抗苗勒氏管激素评价腹腔镜内膜异位囊肿术后卵巢储备功能

Anti Mullerian hormone in evaluating ovarian reserve function after laparoscopic endometriosis cysts surgery

目的探索抗苗勒氏管激素(AMH)评价腹腔镜内膜异位囊肿术后卵巢储备功能影响的临床应用。方法选择2017年5月至2018年8月行腹腔镜手术治疗的内膜异位囊肿患者73例作为研究对象,分别于术前、术后1个月、术后6个月,放射免疫法测定抗苗勒氏管激素(AMH)、卵泡刺激素(FSH)、黄体生成素(LH)、FSH/LH、雌二醇(E2)。单、双侧卵巢内膜异位囊肿的AMH手术前后对比、不同内膜异位囊肿直径患者的AMH手术前后比较。结果 (1)术后1个月,血清FSH、LH、E2水平和FSH/LH高于术前和术后6个月(P<0.05),但术后6个月与术前比较无统计学差异(P>0.05)。术前、术后1个月、术后6个月,AMH水平呈逐渐降低的趋势,差异有统计学意义(P<0.01)。(2)术前及术后1个月,单、双侧卵巢内膜异位囊肿患者和内膜异位囊肿直径≥4 cm、<4 cm患者的AMH水平比较差异无统计学意义(P>0.05)。术后6个月,单侧内膜异位囊肿患者AMH水平高于双侧内膜异位囊肿者,内膜异位囊肿直径≥4 cm的患者显著低于内膜异位囊肿直径<4 cm者,差异有统计学意义(P<0.05,P<0.01)。结论腹腔镜内膜异位囊肿手术可以导致卵巢储备功能下降。血清AMH较其他性激素更能敏感地反映卵巢储备功能,可以作为评价腹腔镜内膜异位囊肿术后卵巢储备功能的参考指标。

Objective To study clinical application of anti Mullerian hormone(AMH) in evaluating ovarian reserve function after laparoscopic endometriosis cysts surgery.Methods A total of 73 patients with endometriotic cyst treated by laparoscopic surgery from May 2017 to August 2018 were selected as the subjects,in whom the levels of AMH,follicle stimulating hormone(FSH),luteinizing hormone(LH),FSH/LH ratio and estrogen(E2) were measured by radioimmunoassay before operation,1 and 6 months after operation.Comparison of AMH was made in patients with single and bilateral ovarian endometriosis cyst and with different diameter of endometriosis cyst before and after operation.Results At one month after operation,the levels of serum FSH,LH,E2 and FSH/LH were statistically higher than those before and 6 months after operation(all P<0.05),but there were no significant differences in them between pre-operation and postoperative 6-month(all P>0.05).From preoperative,postoperative one month to six months after operation,the level of AMH decreased gradually with statistical difference(P<0.01).Before and 1 month after operation,there were no significant differences in AMH between patients with single or bilateral ovarian endometriosis cyst and those with endometriosis cyst diameter ≥ 4 cm or<4 cm.At six months after operation,AMH level in patients with single endometriosis cysts was significantly higher than that in patients with bilateral endometriosis cysts,and it in patients with endometriosis cyst diameter more than 4 cm was significantly lower than that in patients with endometriosis cysts diameter less than 4 cm(P<0.05,P<0.01).Conclusion Laparoscopic endometriosis cysts surgery can lead to decreased ovarian reserve function after operation.AMH is more sensitive than other sex hormones in reflecting ovarian reserve function and can be used as a reference index to evaluate ovarian reserve function after laparoscopic endometriosis cysts.