桥本甲状腺炎育龄妇女AMH与甲状腺功能指标的相关性分析

Correction between AMH levels and thyroid indicators in fertile women with Hashimoto's thyroiditis

目的探讨桥本甲状腺炎(HT)育龄妇女抗苗勒管激素(AMH)表达水平,分析AMH与甲状腺功能指标的相关性,以指导其孕期保健。方法选取2017年1月至2019年6月在绍兴市柯桥区中医医院就诊的HT育龄妇女患者156例,按甲状腺功能情况分HT甲状腺功能正常组63例、HT亚临床甲状腺功能减退组48例、HT甲状腺功能减退组45例。另择同期来院体检的健康育龄妇女53例作为健康对照组。比较各组AMH水平,并分析HT育龄妇女甲状腺功能指标与AMH水平的相关性。结果HT育龄妇女各分组与健康对照组4组间AMH水平比较差异有统计学意义(P<0.05);健康对照组与HT甲状腺功能正常组AMH水平最高,两者比较差异无统计学意义(P>0.05);其次是HT亚临床甲状腺功能减退组(均P<0.05),最低是HT甲状腺功能减退组(均P<0.05)。HT育龄妇女AMH水平与T_(3)、T_(4)、FT_(3)、FT_(4)水平呈弱正相关(分别r=0.253、0.255、0.285、0.374,均P<0.05),与TSH水平呈中等程度负相关(r=-0.493,P<0.05),与甲状腺球蛋白抗体、甲状腺过氧化物酶抗体水平呈极弱负相关(r=-0.192、-0.162,均P<0.05)。结论HT与卵巢贮备功能减退密切相关,随着疾病的发展,AMH水平不断地降低。建议在婚前或备孕前向患者宣教并进行甲状腺功能筛查和AMH检测。

Objective To investigate the correlation between anti-M llerian hormone(AMH)levels and thyroid index in fertile women with Hashimoto's thyroiditis(HT).Methods A total of 156 fertile women with HT in Shaoxing Keqiao District TCM Hospital were enrolled from January 2017 to June 2019,including 63 cases with normal thyroid function,48 cases with subclinical hypothyroidism,45 cases with hypothyroidism.In addition,53 healthy fertile women were also enrolled as controls.AMH level were compared among four groups and the correlation between AMH and thyroid indicators was analyzed.Results There were significant differences in AMH levels among 4 groups(P<0.05).The control group and normal thyroid function HT group had the highest AMH level,and there was no significant difference between the two groups(P>0.05).Followed by subclinical hypothyroidismHT group,and hypothyroidismHT group had the lowest AMH level.AMH level was positively correlated with T_(3),T_(4),FT_(3),FT_(4) levels(r=0.253,0.255,0.285,0.374,all P<0.05),negatively correlated with TSH level(r=-0.493,P<0.05),and had weak negative correlation with TPO-Ab,TG-Ab levels(r=-0.192,-0.162,P<0.05).Conclusion HT is closely related to the decreased ovarian reserve,the AMH levels are decreasing with the disease progress.It is suggested that the AMH and thyroid indicators should been tested before marriage or pregnancy for fertile women.