抗苗勒氏管激素对滋养细胞肿瘤化疗患者卵巢储备功能评价的意义

Significance of anti-mullerian hormone in evaluation of ovarian reserve function in patients receiving chemotherapy with gestational trophoblastic tumor

目的:研究化疗对妊娠滋养细胞肿瘤患者卵巢功能的影响以及AMH用于评价卵巢储备的价值。方法:观察19例妊娠滋养细胞肿瘤患者化疗前至化疗结束后1年期间月经改变、血清抗苗勒氏管激素(AMH)水平变化,以及停化疗1年后卵泡刺激素(FSH)水平、窦状卵泡数与健康妇女的差别。结果:观察组月经异常发生率为84.21%(16/19),在接受化疗5～6周期时63.16%(12/19)的患者出现停经,停化疗后2～5月逐渐自行恢复。发生停经的几率与患者接受化疗的周期数正相关(r=1.000,P=0.01)。停化疗1年后观察组血清AMH水平显著下降(1.02±0.53μg/Lvs2.11±0.24μg/L,P<0.01),并且显著低于健康妇女(1.02±0.53μg/Lvs1.99±0.76μg/L,P<0.01)。观察组患者停化疗1年后血清FSH水平及窦状卵泡数则与对照组健康妇女无显著改变。结论:化疗对滋养细胞肿瘤患者卵巢内分泌功能的影响是可逆的,但可致卵巢储备受损;监测患者血清AMH水平可评价滋养细胞肿瘤患者卵巢储备的变化。

Objective： To investigate the effect of chemotherapy on ovarian function in patients with gestational trophoblastic tumor and the value of anti - mullerian hormone （AMH） in evaluation of ovarian reserve function. Methods ： The changes of menstruation and ser- um level of AMH before chemotherapy to one year after chemotherapy, differences of serum follicle - stimulating hormone （FSH） level and number of antral follicles for one year after chemotherapy between 19 patients with gestational trophoblastic tumor and healthy women were observed. Results： The incidence of abnormal menstruation in observation group was 84. 21% （16/19）, amenorrhea occurred in 12 cases （63.16%） during 5 N 6 cycles, then they recovered 2 N 5 months after chemotherapy. There was a positive correlation between incidence of amenorrhea and number of treatment cycle （ γ= 1. 000, P = 0. 01 ） . The serum level of AMH decreased significantly one year later after chemotherapy （ 1.02 ±0. 53μg/L vs 2. 11 ±0. 24 μg/L, P 〈0. 01 ） , and was significantly lower than that in normal women （ 1.02 ±0. 53 μg/L vs 1.99 ±0. 76 μg/L, P 〈0. 01 ） . There was no difference in serum FSH level and number of antral follicles one year after chemotherapy between observation group and control group. Conclusion： The effect of chemotherapy on ovarian endocrine function is reversible, but which impair ovarian reserve; monitoring serum AMH level may evaluate the changes of ovarian reserve function in patients with gesta- tional trophoblastic tumor.