抗米勒管激素、血管内皮生长因子水平对子宫内膜异位症患者腹腔镜手术后妊娠结局的影响

Effect of preoperative anti-Mullerian hormone and vascular endothelial growth factor levels on postoperative pregnancy outcome of patients with laparoscopic endometriosis

摘要:

目的 探讨抗米勒管激素（AMH）、血管内皮生长因子（VEGF）水平对子宫内膜异位症患者腹腔镜手术后妊娠结局的预测价值。方法 选取2017年4月—2019年7月在武汉市江夏区第一人民医院（华中科技大学协和江南医院）行腹腔镜子宫内膜异位症治疗的137例患者为研究对象。术后随访2年。根据患者术后2年的自然妊娠结局分组，将自然妊娠患者记为自然妊娠成功组，否则记为自然妊娠失败组。比较两组患者的美国生育协会修正分期法（r-AFS）分期，囊肿直径，血清抗精子蛋白17抗体（sp17Ab）、抗顶体蛋白酶抗体（AcrAb）、糖类抗原125、AMH、VEGF水平，以及术后促性腺激素释放激素激动剂治疗情况。采用多因素逐步Logistic回归分析模型分析影响子宫内膜异位症患者腹腔镜手术后妊娠结局的因素。绘制ROC曲线，分析子宫内膜异位症患者腹腔镜手术前AMH、VEGF水平对术后妊娠结局的预测价值。结果 137例患者失访14例。123例患者中自然妊娠成功患者55例，剩余68例自然妊娠失败。多因素逐步Logistic回归分析结果显示，AMH水平［O^R=4.059（95% CI：1.670，9.865）］、VEGF水平［O^R=3.688（95% CI：1.517，8.962）］、sp17Ab水平［O^R=3.662（95% CI：1.507，8.900）］是子宫内膜异位症患者腹腔镜手术后妊娠结局的影响因素（P <0.05）。ROC曲线显示，AMH、VEGF及两者联合预测子宫内膜异位症患者腹腔镜手术后妊娠的AUC分别为0.750（95% CI：0.652，0.849）、0.763（95% CI：0.665，0.861）、0.889（95% CI：0.826，0.952），敏感性分别为72.73%（95% CI：0.588，0.835）、78.18%（95% CI：0.646，0.878）、72.73%（95% CI：0.588，0.835），特异性分别为70.59%（95% CI：0.581，0.807）、80.88%（95% CI：0.692，0.890）、89.71%（95% CI：0.794，0.954）。结论 子宫内膜异位症患者术前血清AMH、VEGF水平对术后妊娠结局有预测价值，两者联合预测子宫内膜异位症患者腹腔镜手术后妊娠结局效能良好。

Abstract:

Objective To explore the effect of preoperative anti-Mullerian hormone and vascular endothelial growth factor levels on postoperative pregnancy outcome of patients with laparoscopic endometriosis.Methods A total of 137 patients who underwent laparoscopic endometriosis treatment in the hospital from April 2017 to July 2019 were selected as the research objects, and they were followed up for 2 years. The pregnancy outcome of 2 years after the operation was calculated, the factors affecting the pregnancy outcome of patients with endometriosis after laparoscopic surgery were analyzed, and the relationship between AMH and VEGF before laparoscopic endometriosis and the pregnancy outcome after laparoscopic endometriosis was analyzed.Results A total of 14 of the 137 patients were lost to follow-up. Among the remaining 123 patients, 55 were successful in spontaneous pregnancy, and the remaining 68 failed in spontaneous pregnancy. Multivariate logistic regression analysis results showed: AMH level [ O^R = 4.059 (95% CI: 1.670, 9.865) ], VEGF level [ O^R = 3.688 (95% CI: 1.517, 8.962) ], anti-sperm protein 17 antibody (spl7Ab) level [O^R = 3.662 (95% CI: 1.507, 8.900) ] were factor affecting the postoperative pregnancy outcome of patients with endometriosis (P < 0.05). The ROC curve showed that the AUC of AMH, VEGF, and their combination in predicting postoperative pregnancy in patients with laparoscopic endometriosis was 0.750 (95% CI: 0.652, 0.849), 0.763 (95% CI: 0.665, 0.861), and 0.889 (95% CI: 0.826, 0.952) respectively, the sensitivity was 72.73% (95% CI: 0.588, 0.835), 78.18% (95% CI: 0.646, 0.878), and 72.73% (95% CI: 0.588, 0.835) respectively, the specificity was 70.59% (95% CI: 0.581, 0.807), 80.88% (95% CI: 0.692, 0.890), and 89.71% (95% CI: 0.794, 0.954) respectively.Conclusion Preoperative serum AMH and VEGF levels in patients with endometriosis are correlated with postoperative pregnancy outcomes. The combination of the two is effective in predicting postoperative pregnancy outcomes in patients with endometriosis.