本文選題：卵泡刺激素 + 黃體生成素　； 參考：《昆明醫(yī)科大學(xué)》2014年碩士論文

【摘要】：[研究目的] 通過測(cè)定促性腺激素釋放激素激動(dòng)劑(GnHR-a)降調(diào)節(jié)后Gn啟動(dòng)日血清和尿液卵泡刺激素(FSH)水平、黃體生成素(LH)水平、以及FSH/LH來探討垂體降調(diào)節(jié)后FSH、LH測(cè)定預(yù)測(cè)卵巢反應(yīng)性的價(jià)值,以及快速全定量尿FSH和LH測(cè)定的應(yīng)用價(jià)值。 [資料與方法] 回顧性分析2012年10月至2014年1月在昆明醫(yī)科大學(xué)第二附屬醫(yī)院生殖醫(yī)學(xué)科接受長(zhǎng)方案體外受精-胚胎移植(IVF-ET)或卵胞漿內(nèi)單精子注射(ICSI)治療的752例取卵周期,促性腺激素(Gn)啟動(dòng)當(dāng)天測(cè)定血清FSH、LH水平并計(jì)算其比值。2012年10月至2013年5月對(duì)其中208個(gè)周期同時(shí)測(cè)定了血清及尿液FSH、LH水平,血、尿FSH各分為三組,分析兩種測(cè)量方法的相關(guān)性以及血、尿FSH、LH與獲卵數(shù)及妊娠結(jié)局的關(guān)系。分析各組間年齡、獲卵數(shù)、正常受精數(shù)、卵裂數(shù)、Gn使用總量、妊娠率等的差異。 記錄752例患者的年齡、體重指數(shù)(BMI)、不孕年限、Gn總量、獲卵數(shù)、正常受精數(shù)及優(yōu)質(zhì)胚胎數(shù)等指標(biāo)。根據(jù)獲卵數(shù)分組,獲卵數(shù)≤3個(gè)為卵巢低反應(yīng)、獲卵數(shù)4-19為卵巢正常反應(yīng),獲卵數(shù)≥20個(gè)為卵巢高反應(yīng)組,比較3組間各指標(biāo)的差異。年齡分三組,Ⅰ組：年齡≤30歲；Ⅱ組：年齡30-35歲；Ⅲ組：年齡≥35歲。 采用SPSS17.0軟件包進(jìn)行數(shù)據(jù)處理,數(shù)據(jù)用均數(shù)土標(biāo)準(zhǔn)差(x±s)表示,3組間計(jì)量資料采用One-way ANOVA或者Welch近似方差分析；組間率的比較采用RxC列聯(lián)表x2檢驗(yàn)；采用ROC曲線分析各指標(biāo)對(duì)卵巢反應(yīng)性的預(yù)測(cè)價(jià)值及判定最佳診斷界值點(diǎn),采用Spearman相關(guān)、Logistic回歸分析各項(xiàng)卵巢儲(chǔ)備功能評(píng)估指標(biāo)與卵巢反應(yīng)性之間的關(guān)系。P0.05有統(tǒng)計(jì)學(xué)意義。 [結(jié)果]1.年齡未分組的情況下,卵巢不同反應(yīng)性各組之間患者年齡、Gn啟動(dòng)日血FSH、Gn總量、獲卵總數(shù)、正常受精數(shù)、優(yōu)質(zhì)胚胎數(shù)都有顯著性差異,P0.01,三組間血FSH/LH也有顯著性差異,P0.05。 2.年齡分組后,卵巢不同反應(yīng)性各組之間患者血FSH有顯著性差異,血LH及FSH/LH無顯著性差異。 3.不同年齡組中,血FSH與獲卵數(shù)呈負(fù)相關(guān),相關(guān)系數(shù)Ⅰ-Ⅲ組分別為-0.183、-0.196、-0.258,P值均0.01。Ⅱ組和Ⅲ組血FSH/LH與獲卵數(shù)呈負(fù)相關(guān),相關(guān)系數(shù)分別為-0.136、-0.143,P0.05。 4.運(yùn)用ROC曲線分析多項(xiàng)指標(biāo)對(duì)卵巢反應(yīng)性的預(yù)測(cè)價(jià)值,結(jié)果顯示：Ⅰ組中血FSH對(duì)卵巢高反應(yīng)有預(yù)測(cè)價(jià)值；Ⅱ組中各指標(biāo)對(duì)卵巢反應(yīng)性的預(yù)測(cè)價(jià)值有限；Ⅲ組中血FSH對(duì)卵巢低反應(yīng)和卵巢高反應(yīng)的預(yù)測(cè)價(jià)值相對(duì)較好,血FSH/LH對(duì)卵巢低反應(yīng)有預(yù)測(cè)價(jià)值。 5.用Logistic逐步回歸法分析患者的年齡、Gn日血清FSH、LH水平以及FSH/LH值對(duì)于卵巢反應(yīng)性的影響,患者年齡、血FSH存在于回歸模型,且二者對(duì)卵巢低反應(yīng)的影響均為保護(hù)性因素,年齡越小,FSH越低,發(fā)生卵巢低反應(yīng)的可能性降低�；颊吣挲g、血FSH也是卵巢高反應(yīng)的影響因素。年齡分組后,在Ⅰ組中,血FSH是卵巢高反應(yīng)的影響因素；Ⅱ組中患者年齡和血FSH都是卵巢低反應(yīng)的影響因素；Ⅲ組中患者年齡、血FSH對(duì)卵巢低反應(yīng)和高反應(yīng)都有影響,二者對(duì)低反應(yīng)是保護(hù)性因素,對(duì)高反應(yīng)是危險(xiǎn)性因素。 6.尿FSH與獲卵數(shù)相關(guān),相關(guān)系數(shù)r為0.152,P0.05; Logistic回歸法分析尿FSH對(duì)卵巢低反應(yīng)有影響,尿FSH/LH對(duì)卵巢高反應(yīng)的有預(yù)測(cè)價(jià)值。 7.尿FSH與血FSH高度正相關(guān)(r=0.508,P0.01),尿LH與血LH正相關(guān)(r=0.328,P0.05)。 [結(jié)論]1.垂體降調(diào)節(jié)后Gn啟動(dòng)日血FSH水平對(duì)卵巢低反應(yīng)和高反應(yīng)都有預(yù)測(cè)價(jià)值,尤其對(duì)于年齡≤30歲和≥35歲者預(yù)測(cè)價(jià)值較高。 2.垂體降調(diào)節(jié)后Gn啟動(dòng)日血FSH/LH對(duì)年齡≥35歲者的卵巢反應(yīng)性有預(yù)測(cè)價(jià)值。 3.全定量尿FSH、LH與血清FSH、LH呈正相關(guān)。 4.全定量尿FSH可作為預(yù)測(cè)卵巢反應(yīng)性的一個(gè)手段,在臨床上具有應(yīng)用價(jià)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.
【學(xué)位授予單位】：昆明醫(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)】：R714.8

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本文編號(hào)：1990822