子宫内膜异位症病人卵巢储备功能与维生素D的关系研究

Relationship between circulating anti-mullerian hormone status and the level of serum vitamin D in women with endometriosis

目的探究子宫内膜异位症病人血清维生素D(VD)及抗苗勒管激素(AMH)水平变化及其相关性。方法选取2019年9—11月苏州市立医院收治的卵巢良性肿瘤病人109例,入院时测定血清VD及AMH水平,根据术后病理,其中49例卵巢子宫内膜异位症为巧囊组,其他类型卵巢肿瘤60例为对照组,对比两组VD及AMH水平并分析其相关性。使用随机数字表法将巧囊组分为VD组和安慰剂组,分别于VD及安慰剂治疗前和治疗3个月后检测两组血清VD和AMH水平。结果巧囊组病人AMH水平(3.39±0.34)μg/L低于对照组(3.61±0.43)μg/L,巧囊组病人和对照组相比,VD水平偏低(12.90±1.14)μg/L比(13.74±1.39)μg/L(P<0.05)。巧囊组病人血清VD与AMH存在弱的正相关性(Pearson’s r=0.345,P=0.015);而对照组病人两者无相关性(Pearson’s r=0.087,P=0.646)。VD组和安慰剂组术后3 d血清AMH下降比率(%)分别为19.43和20.47。VD组在治疗3月后血清AMH值明显高于安慰剂组(P=0.029)。VD组和安慰剂组术后3月血清AMH恢复比率分别为30.26%和23.98%。结论卵巢子宫内膜异位症相对其他良性卵巢肿瘤病人,血清VD及AMH水平较低,且两者存在弱相关性。卵巢子宫内膜异位症术后使用VD治疗,AMH恢复较快。VD有潜力作为一种辅助疗法改善卵巢子宫内膜异位症卵巢储备功能。

Objective To evaluate the level and relationship of serum vitamin D(VD)and anti-Mullerian hormone(AMH)levels in patients with endometriosis.Methods One hundred and nine patients with benign ovarian cysts who admitted to Suzhou Municipal Hospital from September to November 2019 were selected.Serum VD and AMH levels were measured upon admission.According to postoperative pathology,49 patients with endometriotic cysts were selected as endometriosis group,60 patients with other benign cysts were selected as control group.The levels of VD and AMH between the two groups were compared and their correlations were analyzed.The endometriosis group was randomly divided into VD group and placebo group by using simple random sampling.Serum VD and AMH levels were detected before placebo treatment and after treatment of three months.Results The serum AMH level in endometriosis group(3.39±0.34)μg/L was significantly lower than that in the control group(3.61±0.43)μg/L,P<0.05.The level of VD in endometriosis group was lower than that in control group(12.90±1.14)μg/L vs.(13.74±1.39)μg/L,P<0.05.There was a weak correlation between VD and AMH in endometriosis group by global analysis(Pearson’s r=0.345,P=0.015),while there was no correlation in control group(Pearson’s r=0.087,P=0.646).The reduction rate of serum AMH(%)in the VD group and the placebo group was 19.43 and 20.47,respectively,at 3 days after operation.After three months of VD treatment,serum AMH levels in VD group were significantly higher than those in placebo group(P=0.029).The recovery rate of serum AMH in VD group and placebo group was 30.26 and 23.98,respectively,at 3 days after operation.The serum AMH level in VD group recovered to 30.26%after 3 months,while that in placebo group was only 23.98%.Conclusions Compared with control group,endometriosis patients has lower serum VD and AMH levels,and there is a weak correlation between VD and AMH.The AMH level of endometriosis patients recovers quickly after the treatment of VD.VD has the potential as an adjuvant therapy to improve ovarian reserve in ovarian endometriosis.