探讨女性基础性激素及抗苗勒管激素（AMH）水平联合经阴道三维超声对女性卵巢储备功能的评估价值。

选取2018年6月至2020年6月在海南省妇女儿童医学中心就诊的备孕女性224例，分为卵巢储备功能下降组（83例）和卵巢储备功能正常组（141例）。2组均行基础性激素[卵泡刺激素（FSH）、FSH/黄体生成素（LH）、雌二醇]、AMH和经阴道三维超声[卵巢体积、窦卵泡计数（AFC）、卵巢间质血流峰值流速（PSV）]检查。采用t检验比较2组FSH、FSH/LH、雌二醇、AMH、卵巢体积、AFC、PSV的差异，采用受试者操作特征（ROC）曲线分析基础性激素、AMH、三维超声及三者联合在卵巢储备功能中的诊断价值，采用χ²检验比较评价卵巢储备功能的敏感度和特异度的差异。

卵巢储备功能下降组的FSH、FSH/LH、雌二醇水平均高于正常组[（11.65±7.08）U/L vs （7.12±3.44）U/L；（3.47±1.27）vs（1.81±0.68）；（92.48±10.67）vs（64.73±7.95）]，AMH水平低于正常组[（1.14±1.05）vs（3.36±1.82）]，差异均具有统计学意义（t=6.424、12.737、22.163、10.156，P均<0.001）。卵巢储备功能下降组的卵巢体积、AFC、PSV均小于正常组[（3.09±2.13）cm³ vs （4.25±2.41）cm³；（4.62±3.78）个vs（7.53±2.94）个；（10.27±4.16）cm/s vs （15.61±4.35）cm/s]，差异均具有统计学意义（t=3.629、6.422、9.017，P均<0.001）。基础性激素、AMH、三维超声对卵巢储备功能下降组的ROC曲线下面积（AUC）分别为0.749、0.776、0.793，均低于3种检查联合诊断的AUC（0.875）。三者评估卵巢储备功能的敏感度分别为72.66%、72.69%、72.71%，低于3种检查联合诊断的87.93%（χ²=16.348、22.457、16.392，P均<0.001）。三者评估卵巢储备功能的特异度分别为67.21%、68.69%、70.14%，低于3种检查联合诊断的73.72%，但差异无统计学意义（χ²=2.105、1.317、0.707，P均>0.05）。

女性基础性激素、AMH、经阴道三维超声均能够有效评估卵巢储备功能。3种检查联合诊断比单一检查具有更高的敏感度和特异度，有较高的评估价值。

To evaluate the value of female basic hormone and antimullerian hormone (AMH) levels combined with transvaginal three-dimensional ultrasound for the evaluation of ovarian reserve function.

A total of 224 women admitted to Hainan Women and Children's Medical Center from June 2018 to June 2020 were selected and divided into two groups: decreased ovarian reserve function group (n=83) and normal ovarian reserve function group (n=141). Both groups underwent examination of female basic hormones [follicle stimulating hormone (FSH), FSH/luteinizing hormone (LH), and estradiol] and AMH as well as transvaginal three-dimensional ultrasound [ovarian volume, antral follicle count (AFC), and peak systolic blood flow velocity of ovarian stroma (PSV)]. The t test was used to compare the differences of FSH, FSH/LH, estradiol, AMH, ovarian volume, AFC, and PSV between the two groups. Receiver operator characteristic (ROC) curve was used to analyze the diagnostic value of female basic hormones, AMH, and transvaginal three-dimensional ultrasound in ovarian reserve function. The χ² test was used to compare the sensitivity and specificity of female basic hormones, AMH, transvaginal three-dimensional ultrasound, and their combination in evaluating ovarian reserve function.

The levels of FSH, FSH/LH, and estradiol in the decreased ovarian reserve function group were significantly higher than those in the normal group [(11.65±7.08) U/L vs (7.12±3.44) U/L, t=6.424, P<0.001; (3.47±1.27) vs (1.81±0.68), t=12.737, P<0.001; (92.48±10.67) vs (64.73±7.95), t=22.163, P<0.001], while the level of AMH was signficantly lower than that in the normal group [(1.14±1.05) vs (3.36±1.82), t=10.156, P<0.001]. Ovarian volume, AFC, and PSV in the decreased ovarian function group were all significantly lower than those in the normal group [(3.09±2.13) cm³ vs (4.25±2.41) cm³, t=3.629, P<0.001; (4.62±3.78) vs (7.53±2.94), t=6.422, P<0.001; (10.27±4.16) cm/s vs (15.61±4.35) cm/s, t=9.017, P<0.001]. The areas under ROC curves (AUCs) of female basic hormones, AMH, and transvaginal three-dimensional ultrasound for evaluating decreased ovarian reserve function wrtr 0.749, 0.776, and 0.793 respectively, which were all lower than that (0.875) of the combined diagnosis of the three tests. The sensitivities of the three tests to evaluate ovarian reserve function were 72.66%, 72.69%, and 72.71%, respectively, which were all lower than that (87.93%) of the combined diagnosis (χ²=16.348, 22.457, and 16.392, P<0.001); the specificities were 67.21%, 68.69%, and 70.14%, respectively, which were all lower than that (73.72%) of the combined diagnosis (χ²=2.105, 1.317, and 0.707, P>0.05).

Female basic hormones, AMH, and transvaginal three-dimensional ultrasound can be used to evaluate ovarian reserve function effectively. The combined diagnosis of the three tests have higher sensitivity and specificity than each of them.