抗苗勒氏管激素下降率对多囊卵巢患者促排卵疗效的预测价值

AMH descending rate for predicting the response to ovulation induction in women with polycystic ovary syndrome

目的多囊卵巢综合征(polycystic ovary syndrome,PCOS)患者抗苗勒氏管激素(anti-mullerian hormone,AMH)水平异常升高,经炔雌醇环丙孕酮片治疗后AMH水平下降。文中旨在探讨PCOS患者经炔雌醇环丙孕酮片治疗前后AMH的下降率对促排卵后疗效的预测价值。方法回顾性分析2015年8月至2016年3月间于南京军区南京总医院明确诊断的46名PCOS患者临床资料。所有患者经炔雌醇环丙孕酮片治疗3个月后促排卵治疗,其中氯米芬促排卵21例,包括有反应患者13例,无反应8例;来曲唑促排卵25例,包括有反应患者18例,无反应7例。比较炔雌醇环丙孕酮片治疗前后性激素、AMH及其下降率。根据促排卵有无反应,分别比较AMH下降率。结果炔雌醇环丙孕酮片治疗后,AMH水平较治疗前显著下降[(7.79±4.11)ng/m L vs(5.18±3.63)ng/m L],差异有统计学意义(P<0.01);无反应患者的AMH下降率低于有反应者[(18±6)%vs(38±5)%],差异有统计学意义(P<0.05)。来曲唑方案促排卵的无反应患者AMH下降率低于有反应者[(12±9)%vs(40±5)%],差异有统计学意义(P<0.05)。当AMH下降率>33.05%时,预测有反应的敏感度74%、特异性65%。结论炔雌醇环丙孕酮片治疗可降低AMH水平,AMH下降率可预测促排卵治疗的反应性。

Objective Abnormally elevated level of the serum anti-mullerian hormone （AMH） in patients with polycystic ovary syndrome （PCOS） can be decreased by treatment with ethinylestradiol and cyproterone acetate tablets. The aim of this study is to assess the value of the AMH descending rate induced by ethinylestradiol and cyproterone acetate tablets in predicting the response to ovulation induction. Methods Forty-six patients with PCOS underwent ovulation induction after treated with ethinylestradiol and cyproterone acetate tablets for 3 months. Clomiphene citrate was used for induction in 21 cases （13 responders and 8 non-responders） and letrozole for the other 25 （ 18 responders and 7 non-responders）. The levels of sex hormones and AMH of the patients were compared before and after ethinylestradiol and cyproterone acetate tablets treatment and the AMH descending rate was calculated according to the rate of response to ovulation induction. Results After ethinylestradiol and cyproterone acetate tablets treatment, the AMH level was significantly decreased as compared with the baseline （[5.18 ± 3.63] vs [7.79 ±4. II] ng/ml, P〈0.01）, with even a lower de scending rate in the non-responders than in the responders （ [ 18 ±6]vs [ 38 ± 5 ] %, P 〈 0.05）. In the letrozole group, the AMH descending rate was significantly lower in the non-responders than in the responders （ [ 12 ± 9 ] vs [40 ± 5 ] %, P 〈 0.05 ）. The cutoff value of the AMH descending rate was 33.05%, with a sensitivity of 74% and a specificity of 65% in predicting the response to ovulation induction. Conclusion The AMH descending rate induced by ethinylestradiol and cyprote：rone acetate tablets can be used to predict the response to ovulation induction.