促性腺激素释放激素激动剂对激素受体阴性年轻乳腺癌辅助化疗患者卵巢功能的影响及抗苗勒氏管激素检测的价值

Effect of GnRH Agonist on Ovarian Function of Young Patients with Hormone Receptor Negative Breast Cancer Treated with Adjuvant Chemotherapy and Detective Value of Anti-Mullerian Hormone

目的观察促性腺激素释放激素(GnRH)激动剂对激素受体(HR)阴性年轻乳腺癌辅助化疗患者卵巢功能的影响,并探讨抗苗勒氏管激素(AMH)对卵巢功能的评价作用。方法选择HR阴性需辅助化疗的绝经前年轻乳腺癌患者60例,随机分为戈舍瑞林联合化疗组、化疗组,每组各30例,观察2组停经情况、化疗结束后1 a月经恢复率,同时选择同年龄健康女性30例作为对照组,于治疗前、治疗结束时、治疗结束1a监测雌二醇(E2)、促卵泡激素(FSH)、AMH水平。结果戈舍瑞林联合化疗组30例患者有29例闭经,化疗组21例患者闭经,差异有统计学意义(P <0. 05)。戈舍瑞林联合化疗组、化疗组1 a月经恢复率分别为96. 6%、66. 7%,差异有统计学意义(P <0. 05)。戈舍瑞林联合化疗组、化疗组和对照组E2、FSH、AMH水平治疗前比较差异均无统计学意义(P均>0. 05)。戈舍瑞林联合化疗组、化疗组治疗结束时E2、FSH高于对照组,AMH低于对照组,差异均有统计学意义(P均<0. 05)。未闭经HR阴性年轻乳腺癌患者E2、FSH高于对照组,但差异均无统计学意义(P均> 0. 05);而AMH低于对照组,差异有统计学意义(P <0. 05)。戈舍瑞林联合化疗组、化疗组治疗结束1 a后E2、FSH水平与对照组比较差异均无统计学意义(P均> 0. 05);而AMH仍低于对照组,差异有统计学意义(P <0. 05)。治疗结束1 a后2组E2、FSH水平比较差异均无统计学意义(P均>0. 05);戈舍瑞林联合化疗组AMH高于化疗组,差异有统计学意义(P <0. 05)。结论GnRH激动剂对HR阴性年轻乳腺癌辅助化疗患者卵巢功能具有保护作用,AMH对化疗后卵巢储备功能的评价可能优于E2、FSH。

Objective To observe the effect of gonadotropin-releasing hormone( GnRH) agonist on ovarian function of young patients with hormone receptor( HR) negative breast cancer treated with adjuvant chemotherapy and to explore the effect of anti-mullerian hormone( AMH) on ovarian function. Methods Sixty young premenopausal patients with HR negative breast cancer needed assisted chemotherapy were selected and randomly divided into the goserelin combined with chemotherapy group and the chemotherapy group,30 patients in each group. Then,the menopause time and menstruation recovery rate after chemotherapy between the two groups were compared. Also,30 healthy even-aged women were selected as the control group. The level of estradiol( E2),follicle stimulating hormone( FSH) and AMH were monitored before treatment,at the end of chemotherapy and in one year later after chemotherapy,respectively. Results There were 29 cases of amenorrhea patients in the goserelin combined with chemotherapy group and 21 cases of amenorrhea patients in the chemotherapy group,and the differences were statistically significant( P < 0. 05). One year later after chemotherapy,the menstruation recovery rate were 96. 6% and66. 7% in the goserelin combined with chemotherapy group and the chemotherapy group,respectively,the differences were statistically significant( P < 0. 05). For the goserelin combined with chemotherapy group,the chemotherapy group groups and the control group,there was no significant difference in the levels of E2,FSH and AMH before treatment( P > 0. 05). At the end of treatment,the E2 and FSH levels in the goserelin combined with chemotherapy group and the chemotherapy group were significantly more than those in the control group,the AMH levels were less than that in the control group,and the differences were statistically significant( P < 0. 05). The E2 and FSH levels of patients without amenorrhea were more than those in the control group,but there was no statistical difference( P < 0. 05);instead,the AMH was less than that in the control group,the difference had the statistical significance( P < 0. 05). One year later after chemotherapy,the E2 and FSH levels in the goserelin combined with chemotherapy group and the chemotherapy group were still more than that in the control group,but the differences was not statistically significant( P > 0. 05). However,the level of AMH was lass than that in the control group( P <0. 05). There were no significant differences in the E2 and FSH levels between the two groups( P > 0. 05).The AMH level in the goserelin combined with chemotherapy group was more than that in the chemotherapy group,and the difference was statistically significant( P < 0. 05). Conclusion GnRH agonists have protective effects on ovarian function of young patients with HR negative breast cancer treated with adjuvant chemotherapy. AMH may be superior to E2 and FSH in evaluating ovarian reserve function after chemotherapy.