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目的探讨基础睾酮(testosterone,T)水平与不同卵巢储备能力患者体外受精周期(in vitro fertilization,IVF)卵巢反应的相关性。方法对248例首次行IVF的患者行回顾性分析,先按基础日FSH/LH及FSH值大小分成卵巢储备能力正常组(A组164例)和卵巢储备能力低下组(B组84例)分别进行研究,取总体样本248例患者的T值均数为截点,将A、B组分别分为组1(T<0.5ng/ml)和组2(T≥0.5ng/ml),比较组1和组2间卵巢反应参数均值差异;用Pearson相关性分析分别分析A、B两组中T值与卵巢反应参数的相关性;运用多元回归寻找影响获卵数的独立因素;运用受试者工作(receiver operating curve,ROC)曲线分别评价各指标在A、B组患者中预测卵巢反应的价值。结果 (1)A组:①A1组卵巢反应参数低于A2组,差异有统计学意义。②基础T值与卵巢反应参数明显正相关(P<0.05)。③T值是影响获卵数的独立因素之一,且在该组中对获卵数影响最大(P<0.01)。④根据ROC曲线结果当T值为0.500ng/ml的时候,其诊断卵巢低反应的敏感度为86.5%特异度为76.2%。(2)B组中:①B1组部分卵巢反应参数高于B2组,差异有统计学意义。②基础T值与部分卵巢反应参数负相关(P<0.05)。③T值是影响获卵数的独立因素之一,但影响是负面的。④ROC曲线显示该组中基础窦卵泡数(AFC)较T值对卵巢反应具有更高的预测价值。结论在卵巢储备能力低下的组,血清基础睾酮值与体外受精周期卵巢反应参数正相关,对卵巢低反应具有较强的预测价值;卵巢储备能力尚好的组,血清基础睾酮值与部分卵巢反应参数负相关,不具备明显的预测卵巢反应的价值。
Objective To investigate the correlation between testosterone (T) levels and ovarian response in vitro fertilization (IVF) patients with different ovarian reserve. Methods A retrospective analysis was performed on 248 first-line IVF patients. The patients were divided into normal ovarian reserve group (164 cases in group A) and low ovarian reserve group (84 cases in group B) according to the values of FSH / LH and FSH on the basis of day, The T values of 248 patients in the whole sample were taken as the cut-off points. Groups A and B were divided into group 1 (T <0.5ng / ml) and group 2 (T≥0.5ng / ml) 1 and 2, respectively. The Pearson correlation analysis was used to analyze the correlation between T value and ovarian response parameters in groups A and B respectively. The multivariate regression was used to find the independent factors affecting the number of oocytes retrieved. (Receiver operating curve, ROC) curves were used to evaluate the value of each index in predicting ovarian response in group A and B patients. Results (1) Group A: ① The ovarian response parameters of A1 group were lower than A2 group, the difference was statistically significant. The basal T value was positively correlated with ovarian response parameters (P <0.05). ③T value is one of the independent factors affecting the number of oocytes, and the number of oocytes in the group had the greatest impact (P <0.01). ④ According to the ROC curve results when the T value of 0.500ng / ml, the diagnosis of ovarian low response sensitivity was 86.5% specificity was 76.2%. (2) In group B: ① The ovarian response parameters in group B1 were higher than that in group B2, the difference was statistically significant. The basal T value was negatively correlated with some ovarian response parameters (P <0.05). ③T value is one of the independent factors affecting the number of oocytes, but the impact is negative. ROC curve showed that AFC in this group had higher predictive value for ovarian response than T value. Conclusions In the group with low ovarian reserve, serum basal testosterone level is positively correlated with parameters of IVF in vitro fertilization, and has a strong predictive value for low ovarian response; ovarian reserve capacity is still good, basal serum testosterone level and partial ovarian response parameters Negative correlation, does not have a clear prediction of the value of ovarian response.