生殖医学杂志

目的 探讨血清基础神经肽吻素(bKisspeptin)水平在卵巢储备功能减退(DOR)不孕症患者中的变化及其诊断价值。方法 收集2020年7月至2021年1月于我院生殖医学中心首次行辅助生殖技术(ART)助孕的145例患者的临床资料。根据卵巢储备功能检查结果分为两组：DOR不孕症患者为DOR组(n=80),卵巢功能正常的不孕症患者为对照组(n=65)。比较两组患者血清bKisspeptin、其他血清基础激素水平和窦卵泡数(AFC),采用Spearman相关分析法分析血清bKisspeptin与卵巢储备功能指标(其他血清基础激素水平和AFC)的相关性，采用受试者特征工作曲线(ROC)分析血清bKisspeptin、卵巢储备功能指标对DOR的诊断效能。再根据患者年龄分为<35岁低龄组和≥35岁高龄组，比较不同年龄组血清bKisspeptin对DOR的诊断效能。结果 DOR组血清bKisspeptin、基础卵泡刺激素(bFSH)、基础黄体生成素(bLH)水平均显著高于对照组(P<0.05),而抗苗勒管激素(AMH)、AFC、基础雌二醇(bE₂)均显著低于对照组(P<0.05);Spearman相关分析结果显示，DOR组血清bKisspeptin与bFSH、bLH水平呈显著正相关，与AMH、AFC呈显著负相关(P<0.05);血清bKisspeptin、AMH、AFC、bFSH诊断DOR的ROC曲线下面积(AUC)分别为0.87、0.97、0.96、0.95(均P<0.05)。低龄组血清bKisspeptin鉴别DOR的AUC为0.93,截断值为400.68 pg/ml,敏感度为73.53%,特异度为96.55%(P<0.05);而高龄组血清bKisspeptin鉴别DOR的AUC为0.84,截断值为316.92 pg/ml,敏感度为93.48%,特异度为61.11%(P<0.05)。结论 DOR患者血清bKisspeptin水平升高，其可能是一种新的DOR诊断标志物；对于<35岁的DOR患者，血清bKisspeptin的诊断价值较高。

Objective:To investigate the changes and clinical diagnostic value of serum basal Kisspeptin(bKisspeptin) level in patients with diminished ovarian reserve(DOR).Methods:The clinical data of 145 patients who underwent the first assistant reproductive therapy(ART) in Henan Provincial People's Hospital from July 2020 to January 2021 were analyzed. According to the ovarian reserve function examination results, the patients were divided into two groups: infertile DOR patients were in DOR group(n=80),and infertile patients with normal ovarian function were in control group(n=65). Serum level of bKisspeptin, other basal levels of sex hormone and antral follicle counting(AFC) were compared between the two groups. Spearman analysis was used to evaluate the correlation between serum level of bKisspeptin and other parameters(other basal levels of sex hormone and AFC) of ovarian reserve in DOR patients. The receiver operating curve(ROC) curve was used to compare the diagnostic efficiency of bKisspeptin and other indexes of ovarian reserve for DOR. Then, they were divided into younger age group <35 years and elder age group ≥35 years according to the age of patients. The diagnostic efficacy of serum bKisspeptin for DOR in different age groups was compared.Results:The serum levels of bKisspeptin, basal FSH(bFSH) and basal LH(bLH) levels were significantly higher in DOR group than those in the control group(P<0.05),while anti-Mullerian hormone(AMH),AFC and basal estradiol(bE₂) levels were significantly lower in DOR group compared to the control group(P<0.05). Spearman correlation analysis results show that serum level of bKisspeptin was positively correlated with bFSH and bLH levels, but negatively correlated with AMH and AFC levels in DOR group(P<0.05). The area under ROC curve(AUC) of serum levels of bKisspeptin, AMH,AFC and bFSH in the diagnosis of DOR were 0.87,0.97,0.96 and 0.95 respectively(all P<0.05). The AUC of serum level of bKisspeptin to identify DOR was 0.93,and the cut-off value was 400.68 pg/ml with the sensitivity of 73.53% and the specificity of 96.55% in the younger age group(P<0.05),while the AUC of serum bKisspeptin to identify DOR was 0.84,and the cut-off value of bKisspeptin was 316.92 pg/ml with a sensitivity of 93.48% and a specificity of 61.11% in elder age group(P<0.05).Conclusions:Serum level of bKisspeptin is increased in the DOR patients, especially in young patients with DOR,and may become a new diagnostic biomarker for DOR. For DOR patients <35 years old, serum level of bKisspeptin has high diagnostic value.