抗苗勒管激素评价子宫肌瘤剔除术后卵巢功能的改变

The effect on ovarian function after myomectomy assessed by serum anti-Mullerian hormone levels

目的：通过检测新的卵巢功能指标抗苗勒管激素（AMH）,评估子宫肌瘤剔除术对于年轻患者卵巢功能的影响。方法：前瞻性队列观察研究,选取36~45岁因子宫肌瘤行子宫肌瘤剔除术患者35例,于术前,术后2 d,术后3个月检测血清AMH、促卵泡生成素（FSH）、促黄体生成激素（LH）水平,选取同年龄组未行手术的35例子宫肌瘤患者为对照组,比较两组间及各时间点各激素水平的变化差异。结果：（1）子宫肌瘤剔除组患者术前、术后2 d、术后3个月AMH水平分别为（1.54±0.95）ng/mL,（1.18±0.77）ng/mL,（1.50±0.58）ng/mL,术后2 d AMH水平较术前显著降低（P〈0.05）,术后3个月AMH水平逐步回升,与术前相比差异无显著性（P〉0.05）。（2）子宫肌瘤切除组与对照组各时间点AMH水平比较,差异有差异性（P〈0.05）,而FSH、LH水平变化差异无显著性（P〉0.05）。结论：AMH评估卵巢功能的改变优于FSH。子宫肌瘤剔除术短期影响卵巢功能,但3个月后恢复,手术与术中出血可能会暂时性影响AMH水平下降。

Objective The aim of this prospective study was to evaluate the changes in the ovarian reverse after myomectomy based on serum anti-Mullerian Hormone （AMH） levels. Methods This is a prospective longitudinal observational study. Serum AMH levels were measured at the baseline and 2 day , 3months after myomectomy in 35 women aging from 36 to 45years.Follicle stimulate hormone（FSH） and luteal hormone（LH） were measured at the same time. 35 women of the same age with fibroid who did not undergo operation were selected as control group. Result （1）AMH level is （1.54 ± 0.95）ng/mL,（1.18 ± 0.77）ng/mL,（1.50 ± 0.58 ）ng/mL at 0 day, 2 days and 3 months after operation. AMH level decreased significantly at 2 days after operation （P ＆lt; 0.05） and increased gradually 3 months after operation, but showed no significant change （P 〉 0.05）.（2） Significant differences in the serial change of AMH levels existed at each time point between myomectomy group and control group （P ＆lt;0.05）. No significant differences in FSH or LH levels existed at each time point. Conclusion AMH is may be superior to FSH or LH in evaluating the changing of ovarian reverse. The study suggests that myomectomy affect the ovarian function for up to 3 months post-operatively , and hemorrhage during and after operation may decrease serum AMH levels.