抗苗勒氏管激素(AMH)预测卵巢储备功能及反应性的研究

Study of the Prognosticate Value of AMH for the Ovarian Reserve and Response

目的:探讨抗苗勒氏管激素(AMH)对卵巢储备功能及卵巢反应性的预测价值。方法:利用ELISA法对228例不孕症患者基础血清AMH蛋白水平(bAMH)进行检测,其中71例初次接受IVF-ET治疗的患者,分别检测IVF周期中FSH注射后各阶段的血清及卵泡液中AMH蛋白水平,分离并采用RT-PCR检测卵巢颗粒细胞AMH mRNA相对含量。结果:①228例不孕症患者bAMH水平与窦卵泡计数成正相关(r=0.907,P<0.01),与患者年龄、初潮年龄、初潮至就诊的年数成负相关(r=-0.833,P<0.01;r=-0.580,P<0.01;r=-0.783,P<0.01)。②71例接受IVF-ET治疗的患者,bAMH与在FSH注射后各阶段血清AMH水平无明显差异(t=0.042,P>0.05;t=0.278,P>0.05;t=0.255,P>0.05)。③血清、卵泡液AMH蛋白表达及颗粒细胞AMH mRNA相对含量与卵巢反应性有关,卵巢低反应组(获卵数≤5个)与正常组(获卵数>5个)比较,差异有统计学意义(P<0.05)。④获卵数与bAMH水平均呈显著正相关(r=0.527,P<0.01)。颗粒细胞AMH mRNA相对含量与成熟卵数、受精卵数显著相关(r=0.479,P<0.01,r=0.529,P<0.01)。⑤发生卵巢过度刺激综合征患者的bAMH蛋白水平较其他患者显著增高(t=3.173,P<0.01)。结论:AMH的表达不受促性腺激素作用的影响,bAMH水平与患者卵巢的储备功能及卵巢反应性有关,可以作为评价卵巢储备功能及预测促排卵中卵巢反应性的血清学标记物。

Objective：To explore the predictable value of anti-Müllerian hormone on ovarian reserve and response.Methods：The level of AMH protein secretion in serum was examined by ELISA in 228 cases of infertile woman,the level of AMH protein in follicular fluid and the AMH mRNA relative concentration in granulosa cells were examined by ELISA and RT-real-time-PCR in 71 cases who received IVF-ET treatment.The relationship between the expression of AMH and ovary reserve was analyzed by Pearson＇s correlation,Spearman＇s correlation and t-test.Result：1）A positive correlation was found between serum bAMH and AFC（r=0.907,P0.01）in 228 cases of infertile women,and it was correlated negatively with age,age at menarche and years since menarche（r=-0.833,P0.01;r=-0.580,P0.01;r=-0.783,P0.01,respectively）.2）Serum bAMH did not change in response to FSH（t=0.042,P 0.05;t=0.278,P0.05;t=0.255,P0.05）.3）A positive correlation was found between serum bAMH with FF AMH and relative concentration of AMH mRNA in GC（r=0.779,P0.01;r=0.838,P0.01,respectively）.There were significant differences among serum,FF AMH level and GC AMH mRNA relative concentration with the ovary response（P0.05）.4）bAMH levels were highly correlated with the number of oocytes retrieved（r=0.527,P0.01）.5）Women with OHSS had higher bAMH levels than others,a difference was highly statistically significant（t=3.173,P0.01）.Conclusion：There is obvious relationship between serum AMH level with ovary reserve and response.The serum AMH protein level is of more clinical value to predict the ovary reserve and response,and may be applied in clinic as a molecule marker.