抗米勒管激素水平与多囊卵巢综合征患者代谢指标的相关性分析

Correlation between Anti-Mullerian Hormone(AMH)Level and Metabolic Indexes in Patients with Polycystic Ovary Syndrome

目的:研究抗米勒管激素(AMH)水平与多囊卵巢综合征(PCOS)患者一般临床特征、性激素及内分泌代谢指标的相关关系,评估AMH与PCOS严重程度的相关性。方法:选取2018年3月至2019年3月黑龙江中医药大学附属第一医院门诊收治的符合鹿特丹诊断标准的PCOS患者279例作为研究对象进行回顾性分析。分析AMH与PCOS患者一般临床特征、性激素代谢、糖脂代谢、中医证型及甲状腺功能的相关性。比较不同AMH水平下各组间临床指标的差异性。结果:相关性分析显示,AMH与体质量指数(BMI)、腰臀比(WHR)、空腹血糖(FBG)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)及游离三碘甲状腺原氨酸(FT3)负相关,差异有统计学意义(P<0.01),与黄体生成素(LH)、LH/促卵泡激素(FSH)、睾酮(T)、雄烯二酮(AND)、性激素结合球蛋白(SHBG)正相关,差异有统计学意义(P<0.01),与年龄、身高、FSH、孕酮(P)、餐后2 h血糖(2 h PBG)、三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白(LDL)等无相关性,差异无统计学意义(P>0.05);不同中医证型的比较结果显示,痰湿型PCOS患者的AMH水平显著低于非痰湿型患者,差异有统计学意义(P<0.01);组间比较结果显示,较高AMH水平下,BMI、WHR、LH、LH/FSH、AND、HOMA-IR及FT3比较,差异有统计学意义(P<0.01)。结论:AMH与PCOS患者严重程度具有明显相关性,其中伴有较高水平AMH的PCOS患者更易合并高雄激素血症,中医辨证更倾向于非痰湿型;伴有较低AMH水平的PCOS患者糖脂代谢指标更差,更易合并IR及MS,中医上更易辨证为痰湿型。

Objective:To study the correlation between anti-Müllerian hormone(AMH)levels and the general clinical characteristics,sex hormones and endocrine metabolism indexes of patients with polycystic ovary syndrome(PCOS),and to evaluate the correlation between AMH and PCOS severity.Methods:A total of 279 POS patients whol met Rotterdam diagnostic criteria were selected from the Outpatient Department of First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine from March 2018 to March 2019.We analyzed the correlation between AMH and PCOS patients′general clinical characteristics,sex hormone metabolism,glucose and lipid metabolism,TCM syndrome type and thyroid function.The differences of clinical indicators between the groups under different AMH levels were compared.Results:Correlation analysis showed that AMH and body mass index(BMI),waist-to-hip ratio(WHR),fasting blood glucose(FBG),fasting insulin(FINS),insulin resistance index(HOMA-IR)and free triiodothyronine(FT3)were negatively correlated,and the difference was statistically significant(P<0.01).Luteinizing hormone(LH),LH/follicle growth hormone(FSH),testosterone(T),androstenedione(AND),sex hormones Globulin(SHBG)was positively correlated,and the difference was statistically significant(P<0.01),which was related to age,height,FSH,progesterone(P),2 h postprandial blood glucose(2 h PBG),triacylglycerol(TG).There is no correlation between total cholesterol(TC)and low-density lipoprotein(LDL),and the difference was not statistically significant(P>0.05);the comparison of different TCM syndrome types showed that the AMH level of patients with phlegm-damp PCOS was significantly lower than patients with non phlegm-dampness type,the difference was statistically significant(P<0.01);the comparison between groups showed that compared with AMH at higher level,The difference was statistically significant in AMH levels,BMI,WHR,LH,LH/FSH,AND,HOMA-IR and FT3.Conclusion:There was a significant association between AMH and severity of PCOS,PCOS with higher AMH levels are more likely to merge hyperandrogenism,more inclined to non-phlegm-dampness pattern;Those with lower AMH levels have worse glucose and lipid metabolism indexes,and are more likely to combine with IR and MS,more apt to phlegm-dampness pattern.