血清抗苗勒管激素在卵巢早衰患者中的预测价值

Predictive role of serum anti-Mullerian hormone in patients with premature ovarian failure

目的探讨血清抗苗勒管激素(AMH)在卵巢早衰(POF)患者中的预测价值。方法选择2017年2月至2018年2月陕西省人民医院妇产科门诊诊治的82例POF患者,其中绝经POF患者45例(POF绝经组),月经稀发POF患者37例(围POF组),同时选择于我院门诊体检中心体检的50例月经正常女性作为对照组。采用酶联免疫吸附试验(ELISA)检测的所有受检者的血清AMH水平,电化学发光法检测性激素水平,比较组间差异,Pearson分析血清AMH与性激素之间的相关性,ROC分析血清AMH对POF的预测价值。结果 POF绝经组、围POF组患者的血清AMH水平分别为(2.01±0.62) pmol/L和(6.95±2.57) pmol/L、E2水平分别为(20.35±5.68) pmol/L和(162.09±20.51) pmol/L,均明显低于正常对照组的(14.02±6.38) pmol/L和(195.36±31.27) pmol/L,差异均具有统计学意义(P<0.05);POF绝经组、围POF组患者的LH分别为(31.52±8.73) U/L和(10.85±3.95) U/L、FSH水平分别为(52.25±11.09) U/L和(20.95±6.25) U/L,均高于正常对照组的(6.59±3.05) U/L和(5.42±2.36) U/L,差异均有统计学意义(P<0.05);POF绝经组患者的血清AMH、E2水平低于围POF组,LH、FSH水平高于围POF组,差异均有统计学意义(P<0.05);血清AMH与E2呈正相关(r=0.519,P<0.05),与LH、FSH呈正相关(r=-0.413、-0.492,P<0.05);血清AMH预测POF的最佳截断(cut-off)值为5.13 pmol/L,此界值下预测POF的灵敏度、特异度分别为72.20%、79.20%。结论 POF患者血清AMH水平明显下降,血清AMH水平随着卵巢功能减退而降低,血清AMH预测POF价值较大,可作为早期预测POF的敏感血清学指标。

Objective To explore the predictive role of serum anti-Mullerian hormone (AMH) in patients with premature ovarian failure (POF). Methods From February 2017 to February 2018, 82 POF patients from Department of Gynaecology and Obstetrics, including 45 menopausal POF patients (POF menopausal group), 37 patients with poorly menstruated POF (perimenopausal POF group), and 50 normal menstrual women in the Outpatient Physical Examination Center of Shaanxi Provincial People's Hospital were selected as the control group. Enzyme-linked immunosorbent assay (ELISA) was used to detect serum anti-Mullerian hormone levels, and electrochemiluminescence (ECL) was used to detect sex hormone levels. Pearson was used to analyze the correlation between serum anti-Mullerian hormone and sex hormone. ROC was used to analyze the predictive value of serum anti-Mullerian hormone on POF. Results The serum AMH levels in the POF menopausal group and peri-POF group were (2.01±0.62) pmol/L and (6.95±2.57) pmol/L, respectively; the levels of E2 were (20.35±5.68) pmol/L and (162.09±20.51) pmol/L respectively; they were significantly lower than corresponding (14.02±6.38) pmol/L and (195.36±31.27) pmol/L in the normal control group (P<0.05). The LH of POF menopausal group and POF group were (31.52±8.73) U/L and (10.85±3.95) U/L respectively; the levels of FSH were (52.25±11.09) U/L and (20.95±6.25) U/L respectively; they were higher than corresponding (6.59±3.05) U/L and (5.42±2.36) U/L in the normal control group (P<0.05). The serum levels of AMH and E2 in POF menopausal group were significantly lower than those in peripheral POF group (P<0.05); the levels of LH and FSH were significantly higher than those in POF group (P<0.05). Serum AMH was positively correlated with E2 (r=0.519, P<0.05), LH and FSH (r=-0.413, -0.492, P<0.05). The best cut-off value of serum anti-Mullerian hormone for predicting POF was 5.13 pmol/L. The sensitivity and specificity were 72.20% and 79.20% respectively. Conclusion The level of serum anti-Mullerian hormone in POF patients decrease significantly, and the level of serum anti-Mullerian hormone decrease with the decline of ovarian function. The value of serum anti-Mullerian hormone in predicting POF is high, which can be used as a sensitive serological index for the early prediction of POF.