抗苗勒管激素在高龄妇女卵巢功能评估中的价值探讨

Value of anti-Müllerian hormone in ovarian function assessment among elderly women

目的探讨抗苗勒管激素(Anti-mullerian hormone,AMH)在高龄妇女卵巢功能评估中的价值。方法收集2014年10月-2015年2月在柳州市妇幼保健院门诊接受咨询的高龄妇女100例,根据其月经状态将其分正常组32例,围绝经期组35例,卵巢早衰(Premature Ovarian Failure,POF)组33例,比较各组的黄体生成素(Luteinizing Hormone,LH)、卵泡刺激素(Follicle-Stimulating Hormone,FSH)、雌二醇(Estradiol,E2)和AMH水平,分析围绝经期组女性入组时、6个月、12个月时LH、FSH、E2和AMH水平变化,对比随访自然妊娠女性与非妊娠女性在入组时的LH、FSH、E2和AMH水平差异。结果围绝经期组血清FSH水平明显高于正常组(P<0.05),AMH水平明显低于正常组(P<0.05);POF组LH、FSH水平明显高于正常组和围绝经期组(P<0.05),E2、AMH水平明显低于正常组和围绝经期组(P<0.05)。围绝经期组入组后6个月、12个月时AMH水平较初测时均明显降低(P<0.05),12个月时AMH水平较6个月时明显降低(P<0.05);12个月时LH、FSH水平较初测、6个月时均明显升高(P<0.05),E2水平较初测、6个月时均明显降低(P<0.05)。正常组中妊娠妇女入组的初测AMH水平明显高于非妊娠妇女的初测水平(P<0.05)。结论 AMH能较早、准确地反映高龄女性的卵巢功能变化,评估其自然受孕能力,因此在高龄妇女的生育能力评估中具有高的临床应用价值。

Objective To explore the value of anti-Mullerian hormone （AMH） in ovarian function assessment among elderly women. Methods One hundred elderly women receiving consultation in Outpatient Department of the hospital from October 2014 to February 2015 were collected, then they were divided into normal group （32 cases） , perimenopausal period group （35 cases）, and premature ovarian fail- ure （POF） group （33 cases） according to menstrual status. The levels of luteinizing hormone （LH） , follicle-stimulating hormone （FSH）, estradiol （E2） , and AMH in the three groups were compared. The changes of LH, FSH, E2, and AMH levels at admission, 6 and 12 months in perimenopausal period group were analyzed. The levels of LH, FSH, E2 , and AMH at admission among spontaneous pregnant women and non-pregnant women were compared and followed up. Results The level of serum FSH in perimenopausal period group was sta- tistically significantly higher than that in normal group （ P〈0. 05 ） . The level of AMH in perimenopausal period group was statistically signif- icantly lower than that in normal group （ P〈0. 05 ） . The levels of LH and FSH in POF group were statistically significantly higher than those in normal group and perimenopausal period group （ P〈0. 05 ） . The levels of E2 and AMH in POF group were statistically significantly lower than those in normal group and perimenopausal period group （P〈0. 05） . In perimenopausal period group, the levels of AMH at 6 and 12 months were statistically significantly lower than those at admission （ P〈0. 05 ） , the level of AMH at months was statistically significantly low- er than that at 6 months （P〈0. 05 ） ; the levels of LH and FSH at 12 months were statistically significantly higher than those at admission and 6 months （P〈0. 05）, the level of E2 at 12 months was statistically significantly lower than those at admission and 6 months （P〈0. 05） . In normal group, AMH level at admission among pregnant women was statistically significantly higher than that among non-pregnant women （ P〈0. 05 ） . Conclusion AMH can early and accurately reflect the change of ovarian function and evaluate the ability of natural conception of elderly women, which has high clinical application value in evaluation of fertility among elderly women.