抗苗勒激素预测多囊卵巢综合征患者促排卵疗效临床研究

Prediction of clinical efficacy of ovulation with anti-Mullerian in patients with PCOS

目的探究血清抗苗勒激素(AMH)值预测多囊卵巢综合征(PCOS)患者对克罗米酚促排卵的反应性。方法选择无排卵的PCOS患者38例,在月经第3天空腹测定胰岛素、雌激素(E2)、总睾酮(T)、促卵泡素(FSH)、促黄体生成素(LH)、血糖、抗苗勒激素,查身高、体重,计算体质指数。月经第5天开始口服克罗米酚50 mg/d,共5 d,口服第8天开始用阴道或直肠超声监测卵泡,直到优势卵泡达18 mm后,用绒毛膜促性腺激素(hCG)5 000 U/d,肌内注射,共两天。无反应者第2个月克罗米酚加量至100 mg/d×5 d口服,仍无反应者第3个月加量至150 mg/d×5 d,最终无反应者归为克罗米酚抵抗组,其余患者归为有反应组。采用SPSS 12.0软件作统计学处理,组间比较用t检验,P<0.05为差异有统计学意义。结果克罗米酚治疗后有反应者22例,克罗米酚抵抗者16例。两组年龄、体质指数、LH、FSH、E2、T差异无统计学意义;克罗米酚抵抗组胰岛素稳态模型(HOMAIR)较有反应组明显增高,但差异无统计学意义;克罗米酚有反应组AMH、黄体期孕激素值及子宫内膜厚度较克罗米酚抵抗组明显增高,差异有统计学意义,P均<0.05。结论本研究表明AMH可以作为预测PCOS患者克罗米酚促排卵反应性的理想指标。

Objective To evaluate the role of anti-Mullerian hormone（AMH）as a predictor of ovulation inducted by clomiphene citrate in patients with PCOS.Methods Thirty-eigth patients with anovulatory PCOS were tested for fasting insulin,estrogen（E2）,total testosterone（T）,follicle stimulating hormone（FSH）,luteinizing hormone（LH）,blood sugar and serum anti-Mullerian hormone（AMH）in the first three days of the period.All patients received clomiphene citrate 50 mg/d from the fifth day of the cycle for 5 days.Transvaginal or transrectal ultrasonographic serial folliculometry was performed to check ovulation from day 8 until the leading follicle reached 18 mm in diameter.Patients were intramuscularly injected with 5 000 U/d of human chorionic gonadotropin for two days.Clomiphene citrate were increased from 100 to 150 mg/d in the third month for patients without response to the treatment in the second month.Clomiphene resistance was determined if no response was confirmed after the three months of treatment.Results There were 22 women responded,while 16 women resistant to clomiphene citrate.There was no difference between the two groups in age,body mass index,estrogen（E2）,total testosterone（T）,follicle stimulating hormone（FSH）and luteinizing hormone（LH）.However,there were significant differences between the two groups in AMH,P and endometrial thickness.Conclusion AMH measurement could be useful in the prediction of ovarian response to clomiphene citrate.