抗苗勒管激素及性激素评估不孕症女性卵巢储备功能的价值

The Value of Anti-Mullerian Hormone and Sex Hormone in Evaluating Ovarian Reserve Function in Infertile Women

目的:分析抗苗勒管激素(AMH)及性激素对不孕症女性卵巢储备的诊断价值及相关因素。方法:纳入2018年5月至2020年9月于福建医科大学附属福建省妇幼保健院妇四科住院的诊断为不孕症的女性43例,在月经周期第3天测定基础性激素6项,月经周期任意1日测定AMH。按卵巢功能分为卵巢储备下降(DOR)组和卵巢储备正常(NOR)组,比较两组的AMH和性激素六项水平,采用受试者操作特征曲线(ROC)比较AMH和性激素评价卵巢储备功能的预测价值,并分析AMH与相关变量的相关性。结果:DOR组AMH水平明显低于NOR组,雌二醇(E2)、睾酮(T)水平明显高于NOR组,差异具有统计学意义(P<0.05)。单项指标中E2的ROC曲线下面积(AUC)最大,截断值49.00 pg·mL^(-1),联合诊断的AUC为0.945,灵敏度为94.70%,特异度为87.50%;AMH与年龄、卵泡刺激素(FSH)呈负相关。结论:AMH具有月经稳定性,检测基本不受其他因素影响,而性激素容易受月经周期及其他反馈调节影响,临床上可用AMH及性激素联合评价不孕症女性卵巢储备功能,增加其准确性。

Objective To evaluate the diagnostic value of anti-Mullerian hormone(AMH)and sex hormone in ovarian reserve of infertile women and analyze the related factors.Methods 43 infertile women diagnosed in the Fourth Department of Gynecology,Fujian Maternal and Child Health Hospital affiliated to Fujian Medical University from May 2018 to September 2020 were included.Six basic sex hormones were measured on the third day of the menstrual cycle,and AMH was measured on any day of the menstrual cycle.According to ovarian function,they were divided into decreased ovarian reserve(DOR)group and normal ovarian reserve(NOR)group.The levels of six sex hormones and AMH were compared between the two groups.Receiver operating Characteristic Curve(ROC)was used to compare the predictive value of AMH and sex hormones in evaluating ovarian reserve function,and the correlation between AMH and related variables was analyzed.Results The level of AMH in DOR group was significantly lower than that in NOR group,and the levels of estradiol(E2)and testosterone(T)in DOR group were significantly higher than that in NOR group,with statistical significance(P<0.05).Among the single indexes,E2 had the largest area under ROC curve(AUC),with a cut-off value of 49.00 pg·mL^(-1).The AUC of combined diagnosis was 0.945,with a sensitivity of 94.70%and specificity of 87.50%.AMH was negatively correlated with age and follicle stimulating hormone(FSH).Conclusion AMH has the stability of menstruation,and the detection is basically not affected by other factors,while sex hormones are easily affected by menstrual cycle and other feedback regulation.AMH and sex hormones can be used to jointly evaluate ovarian reserve function of infertile women in clinical practice to increase its accuracy.