AMH在围绝经期卵巢良性肿瘤患者术后卵巢功能改变的预测作用

Efficacy of AMH on evaluating ovarian function recovery after surgery in perimenopausal patients with benign ovarian tumor

目的探讨AMH在围绝经期卵巢良性肿瘤患者术后卵巢功能改变的预测作用。方法共54例围绝经期卵巢良性肿瘤患者,行术前至术后至少6个月的临床跟踪研究,手术方式选择腹腔镜下卵巢囊肿剥除术,缝合止血,术前检测AMH、卵巢激素(FSH,LH,E2)及MRS评分;术后1月复查AMH,卵巢激素;术后3月复查AMH,卵巢激素,记录月经性状,MRS评分;对于此时月经性状异常患者(月经异常组)口服芬吗通行人工周期,并于术后6月再次随访记录AMH,卵巢激素,记录月经性状,MRS评分。结果术后AMH指标呈一过性下降,术后3月两组(月经正常组,月经异常组)患者的AMH、E2、FSH/LH、MRS评分均表现出的显著的统计学差异(P<0.01);术后6月临床观察组(月经未恢复拒绝行人工周期者)患者的E2,FSH/LH,MRS评分较月经正常组、人工周期组(月经异常组行人工周期)均有统计学差异(P<0.05)。结论术前的AMH数值对于预测术后3月内患者月经性状及预评估患者术后生活质量有临床指导意义。术前AMH较低特别是在1.5 ng/ml以下的患者术后早期开始服用芬吗通行人工周期,可以有效促进卵巢功能恢复,提高围绝经期生活质量。

Objective To explore the efficacy of AMH to evaluate ovarian function recovery after surgery in perimenopausal patients with benign ovarian tumor. Methods 54 perimenopausal patients with benign ovarian tumor were tracked clinically from a time before the surgery to six months after the surgery. The patients received laparoscopic cophorocystectomy, and suture method of bleeding. And then AMH and ovarian hormone （FSH, LH, E2） was detected together with the record of MRS score. AMH and ovarian hormone was re-detected 1 month after the surgery. 3 months after the surgery, AMH and ovarian hormone was re-detected, menstruation status and MRS score was recorded. For patients with abnormal menstruation 3 months after the surgery, oral administration of Femoston was given to restore artificial menstruation period. 5 months after the surgery, AMH and ovarian hormone was re-detected, menstruation status and MRS score was recorded for these patients. Results AMH experienced transient decrease. AMH, E2, FSH/LH and MRS score between the two groups had significant differences 3 months after the surgery （P〈0.O1）. Whether between the clinical observation group and the normal menstruation group or between the clinical observation group and the artificial menstruation group, E2, FSH/LH and MRS score had significant differences 6 months after the surgery （P〈0. 05 ）. Conciusions It is clinically useful to use AMH before the surgery to evaluate menstruation status and post-operative life quality 3 months after the surgery. For patients with low AMH, even at a level of 1.5ng/ml, using Femoston to restore artificial menstruation period is feasible, which can promote the recovery of ovarian function and improve the life quality for perimenopausal patients.