血清AMH与外源性促性腺激素剂量对夫精人工授精妊娠结局的预测效能分析

Predictive value of serum AMH and exogenous gonadotropin dose on pregnancy outcome of artificial insemination with husband's sperm

摘要:

目的 探讨血清抗米勒管激素（AMH）与外源性促性腺激素（Gn）剂量对夫精人工授精（AIH）妊娠结局的预测效能。方法 回顾性分析2019年2月—2021年3月在武汉市第四医院（古田院区）行AIH治疗并有妊娠结局的143例不孕症患者的临床资料。根据妊娠结局分为妊娠成功组和妊娠失败组。比较两组患者的临床资料；采用多因素Logistic逐步回归分析行AIH治疗不孕症患者妊娠结局的影响因素；绘制受试者工作特征（ROC）曲线，以曲线下面积（AUC）分析AMH、外源性Gn剂量及两者联合对行AIH治疗的不孕症患者妊娠结局的预测效能。结果 143例不孕症患者妊娠成功率为21.68%，周期临床妊娠成功率为19.20%。妊娠失败组的年龄、不孕症病程、Gn剂量高于妊娠成功组（P <0.05），妊娠失败组的基础促卵泡素（FSH）、AMH则低于妊娠成功组（P <0.05）。多因素Logistic逐步回归分析结果显示，年龄［O^R =2.927（95% CI：1.274，6.725）］、不孕症病程［O^R =2.878（95% CI：1.253，6.611）］、AMH［O^R =3.979（95% CI：1.732，9.141）］及Gn剂量［O^R =3.695（95% CI：1.608，8.489）］均为行AIH治疗的不孕症患者妊娠结局的影响因素（P <0.05）。ROC曲线分析结果显示，血清AMH、外源性Gn剂量及两者联合预测行AIH治疗不孕症患者妊娠结局的敏感性分别为77.42%（95% CI：0.630，0.854）、74.19%（95% CI：0.596，0.828）、70.97%（95% CI：0.579，0.815），特异性分别为68.75%（95% CI：0.540，0.805）、74.11%（95% CI：0.601，0.852）、98.21%（95% CI：0.882，0.999），AUC分别为0.752（95% CI：0.662，0.829）、0.763（95% CI：0.674，0.838）、0.868（95% CI：0.792，0.925）。结论 血清AMH、外源性Gn剂量及两者联合对AIH妊娠结局的预测效能较高。

Abstract:

Objective To investigate the predictive value of serum anti-Müllerian hormone (AMH) and exogenous gonadotropin (Gn) doses on the pregnancy outcome of artificial insemination with husband's sperm (AIH).Methods The clinical data of 143 infertile patients with pregnancy outcomes who underwent AIH treatment in our hospital from February 2019 to March 2021 were retrospectively analyzed. Pregnancy outcomes were counted and divided into pregnancy success group and pregnancy failure group according to whether the pregnancy was successful or not. The clinical data of the patients in the pregnancy success group and the pregnancy failure group were compared. Logistic regression analysis was used to explore the related factors affecting the clinical outcome of AIH infertility patients. The receiver operating characteristic curve (ROC) was prepared, and the area under the curve (AUC) was used to analyze the predictive value of AMH, exogenous Gn dose and their combination on clinical outcomes of infertile patients with AIH.Results The pregnancy success rate of 143 infertile patients was 21.68%, and the cycle clinical pregnancy success rate was 19.20%. The age, infertility duration and Gn dosage in the pregnancy failure group were higher than those in the pregnancy success group (P < 0.05), and the basal follicle stimulating hormone (FSH) and AMH in the pregnancy failure group were lower than those in the pregnancy success group (P < 0.05). Multivariate analysis showed that age [O^R = 2.927 (95% CI: 1.274, 6.725) ], duration of infertility [O^R = 2.878 (95% CI: 1.253, 6.611) ], AMH [O^R = 3.979 (95% CI: 1.732, 9.141) ], and Gn dosage [O^R = 3.695 (95% CI: 1.608, 8.489) ] were related factors affecting the pregnancy outcome of infertile patients with AIH (P < 0.05). ROC analysis showed that the sensitivities of serum AMH, exogenous Gn dose and their combination in predicting pregnancy outcome in AIH infertility patients were 77.42% (95% CI: 0.630, 0.854), 74.19% (95% CI: 0.596, 0.828), 70.97% (95% CI: 0.579, 0.815); the specificity was 68.75% (95% CI: 0.540, 0.805), 74.11% (95% CI: 0.601, 0.852), 98.21% (95% CI: 0.882, 0.999); AUC were 0.752 (95% CI: 0.662, 0.829), 0.763 (95% CI: 0.674, 0.838), 0.868 (95% CI: 0.792, 0.925).Conclusion Serum AMH, exogenous Gn doses and their combination have high predictive value for AIH pregnancy outcome.