控制性卵巢过度刺激中不同卵巢反应者血清性激素结合球蛋白水平变化及其临床意义-东南大学学报医学版

控制性卵巢过度刺激中不同卵巢反应者血清性激素结合球蛋白水平变化及其临床意义

单位：海口市妇幼保健院妇科, 海南海口 570203

分类号：R711.4;R711.75

出版年·卷·期（页码）：2022·41·第四期（538-546）

摘要：

目的：探讨控制性促排卵（COH）中不同卵巢反应者血清性激素结合球蛋白（SHBG）水平变化及其临床意义。方法：选取2018年1月至2020年1月在我院生殖中心接受固定促性腺激素释放激素拮抗剂（GnRH-ant）方案的378例体外受精女性，包括83例低卵巢反应（POR）、204例正常反应、91例高卵巢反应（HOR）者。在COH周期中，每2~3 d收集每个参与者的血清样本，检测血清SHBG、促卵泡激素（FSH）、黄体生成素（LH）、雌二醇（E2）水平。结果：与正常反应组相比，POR组血清SHBG基线值和注射人绒毛膜促性腺激素（HCG）当天血清SHBG水平均显著降低，相反HOR组则显著升高（P<0.05）。多因素非条件Logistic回归分析显示，HCG注射当天血清SHBG水平与POR或HOR的发生均有关（P<0.05）。在COH期间，血清SHBG水平总体下降（P<0.001），血清E2浓度和优势卵泡（直径>10 mm）数量显著增加，而血清LH水平下降（P<0.001），不同卵巢反应组的变化趋势差异无统计学意义（P>0.05）。HCG注射当天血清SHBG水平与卵母细胞数、有效胚胎数以及血清E2水平、GnRH-ant注射第3天（D3）血清LH水平呈正相关（P<0.05）。受试者工作特征曲线分析显示，HCG当日血清SHBG水平预测POR或HOR的曲线下面积（AUC）分别为0.718（95%CI 0.636~0.801）和0.489（95%CI 0.391~0.604）。结论：GnRH-ant治疗期间，血清SHBG水平与卵巢反应呈正相关，可作为POR的有效预测指标之一。

Objective: To investigate the changes and clinical significance of serum sex hormone-binding globulin(SHBG) in patients with different ovarian responses during controlled ovarian hyperstimulation(COH).Methods: A total of 378 women, including 83 with poor ovarian response(POR), 204 with normal response, and 91 with high ovarian response(HOR), were selected for in vitro fertilization(IVF) with gonadotropin-releasing hormone antagonist(GnRH-ant) in the reproductive center of our hospital from January 2018 to January 2020. Serum samples were collected from each participant every 2-3 days during the COH cycle to measure serum SHBG, follicle stimulating hormone(FSH), luteinizing hormone(LH), estradiol(E2). Results: Compared with the normal response group, the baseline value of serum SHBG in POR group and the serum SHBG level on the day of human chorionic gonadotropin(HCG) injection decreased significantly(P<0.05), whereas the level of serum SHBG in the HOR group was significantly higher(P<0.05). By multivariate Logistic regression analysis, the serum SHBG level on the day of HCG injection was correlated with the occurrence of POR or HOR(P<0.05). During COH, the serum SHBG level decreased overall(P<0.001). Serum E2 concentration and number of dominant follicles(diameter>10 mm) were significantly increased, while serum LH level was decreased(P<0.001). There was no significant difference in the change trend of different ovarian response groups(P>0.05). The serum level of SHBG on the day of HCG injection was positively correlated with oocyte count, effective embryo count, serum level of E2 and serum level of LH at Day 3(D3) of GnRH-ant injection(P<0.05). According to the analysis of receiver operating characteristic curve, the AUC of serum SHBG level on the day of HCG injection on predicting POR or HOR was 0.718(95% CI 0.636-0.801) and 0.489(95% CI 0.391-0.604), respectively. Conclusion: During GnRH-ant, the serum SHBG level is positively correlated with the ovarian response, and can be used as one of the effective predictors of POR.

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