抗苗勒管激素对子宫内膜异位症患者妊娠的影响及其相关性分析

Effect of anti-Mullerian hormone on pregnancy in patients with endometriosis and analysis of its correlation

目的通过分析手术对子宫内膜异位症(endometriosis,EMs)患者血清抗苗勒管激素(antimüllerian hormone,AMH)的影响,探讨EMs患者AMH及糖类抗原125(carbohydrate antigen 125,CA 125)对妊娠的影响,并对AMH行相关性分析。方法选取中山市博爱医院生殖内分泌科2016年1月至2017年1月因不孕就诊,行腹腔镜检查证实为EMs患者104例,检测术前AMH、CA 125及基础性激素水平,术中进行子宫内膜异位症的r-AFS评分;术后3个月检测AMH水平,术后随访12个月。结果术后1年累积妊娠率50. 96%(53/104)。无论是自然妊娠、促排卵-人工授精(controlled ovarian hyperstimulation-intrauterine insemination,COH-IUI),还是体外受精-胚胎移植(in vitro fertilization-embryo transplantation,IVF-ET)患者,术后3个月AMH水平与术前比较虽均有下降,但差异无统计学意义(P> 0. 05); 3种妊娠方式中妊娠组术前血清AMH水平均高于未妊娠组(P <0. 05)。自然妊娠及COH-IUI患者妊娠组术前CA 125水平均低于未妊娠组(P <0. 05)。腹膜型EMs及卵巢型子宫内膜异位囊肿患者术后3个月AMH水平与术前比较虽均有下降,但差异均无统计学意义(P>0. 05);两种EMs类型中妊娠组术前血清AMH水平均高于未妊娠组(P <0. 05),而CA 125水平均低于未妊娠组(P <0. 05)。对AMH进行相关性分析,AMH与年龄及血清基础卵泡刺激素(follicle stimulating hormone,FSH)水平呈负相关(P <0. 05),与雌二醇(estradiol,E2)、黄体生成素(luteinizing hormone,LH)、CA 125、r-AFS评分及不孕年限无相关性(P> 0. 05)。结论血清AMH反映卵巢的储备功能,EMs患者的年龄及血清FSH水平是卵巢储备功能的影响因素。排除手术对卵巢功能的影响,术前血清AMH及CA 125可作为预测EMs合并不孕患者术后妊娠的指标,在临床上有广泛的应用前景。

Objective To analyze the effect of surgery on serum anti-müllerian hormone( AMH) in patients with endometriosis( EMs),and to explore the effect of AMH and CA 125 on pregnancy in patients with EMs,and the correlation analysis of AMH. Methods 104 patients confirmed with EMs by laparoscopy due to infertility in Department of Reproductive Endocrinology,Bo'ai Hospital of Zhongshan City were selected,The preoperative AMH,CA 125 and basal hormone levels were measured. The r-AFS score of EMs was performed during the operation. The AMH level was detected 3 months after operation. Followed up for 12 months. Results The cumulative pregnancy rate at 1 year after surgery was 50. 96 %( 53/104). Regardless of natural pregnancy,COH-IUI or IVF-ET patients,the AMH level at 3 months after surgery was lower than the preoperative level. However,the difference was not statistically significant( P > 0. 05). The preoperative serum AMH levels in the three groups of pregnancy were higher than those in the non-pregnant group( P < 0. 05). The preoperative CA 125 level in the pregnancy group of patients with natural pregnancy and COH-IUI was lower than that of the non-pregnant group( P < 0. 05). The AMH level of peritoneal EMs and ovarian EMs patients decreased 3 months after operation,but the difference was not statistically significant( P > 0. 05). Regardless of peritoneal EMs or ovarian endometriotic cysts,serum AMH levels in the pregnant group were higher than those in the non-pregnant group( P < 0. 05),while CA 125 levels were lower than those in the non-pregnant group( P < 0. 05). Correlate analysis of AMH,AMH was negatively correlated with age and serum basal FSH( P < 0. 05),but was not associated with E2,LH,CA 125,r-AFS scores,and infertile years( P > 0. 05). Conclusion Serum AMH reflects ovarian reserve function,age and serum FSH levels in patients with EMs are influencing factors of ovarian reserve function. Excluding the effect of surgery on ovarian function,preoperative serum AMH and CA125 can be used as indicators for predicting postoperative pregnancy in patients with EMs complicated with infertility,and have broad application prospects in clinical practice.