抗米勒管激素和相关临床因素间关系的初步探索

Preliminary exploration of the relationship between the serum anti-Müllerian hormone and the related clinical factors

目的初步探索健康女性血清抗米勒管激素(AMH)值与相关临床因素间的关系,建立并验证健康女性年龄和血清AMH值的相关方程。方法回顾性分析苏州大学附属第二医院核医学科2015年3月至2016年12月间602例检测血清AMH值且临床资料相对齐全的女性受试者资料,分为健康组(484名,20~52岁)和病例组(118例,20~42岁;月经失调者)。采用Spearman秩相关分析健康组雌二醇(E2)、睾酮(T)、卵泡刺激素(FSH)、促黄体生成素(LH)、体质指数(BMI)与AMH值间的关系;采用Kruskal-Wallis秩和检验分析孕产史对血清AMH值的影响。以健康组AMH数据为基础,建立AMH值预测方程。纳入检测AMH值的健康女性对方程进行内部(27名)和外部(37名)验证(符号秩检验)。另通过两独立样本t检验分析病例组与相应年龄健康组AMH值间的差异。结果健康组女性血清AMH值与E2和T呈正相关(rs值:0.263和0.334,均P<0.001),与FSH、LH和BMI呈负相关(rs值:-0.515~-0.110,均P<0.05)。建立的健康女性AMH值预测方程为:LogAMH=-1.208+0.1×年龄-0.000042×年龄3(R^(2)=0.735,P<0.001)。内、外部验证示血清AMH实测值与预测值间的差异无统计学意义(z值:-1.62和-1.52,均P>0.05)。将病例组(118例)和相应年龄段健康组(446名)分别分为<35岁及≥35岁亚组,在2个年龄亚组中,病例组血清AMH值均更低(t值:18.64和11.70,均P<0.001)。结论健康女性中,血清AMH值仅与部分临床因素有关。建立的血清AMH值和年龄间的适用方程有望为临床诊疗提供参考依据。

Objective To explore the relationship between serum anti-Müllerian hormone(AMH)level and related clinical factors in healthy females,and establish and validate equation of correlation between age and serum AMH level for healthy females.Methods From March 2015 to December 2016,a total of 602 females who measured serum AMH level in Department of Nuclear Medicine,the Second Affiliated Hospital of Soochow University were retrospectively enrolled.All cases had relatively complete clinical data,and were divided into healthy group(484 cases,20-52 years)and case group(118 cases,20-42 years;patients with menstrual disorders).Relationships between serum AMH level and estradiol(E2),tesosterone(T),follicle stimulating hormone(FSH),luetinizing hormone(LH),body mass index(BMI)of healthy group were analyzed by Spearman rank correlation.Kruskal-Wallis rank sum test was used to analyze the relationship between history of gestation and serum AMH level.Serum AMH level of health group was processed to establish predictive equation for serum AMH level.Internal(n=27)and external(n=37)validation group were chosen from healthy females with serum AMH level measured to validate the equation,and signed rank test was used to analyze the data.Difference between serum AMH level in case group and healthy group with corresponding age was explored by independent-sample t test.Results Serum AMH levels were positively correlated with E2 and T(rs values:0.263,0.334,both P<0.001),and negatively correlated with FSH,LH,BMI(rs values:from-0.515 to-0.110,all P<0.005).Predictive equation was established as LogAMH=-1.208+0.1×age-0.000042×age3(R^(2)=0.735,P<0.001).No statistically significant difference was found between real serum AMH levels and calculated serum AMH levels in the internal and external validation groups(z values:-1.62 and-1.52,both P>0.05).Females in case group(n=118)and control group(n=446)were divided into two sub-groups respectively(<35 years and≥35 years),and serum AMH levels of case group were lower than those of control group with corresponding age(t values:18.64,11.70,both P<0.001).Conclusions In healthy females,serum AMH level is related to some clinical data.The equation between serum AMH level and age established in the study may provide reference for clinical diagnosis and treatment.