化疗对绝经前乳腺癌患者卵巢储备功能的影响

Effect of chemotherapy on ovarian reserve in premenopausal patients with breast cancer

目的:了解乳腺癌化疗对患者卵巢功能的损伤程度及相关因素并初步评估AMH在卵巢储备功能测定方面的作用。方法:纳入女性绝经前乳腺癌患者120例作为病例组,其中自愿留取血清者30例,年龄匹配的30例健康人为对照组。调查化疗后的更年期症状、月经改变等,同时检测其血清AMH、FSH。结果:患者闭经率随着化疗年龄增长而升高;化疗后不同时期闭经率无明显变化;闭经组化疗开始年龄比有月经者高。常用化疗方案CEF/EC、CMF、ET导致的闭经率无明显差异。病例组的血清FSH水平明显升高、AMH明显降低,FSH<20 IU/L的病例血清AMH明显降低,病例组中血清FSH及AMH负相关。结论:乳腺癌常用的化疗方案均可不同程度的损害患者的卵巢功能。化疗损伤卵巢功能的程度与化疗年龄有关。化疗后月经正常者,其卵巢储备功能可能已经下降。血清AMH水平与FSH呈负相关,其水平下降提示卵巢储备功能降低,可以作为化疗患者卵巢储备功能的监测指标。

Objective： To explore the effect of chemotherapy on ovarian reserve of premenopausal patients with breast cancer and the correlative factors, evaluate the effect of anti - mullerian hormone （AMH） as one of the markers on the detection of ovarian reserve in patients with breast cancer. Methods： 120 female with breast cancer were recruited as patient group, 30 patients were phlebotomized of their own accord. 30 healthy volunteers with regular menses and comparable age were selected as control group. The perimenopausal symptoms and menstruation pattern after chemotherapy were recorded and the levels of follicule - stimulating hormone （FSH） and AMH were detected. Results： Incidence of amenorrhea rase along with patients＇age and there was no difference between different time - points after the start of chemotherapy. The start age of chemotherapy in amenorrhea group was older than that in menstruation group. There was no difference in amenorrhea rate between the standard regimens of CEF/EC, CMF and ET. The level of FSH in patient group was significantly higher than that in control group, while the level of AMH reversed. The survivors with FSH 〈 20 IU/L had significantly lower AMH. There was negative correlation between FSH and AMH in patient group. Conclusion： The commonly used adjuvant chemotherapy regimens for breast cancer might lead to ovarian damage. The impairment of chemotherapy on ovarian function is associated with the patients＇age. Survivors with regular menstrual cycles seems to have a diminished ovarian reserve. There is negative correlation between AMH and FSH, the declined AMH level indicates diminished ovarian reserve, which can be regarded as a monitoring markers of ovarian reserve in patients with breast cancer.