guān)性;(3)在IVF患者中,AMH與獲卵數(shù)、獲胚數(shù)、臨床妊娠率等相關(guān);與不孕抗體無相關(guān)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.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R714.8

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