腹腔镜下卵巢子宫内膜异位囊肿术后卵巢储备功能评价中抗苗勒氏管激素的应用价值

Application value of anti-Müllerian hormone in the evaluation of ovarian reserve function after laparoscopic endometriosis cyst.

目的探讨抗苗勒氏管激素(AMH)在内膜异位囊肿患者术后卵巢储备功能评价中的临床应用价值。方法选取深圳市妇幼保健院2017年1月至2019年11月期间收治的80例子宫内膜异位囊肿患者进行回顾性研究,所有患者均接受腹腔镜下异位囊肿切除手术。分别于术前、术后1个月及术后6个月测定患者的卵泡刺激素(FSH)、促黄体生成素(LH)、雌二醇(E2)及血清AMH水平,比较手术前后不同时段及单双侧囊肿患者的AMH及基础内分泌激素水平。结果术后1个月,患者的AMH和E2水平较手术前明显降低,而FSH和LH水平较手术前明显升高,差异均有统计学意义(P<0.05);术后6个月,患者的AMH水平较术后1个月明显上升,但仍低于手术前水平,FSH、LH水平较术后1个月明显下降,差异均有统计学意义(P<0.05);患者的E2水平较术后1个月明显上升,差异有统计学意义(P<0.05),但与手术前水平差异无统计学意义(P>0.05);术后1个月,单侧囊肿和双侧囊肿患者的AMH水平明显低于术前水平,差异有统计学意义(P<0.05);术后6个月,单侧囊肿患者的AMH水平明显高于术后1个月水平,差异有统计学意义(P<0.05),但与术前AMH水平比较差异无统计学意义(P>0.05);双侧囊肿患者的AMH水平较术后1个月明显升高,但仍明显低于术前的AMH水平,差异有统计学意义(P<0.05);双侧囊肿患者术后6个月的AMH水平明显低于单侧囊肿患者,差异有统计学意义(P<0.05)。结论腹腔镜下卵巢子宫内膜异位囊肿切除手术会在一定程度上损害患者的卵巢储备功能,同时双侧囊肿患者较单侧囊肿患者受影响更大,手术给患者卵巢储备能力带来的损害越大。血清AMH较常规基础内分泌激素指标具有更好的敏感性,在异位囊肿患者术后的卵巢储备功能评价中具有较好的应用价值。

Objective To investigate the clinical application value of anti-Müllerian hormone(AMH)in the evaluation of postoperative ovarian reserve function in patients with endometriotic cysts.Methods A retrospective study of 80 patients with endometriotic cysts admitted to Shenzhen Maternal and Child Health Hospital from January 2017 to November 2019 was performed,and all patients underwent laparoscopic ectopic cystectomy.The levels of follicle stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E2),and serum AMH were measured before surgery,1 month after surgery,and 6 months after surgery,and the changes of AMH and basal endocrine hormone levels in patients at different periods before and after surgery and under unilateral and bilateral cysts were compared.Results At one month after operation,the AMH and E2 levels of the patients were significantly lower than before operation(P<0.05),while the FSH and LH levels of the patients were significantly higher than before operation(P<0.05).At 6 months after the operation,the AMH level of the patients increased significantly compared with that one month after the operation,but it was still lower than the level before operation,and the difference was statistically significant(P<0.05);the FSH and LH levels of the patients decreased significantly compared with at one month after the operation(P<0.05),but there was no significant difference from the level before the operation(P>0.05);the E2 level of the patient was significantly higher than at one month after the operation(P<0.05),but there was no significant difference from the level before the operation(P>0.05).One month after operation,the AMH level of patients with unilateral cysts was significantly lower than that before surgery(P<0.05),and the AMH level of patients with bilateral cysts was significantly lower than that before surgery(P<0.05).At 6 months after surgery,the AMH level of patients with unilateral cysts was significantly higher than that at 1 month after surgery(P<0.05),and there was no significant difference from the preoperative AMH level(P>0.05);the AMH level of patients with bilateral cysts was significantly higher than that at 1 month after operation(P<0.05),but significantly lower than the preoperative AMH level(P<0.05).The AMH level of patients with bilateral cysts at 6 months after operation was significantly lower than that of patients with unilateral cysts(P<0.05).Conclusion Laparoscopic resection of endometriotic cyst can damage the ovarian reserve capacity of patients to a certain extent.At the same time,patients with bilateral cysts are more affected than those with unilateral cysts,and the more severe the cysts,the greater the damage to the patients'ovarian reserve capacity.Serum AMH has better sensitivity than conventional basic endocrine hormone indicators,and has good application value in the evaluation of ovarian reserve function in patients with heterotopic cysts.