术后抗苗勒管激素水平与卵巢子宫内膜异位囊肿剥除术后卵巢早衰的相关性

Postoperative levels of anti-Mullerian hormones and premature ovarian failure after ovarian endometriosis cyst removal

目的:分析术后抗苗勒管激素(AMH)水平与卵巢子宫内膜异位囊肿剥除术后卵巢早衰(POF)中的相关性,为临床诊断和治疗工作提供研究依据。方法:选取2015年1月~2017年12月的619例行卵巢子宫内膜异位囊肿剥除术患者作为研究对象,对其术后血清AMH、卵泡刺激素(FSH)、雌二醇(E2)、黄体生成素(LH)水平、POF发生情况、术后12月内妊娠成功率进行回顾性分析。结果:有198例患者发生POF,发病率为31.99%,发生POF患者术后第1月的血清AMH、E2水平低于未发生POF患者,血清FSH、LH水平高于未发生POF患者,差异均有统计学意义;四种血清激素水平预测POF的受试者工作特征曲线下面积(AUC)分别为0.929、0.886、0.849、0.846,其中,血清AMH水平在预测POF中的AUC最高;有471例患者有生育需求,在术后12个月内有248例妊娠成功,妊娠成功率为52.65%,POF患者和非POF患者的妊娠成功率分别为17.05%(22/109)和66.08%(226/342),差异有统计学意义;妊娠成功患者的血清AMH、E2水平高于妊娠失败患者,血清FSH、LH水平低于妊娠失败患者,差异有统计学意义。结论:卵巢子宫内膜异位囊肿剥除术后POF患者在术后早期可表现为血清AMH水平的下降,相对于性激素指标,血清AMH在预测术后POF中的价值较高,并与患者的远期妊娠成功率具有关联性,可作为评价术后卵巢功能、预测POF和妊娠率的辅助指标。

Objective To analyze the values of postoperative anti-Mullerian hormone(AMH)level in predicting premature ovarian failure(POF)after ovarian endometriosis cystectomy to provide research basis for clinical diagnosis and treatment.Methods 619 patients who underwent ovarian endometriosis cystectomy from January of 2015 to December of 2017 were selected as the study subjects.The serum AMH,follicle stimulating hormone(FSH),estradiol(E2),luteinizing hormone(LH)levels,the occurrence of POF and the pregnancy success rate within the postoperative 12 months were analyzed retrospectively.Results There were 198 patients with POF,the incidence of POF was 31.99%.The serum AMH and E2 levels of the patients with POF in the first month after the operations were lower than those of the patients without POF,and the serum FSH and LH levels were higher than those of the patients without POF,the differences were statistically significant.The area under the Receiver Operating Characteristic curve(AUC)of the four serum hormone levels in predicting POF was 0.929,0.886,0.849 and 0.846 respectively,among them,AUC of the serum AMH level was the highest in predicting POF;471 patients had reproductive needs,248 cases had successful pregnancy within 12 months after the operations,and the pregnancy success rate was 52.65%.The pregnancy success rates of the patients with POF and the patients without POF were 17.05%(22/109)and 66.08%(226/342),respectively,the differences was statistically significant;The serum AMH and E2 levels of the patients with successful pregnancy were higher than those with pregnancy loss,and the serum FSH and LH levels were lower than those in patients with pregnancy loss,the differences was statistically significant.Conclusions The serum AMH level of the patients with postoperative POF after ovarian endometriosis cystectomy may decrease in the early stage after the operations.Compared with the sex hormone indicators,the serum AMH has a higher value in predicting POF after the operations,and has a correlation with the long-term pregnancy success rate of the patients,which can be used as an auxiliary indicator to evaluate ovarian functions,predict POF and pregnancy rate after ovarian endometriosis cystectomy.