化疗对恶性肿瘤患者卵巢功能的影响

Impact of chemotherapy on ovarian function of patients with malignant tumor

目的研究化疗对恶性肿瘤患者卵巢功能的影响。方法收集34例女性恶性肿瘤存活者（病例组）与34例月经正常的女性健康者（对照组）临床资料，调查病例组恶性肿瘤类型与治疗后月经情况，比较两组血清卯泡刺激素（FSH）、黄体生成素（LH）、抗苗勒氏管激素（AMH）水平。结果34例病例组中23例（67．6％）闭经，7例（20．6％）月经不规则，4例（11．8％）月经规则。病例组血清FSH、LH水平分别为（50．88±27．12）U／L、（36．87±27．86）U／L，对照组血清FSH、LH分别为（5．94±1．46）U／L、（4．13±1．78）U／L，两组血清FSH、LH水平差异有统计学意义（P均=0．000）。病例组血清AMH显著低于对照组[（0．412±0．183）μg／L比（1．770±0．941）μg/L，P=0．000]。病例组中月经规则的患者血清AMH水平显著低于对照组[（0．811±0．155）μg／L比（1．770±0．941）μg/L，P=0．000）。病例组中血清FSH〈10U／L的患者，其AMH水平亦显著低于对照组[（0．581±0．225）μg/L比（1．770±0．941）μg／L，P=0．000]。结论化疗对恶性肿瘤患者的卵巢功能有损害。血清AMH水平对恶性肿瘤患者卵巢储备功能下降的评估可能比FSH更敏感。

Objective To explore the impact of chemotherapy on ovarian function of patients with malignant tumor. Methods The clinical data of 34 malignant tumor survivors （ case group ） and 34 healthy women with regular menstrual cycles （control group ） were collected. The malignant tumor types and menstrual cycle after treatment in the case group were investigated. Serum follicle stimulating hormone （FSH）, luteinizing hormone （LH） and anti-Mullerian hormone （AMH） in two goups were compared. Results In the case group including 34 patients, 23 （ 67.6% ） experienced amenorrhea, 7 （ 20.6% ） irregular menstruation and 4 （11.8%） regular menstruation. Serum FSH and LH levels were （50.88 ＋1 27. 12） U/L,（36.87 ±27.86） U/L respectively in the case group, while those were （5.94 ± 1.46） U/L and （4.13 ± 1.78 ） U/L in the control group. There were significant differences between two groups （ all P = 0. 000）. The serum level of AMH in the case group was significant lower than that in the control group [ （0. 412 ± 0. 183 ） p,g/L vs （ 1. 770 ± 0. 941 ） μg/L, P = 0. 000]. Serum AMH level in patients with regular menstrations and those with serum FSH 〈 10 U/L in the case group were significantly lower than those in the control group [ （0. 811 ± 0. 155 ） μg/L vs （ 1. 770 ± 0. 941 ） μg/L, （0. 581 ± 0. 225 ） μg/L vs （ 1. 770 ± 0. 941 ） μg/L, all P = 0. 000 ]. Conclusions Chemotherapy may lead to the damage of ovarian function. The serum levels of AMH may be more sensitive than FSH to predict the descent of ovarian reserve in malignant tumor survivors.