激素检测在女性不孕症诊治中的临床应用

doi:10.3969/j.issn.1673-8640.2015.07.021

摘要/Abstract

摘要：

女性激素水平的实验室检测在不孕症的诊治中,特别是在体外受精(IVF)的周期中起着重要作用。这些激素包括卵泡刺激素(FSH)、雌二醇(E2)、抗苗勒氏管激素(AMH)、抑制素B(Inh B)、孕酮和黄体生成素(LH)。血清FSH、E2 和AMH通常作为评估女性卵巢储备功能的检测项目。E2通常也被用于监测控制性超排卵(COH)中的卵泡发育。除了用于评估卵巢储备功能以外,AMH还可在诱导排卵过程中作为对促性腺激素反应的预测因子。Inh B不能被视为一个评估卵巢储备功能的可靠标志物。促性腺激素反应不良的患者Inh B水平一般较低。孕酮是一个检测卵巢功能的简单指标。孕酮和LH在预测IVF是否成功方面的价值存在争论。

关键词: 激素, 女性, 不孕症, 体外受精

Abstract:

Laboratory determination for female hormones plays a large part in infertility treatment, especially during in vitro fertilization(IVF) cycle. The hormones contain follicle stimulating hormone(FSH), estradiol(E2), anti-Müllerian hormone(AMH), inhibin B(Inh B), progesterone and luteinizing hormone(LH). Serum FSH, E2 and AMH levels are commonly determined for women as a part of ovarian reserve testing. E2 levels are also frequently evaluated in a controlled-ovarian-hyperstimulation(COH) setting to monitor follicular development. In addition to its role in evaluating ovarian reserve, researchers have studied AMH as a predictor of response to gonadotropin stimulation during ovulation induction. Inh B levels are not regarded as a reliable assessment index of ovarian reserve. Poorer responders to gonadotropin generally have lower Inh B levels. Progesterone is a simple determination for ovarian function. The role of progesterone and LH levels in evaluating the success of IVF cycle has been the subject of debate for many years.

Key words: Hormone, Female, Infertility, In vitro fertilization

中图分类号:

R446.1

张春燕, 潘柏申. 激素检测在女性不孕症诊治中的临床应用[J]. 检验医学, 2015, 30(7): 761-765.

ZHANG Chunyan, PAN Baishen. Clinical application of female hormone determination in infertility treatment[J]. Laboratory Medicine, 2015, 30(7): 761-765.

图/表 2

参考文献 21

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检测项目	参考区间	检测时间	临床意义
FSH	5~20 mIU/L	月经期第2~3天(卵泡期早期)	>10 IU/L预示卵巢刺激不良 >18 IU/L预示怀孕预后不良
E2	20~400 pg/mL	月经期第2~3天(卵泡期早期)	与FSH的联合应用能有助于评估基础卵巢功能和COH监测;<3 000 pg/mL 时OHSS风险较低
AMH	0.9~9.5 ng/mL	可随时检测,不依赖于月经周期时间	低值(0.2~0.7 ng/mL)预示COH反应不良,但对怀孕预后没有预测作用
Inh B	卵泡期:<139 pg/mL	月经期第2~3天(卵泡期早期)	血清水平<45 pg/mL与促性腺激素反应不良有关
孕酮	卵泡期:<3 ng/mL 排卵期:5~30 ng/mL	预期月经开始前1周(黄体期中期)	排卵期<3 ng/mL提示排卵障碍
LH	5~20 mIU/mL	卵泡期中期	LH的临床价值尚不明确

检测项目	参考区间	检测时间	临床意义
FSH	5~20 mIU/L	月经期第2~3天(卵泡期早期)	>10 IU/L预示卵巢刺激不良 >18 IU/L预示怀孕预后不良
E2	20~400 pg/mL	月经期第2~3天(卵泡期早期)	与FSH的联合应用能有助于评估基础卵巢功能和COH监测;<3 000 pg/mL 时OHSS风险较低
AMH	0.9~9.5 ng/mL	可随时检测,不依赖于月经周期时间	低值(0.2~0.7 ng/mL)预示COH反应不良,但对怀孕预后没有预测作用
Inh B	卵泡期:<139 pg/mL	月经期第2~3天(卵泡期早期)	血清水平<45 pg/mL与促性腺激素反应不良有关
孕酮	卵泡期:<3 ng/mL 排卵期:5~30 ng/mL	预期月经开始前1周(黄体期中期)	排卵期<3 ng/mL提示排卵障碍
LH	5~20 mIU/mL	卵泡期中期	LH的临床价值尚不明确