CAJ | 학술논문

目的：对基础窦卵泡数（ AFC）预测卵巢低反应性及体外受精临床结局的能力进行Meta分析。方法计算机检索PUBMED、EMBASE、Cochrane图书馆、中国生物医学文献数据库、万方数据库等，收集符合纳入标准的研究，检索时限均为从建库至2013年4月，并追溯纳入研究的参考文献和手工检索相关会议资料。由2位研究者按照纳入与排除标准独立筛选文献、提取资料和评价质量后，采用MetaDisc1．4软件进行Meta分析。结果共纳入14篇文献2306个周期。结果显示：AFC对卵巢低反应（ POR）的汇总受试者工作特征曲线（ SROC）的AUC＝0．8250， Q*＝0．7581；对未临床妊娠（NCP）的AUC＝0．5283，Q*＝0．5212。表明AFC对POR的准确性及诊断价值较高，具有较好的预测能力；而对NCP的诊断价值较低。亚组分析中，当AFC诊断阈值由＜4个增多至＜6或7个时，POR方面合并敏感度由0．47升至0．81，合并阳性似然比由4．11降至2．76；NCP方面合并敏感度由0．21升至0．41，合并阳性似然比由1．17升至1．96；表明随着AFC诊断阈值的增高，其对POR及NCP的准确预测能力逐渐增强；研究对象发生POR的概率逐渐降低；但发生NCP的可能性增高，此点与临床不符。结论 AFC对卵巢低反应有较好的预测能力，可作为独立预测指标；但对体外受精结局的预测能力相对较差，尚需结合其他诊断指标来综合判断妊娠结局。
목적：대기출두란포수（ AFC）예측란소저반응성급체외수정림상결국적능력진행Meta분석。방법계산궤검색PUBMED、EMBASE、Cochrane도서관、중국생물의학문헌수거고、만방수거고등，수집부합납입표준적연구，검색시한균위종건고지2013년4월，병추소납입연구적삼고문헌화수공검색상관회의자료。유2위연구자안조납입여배제표준독립사선문헌、제취자료화평개질량후，채용MetaDisc1．4연건진행Meta분석。결과공납입14편문헌2306개주기。결과현시：AFC대란소저반응（ POR）적회총수시자공작특정곡선（ SROC）적AUC＝0．8250， Q*＝0．7581；대미림상임신（NCP）적AUC＝0．5283，Q*＝0．5212。표명AFC대POR적준학성급진단개치교고，구유교호적예측능력；이대NCP적진단개치교저。아조분석중，당AFC진단역치유＜4개증다지＜6혹7개시，POR방면합병민감도유0．47승지0．81，합병양성사연비유4．11강지2．76；NCP방면합병민감도유0．21승지0．41，합병양성사연비유1．17승지1．96；표명수착AFC진단역치적증고，기대POR급NCP적준학예측능력축점증강；연구대상발생POR적개솔축점강저；단발생NCP적가능성증고，차점여림상불부。결론 AFC대란소저반응유교호적예측능력，가작위독립예측지표；단대체외수정결국적예측능력상대교차，상수결합기타진단지표래종합판단임신결국。
Objective To assessment the predictive value of antral follicle count for ovarian poor response and IVF outcome.Methods We searched PUBMED, EMBASE, Cochrane Library, Chinese Biomedical Literature Database , data-base, etc.Articles collected studies met the inclusion criteria , were retrieved from time building a database to April 2013, with retrospective references and manual included in the study retrieve relevant meeting materials .By the two researchers ac-cording to inclusion and exclusion criteria independently screened the literature and evaluation of the quality of the extracted data, using MetaDisc1.4 Meta-analysis software.Results 2 306 cycles in 14 literatures were included.The results showed that:AFC low ovarian response (POR) summary receiver operating characteristic curve (SROC) of AUC =0.825 0, Q* =0.758 1;for non-clinical pregnancy (NCP) of AUC =0.528 3, Q* =0.521 2.AFC indicate the accuracy and diagnostic value of POR is high, has a better predictive capability;while lower diagnostic value of the NCP .Subgroup analysis showed that, when the AFC diagnostic threshold increased by a <4 to <6 or 7, POR aspects combined sensitivity rose from 0.47 to 0.81, positive likelihood ratio from the merger fell from 4.11 to 2.76;NCP combined aspects of the sensitivity rose from 0.21 to 0.41, positive likelihood ratio combined rose from 1.17 to 1.96;show that with the increase of AFC diagnostic threshold , and its ability to accurately predict and NCP POR gradually increased; probability study POR occurs gradually reduced; yet occurred NCP's possibility of increased , its discrepancies with clinic .Conclusion AFC has good prediction ability to the ovarian poor response , but has poorer prediction ability to IVF outcome .Prediction of pregnancy outcome remains to be com-bined with other diagnostic indicator to overall judgment .