卵巢早衰治疗过程中随访血清抗苗勒管激素和基础性激素水平的临床意义

The clinical significance of serum anti-müllerian hormone and basic sexal hormone level in therapeutic processof premature ovarian failure

目的探讨在激素序贯法治疗卵巢早衰过程中,联合检测血清抗苗勒管激素和基础性激素水平的临床意义。方法选择在我院就诊,确诊为卵巢早衰的患者86例,给予补佳乐+地屈孕酮序贯口服法进行治疗,疗程6个月,检测和记录患者治疗前、治疗3个月、治疗6个月时的血清抗苗勒管激素(AMH)、促卵泡素(FSH)、雌二醇(E2)水平,和改良Kupperman评分。治疗6个月时,按血清AMH、FSH的水平,将患者分为三组:A组为血清AMH、FSH水平均恢复正常;B组为血清FSH水平正常,AMH水平未正常;C组为FSH和AMH水平均未正常。停药3个月后,再次检测和记录患者的血清AMH、FSH、E2水平和Kupperman评分。结果治疗3个月时,患者血清FSH、E2水平,改良Kupperman评分和治疗前相比,差异有统计学意义(P<0.05),AMH水平和治疗前相比无明显变化(P>0.05);治疗6个月时,患者血清AMH、FSH、E2水平,改良Kupperman评分和治疗前相比,差异有统计学意义(P<0.05)。停药3个月后,A组血清FSH、E2水平,改良Kupperman评分与停药时相比,差异无统计学意义(P>0.05),B组、C组血清FSH、E2水平,改良Kupperman评分和停药时相比均有明显变化(P<0.05)。结论雌孕激素序贯治疗可有效的改善卵巢早衰患者的性激素水平和不良症状,AMH联合基础性激素FSH、E2检测评估卵巢功能恢复的情况,其准确性、敏感性优于基础性激素检测。

Objective To investigate the clinical significance in the process of hormone treatment forpremature ovarian failure of detecting serum anti-müllerian hormone combined with basic sexal hormone levels.Methods 86 patients were choosed who had been diagnosed as premature ovarian failure in our hospital ,treatedwith estrogen and progesterone sequential therapy. Total treatment for 6 months, recorded and detected the serumAMH,FSH,E2 levels and improved Kupperman scores. At the end of the course , divided the patients into three groupsaccording to the serum AMH and FSH levels group A 15 cases the serum AMH and FSH were both recovered tonormal levels; group B 29 cases the serum FSH level were normal, while serum AMH level were still unnormal ; groupC 42 cases serum AMH and FSH levels were both unnormal. 3 months after therapy , detected the serum AMH,FSH, and E2 levels , recorded advanced Kupperman scores again. Results At the 3 months of therapy , the serum levelsof FSH ,E2 and advanced Kupperman scores were significant difference compared to those before therapy （P〈0.05）,while the serum level of AMH was no significant difference compared to that of before therapy （P〉0.05）. At the6 months of therapy , the serum levels of FSH, AMH, E2 and the advanced Kupperman scores were significantdifference compared to those of before therapy （P〈0.05）. 3 months after terapy , in group A , the serum levels ofFSH,E2 and advanced scores had no obviously changed （P〉0.05） ; In group B and C,the serum levels of FSH, E2and advanced Kupperman scores were significant differences compared to those at the end of the therapy （P〈0.05）.Conclusion Estrogen and progesterone sequential therapy can efficiently improve the basic hormone levels andmenopause syndrome of POF patients . AMH combined with basic sexal hormone FSH, E2 would be more accurateand sensitive than detecting sexal hormone only when assess the ovarian reserve function recovery of POF patients.