AMH水平与不同证型多囊卵巢综合征各临床指标的差异及相关性分析

Differences and Correlation Analysis between AMH Level and Clinical Indexes of Different Syndrome Types of Polycystic Ovary Syndrome

目的通过比较痰湿型及非痰湿型多囊卵巢综合征患者的一般临床特征、生化指标的差异及每组抗苗勒管激素(anti-Müllerian hormone,AMH)水平与临床指标间相关性,探究其典型临床特征和指标间相关性,为疾病的个性化诊疗提供依据。方法回顾2017年11月~2018年8月黑龙江中医药大学附属第一医院妇科门诊临床科研信息一体化系统中诊断为多囊卵巢综合征(polycystic ovary syndrome,PCOS)的205例患者,根据相关参考标准拟定痰湿证型中医辨证标准,将患者分为痰湿型组(134例)和非痰湿型组(71例)两组,后对统计的数据进行差异性及相关性分析。结果(1)痰湿型及非痰湿型PCOS患者一般临床特征及生化指标比较:痰湿型组患者的AMH值、腰臀比(WHR)、甲状腺球蛋白抗体(TGAB)值均高于非痰湿型组(P<0.05),痰湿型组收缩压、舒张压、体重、体重指数(BMI)、腰围、臀围、空腹血糖值(FPG)、空腹血清胰岛素值(FINS)、胰岛素抵抗指数(IR)、甘油三酯(TG)、载脂蛋白A(APOA)、载脂蛋白B(APOB)、血清游离三碘甲状腺原氨酸(FT3)、血清游离甲状腺素(FT4)值均显著高于非痰湿型组(P<0.01);非痰湿型组患者的初潮年龄、卵泡刺激素(FSH)、LH/FSH、雄烯二酮(AND)、促甲状腺激素(TSH)值均高于痰湿型组(P<0.05),非痰湿型组性激素结合蛋白(SHBG)、总胆固醇(TC)、低密度脂蛋白(LDL)、脂蛋白(a)值均显著高于痰湿组(P<0.01)。(2)痰湿型及非痰湿型PCOS患者与临床及生化指标的相关性分析:痰湿型PCOS患者AMH水平与初潮年龄、BMI、LH、LH/FSH、T、AND、FPG、FINS、LDL、IR呈正相关(P<0.05)。非痰湿型PCOS患者AMH水平与LH、LH/FSH、T、AND、SHBG、IR、FT3呈正相关(P<0.05);与FSH呈负相关(P<0.05)。结论痰湿型和非痰湿型PCOS患者在AMH水平、性激素和糖脂代谢指标方面较为明显的差异性;两组AMH的相关性方面比较差异有统计学意义,尤其在初潮年龄、BMI、FPG、FINS、LDL、SHBG、FT3、FSH方面存在不同的相关性,但与LH、LH/FSH、T、AND、IR均呈正相关。

Objective By comparing the correlation of the general clinical characteristics,biochemical indexes and anti-mullerian hormone(AMH)of polycystic ovary syndrome(PCOS) of phlegm dampness and non phlegm dampness,we explored the correlation between typical clinical characteristics and indicators to provide the basis for individualized treatment of the disease.Methods From November 2017 to August 2018,the data about clinical characteristics and biochemical indexes of gynecological outpatient patients with PCOS from Clinical Research Information Integration System of First Affiliated Hospital,Heilongjiang University of Chinese Medicine were analyzed retrospectively.All the patients were divided into two groups according to the diagnostic criteria of PCOS with syndrome of phlegm dampness.Among 205 cases of PCOS,134 cases were PCOS with syndrome of phlegm dampness,and 71 cases were non phlegm dampness.Then,the differences and correlation of statistical data between the two groups are analyzed.Results (1)Differences of PCOS of phlegm dampness and non phlegm dampness:the AMH,WHR and TGAB of phlegm dampness group are higher than those of non phlegm dampness group ( P <0.05).Systolic blood pressure,diastolic blood pressure,body weight,body mass index (BMI),waist circumference,hip circumference,fasting blood glucose (FPG),fasting serum insulin value (FINS),insulin resistance index (IR),triglyceride (TG),apolipoprotein A (APOA),apolipoprotein B (APOB),serum free triiodothyronine (FT 3),serum free thyroxine (FT 4) of phlegm dampness group are higher than those of non phlegm dampness group ( P <0.01).Menarche age,follicle stimulating hormone (FSH),LH/FSH,androstenedione (AND) and thyroid stimulating hormone (TSH) of phlegm dampness group are lower than those of non phlegm dampness group ( P <0.05).Sex hormone binding protein (SHBG),total cholesterol (TC),low density lipoprotein (LDL) and lipoprotein (a) of phlegm dampness group are lower than those of non phlegm dampness group ( P <0.01).(2)Correlation of clinical characteristics and biochemical indexes of PCOS of phlegm dampness and non phlegm dampness:The AMH of PCOS of phlegm dampness is positively correlated with menarche age,BMI,LH,LH/FSH,T,AND,FPG,FINS,LDL and IR (P <0.05).The AMH of PCOS of non phlegm dampness is positively correlated with LH,LH/FSH,T,AND,SHBG,IR and FT 3 ( P <0.05) and it is negatively correlated with FSH ( P <0.05).Conclusion There are significant differences in AMH level,sex hormones and glycolipid metabolism between phlegm dampness and non phlegm dampness of PCOS patients.There are different correlations of the AMH level with other biochemical indexes between the two groups,especially in the aspects of menarche age,BMI,FPG,FINS,LDL,SHBG,FT 3,and FSH.And there are positive correlations of the AMH level with LH,LH/FSH,T,AND and IR.