Abstract:

Objective　To compare the common evaluation indicators of ovarian reserve function, and to observe the predictive effect of each indicator on decreased ovarian reserve function (DOR). Methods　This was a retrospective analysis. The women of childbearing age who were examined in Guangdong Second Traditional Chinese Medicine Hospital from June 2019 to June 2022 were selected. According to the clinical diagnosis, they were divided into a hypofunctional ovarian reserve group (72 cases; a decreased group) and a normal ovarian reserve group (42 cases; a normal group). Age, follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E₂), ovarian volume (OVVOL), antral follicle number (AFC), ovarian interstitial artery blood flow velocity (PSV), resistance index (RI), and pulsatile index (PI) were collected from all the women as the evaluation indicators, and the differences between the two groups were compared by independent-sample t test and Mann-Whitney test. The correlations between the above indicators and ovarian reserve dysfunction were analyzed by Pearson correlation analysis. The indicators' sensitivities and specificities were measured by receiver operating characteristic curve (ROC). Results　The age, levels of FSH and LH, RI, and PI of the decreased group were higher than those of the normal group, while the E₂ level, AFC, OVVOL, and PSV of the decreased group were significantly lower than those of the normal group, with statistical differences (all P<0.01). DOR was positively correlated with age, FSH, LH, RI, and PI (r=0.353, 0.332, 0.275, 0.448, and 0.491; all P<0.01), and negatively with E₂, AFC, OVVOL, and PSV (r=-0.034, -0.860, -0.623, and 0.330; P> 0.05 for E₂ and P<0.01 for the rest). The areas under the ROC's of AFC, FSH, and OVVOL for predicting ovarian reserve were the top three, 0.996, 0.935, and 0.893, respectively; their AUC's were above 0.850; they were very good in accordance with the AUC classification. The corresponding cutoff values, sensitivities, and specificities were 5.75, 95%, and 97%, 8.66 U/L, 88%, and 95%, and 4.49 cm³, 76%, and 89%, respectively. Conclusion　At present, the commonly used evaluation indicators of ovarian reserve function (AFC, FSH, and OVVOL) have high accuracies in determining whether ovarian reserve function is decreased, with promotion and application value in clinical diagnosis.

Key words:

Ovarian reserve, Color Doppler, Basal antral follicle, Ovarian interstitial blood flow, Follicle-stimulating hormone

摘要：

目的　通过对常用卵巢储备功能评价指标进行比较，观察各指标对卵巢储备功能减退的预测效果。方法　采用回顾性分析。选取2019年6至2022年6月在广东省第二中医院检查的育龄期妇女，根据临床诊断分为卵巢储备功能减退72例（减退组）、卵巢储备功能正常42例（正常组）。收集两组育龄期妇女年龄、促卵泡生成素（FSH）、促黄体生成素（LH）、雌二醇（E₂）、卵巢体积（OVVOL）、窦卵泡数（AFC）及卵巢间质动脉血流流速（PSV）、阻力指数（RI）、搏动指数（PI）作为评价指标，比较两组各指标数值之间的差异性，组间比较采用独立样本t检验、Mann-Whitney检验，应用Pearson相关分析对上述指标与卵巢储备功能减退之间进行相关性分析，应用受试者工作曲线（ROC）测试各指标的灵敏度与特异度。结果　减退组年龄、FSH、LH、RI、PI值均高于正常组，减退组E₂、AFC、OVVOL、PSV明显低于正常组，差异均有统计学意义（均P<0.01）；卵巢储备功能减退与年龄、FSH、LH、RI、PI呈正相关（r分别为0.353、0.332、0.275、0.448、0.491，均P<0.01），与E₂、AFC、OVVOL及PSV呈负相关（r分别为-0.034、-0.860、-0.623、0.330，其中E₂指标P>0.05，余均P<0.01）；单指标预测卵巢储备功能减退的ROC曲线下面积（AUC）：AFC、FSH、OVVOL三者居前，分别为0.996、0.935、0.893，AUC值在0.850以上，符合AUC值分类中效果非常好，相应的cutoff值及所对应的灵敏度、特异度分别为5.75个、95%、97%，8.66 U/L、88%、95%，4.49 cm³、76%、89%。结论　常用卵巢储备功能部分评价指标（AFC、FSH、OVVOL）对判断卵巢储备功能是否减退有较高的准确率，在临床诊断中值得推广运用。

关键词:

卵巢储备, 彩色多普勒, 基础窦卵泡, 卵巢间质血流, 促卵泡生成素