血清抗苗勒管激素对多囊卵巢综合征临床诊断和促排卵疗效的评估价值

Value of serum anti-Mullerian hormone in clinical diagnosis of polycystic ovary syndrome and evaluation of the efficacy of ovulation induction

目的:探讨血清抗苗勒管激素(anti-Mullerian hormone,AMH)对多囊卵巢综合征(polycystic ovarian syndrome,PCOS)临床诊断和促排卵效果的评估价值。方法:选取2020年1月至2021年9月海口市妇幼保健院生殖医学中心收治的85例PCOS患者以及同期来院体检的40例健康同龄女性,分别记为PCOS组与健康组,检测两组血清AMH水平。PCOS组接受促排卵药物治疗,并依据促排卵疗效不同,分成排卵组(n=67)与无排卵组(n=18),检测两组治疗前后血清AMH水平并计算AMH下降率。分析PCOS患者血清AMH水平与促卵泡激素(follicle stimulating hormone,FSH)、黄体生成素(luteinizing hormone,LH)、雌二醇(estradiol,E_(2))和睾酮(testosterone,T)的相关性,并绘制受试者工作特征(receiver operating characteristic,ROC)曲线分析血清AMH在PCOS临床诊断和促排卵疗效中的应用价值。结果:PCOS组血清AMH和LH、T水平均高于健康组(均P<0.05),且血清AMH与LH、T呈正相关(分别r=0.692、0.516,均P<0.05)。血清AMH诊断PCOS的曲线下面积(area under curve,AUC)为0.814,最佳截断值为6.83 ng/mL,敏感度、特异度和准确度分别为84.71%、72.50%、80.80%。PCOS组促排卵治疗后血清AMH明显低于治疗前(P<0.05),排卵组治疗前后血清AMH水平均低于无排卵组,血清AMH下降率高于无排卵组(P<0.05)。血清AMH下降率评估PCOS患者促排卵疗效的AUC为0.877,明显大于血清AMH基线值的0.793(P<0.05),血清AMH下降率评估促排卵疗效的最佳截断值29.32%,敏感度、特异度和准确度分别为83.58%、83.33%、83.53%。结论:PCOS患者血清AMH表达异常升高,促排卵治疗后明显下降,血清AMH可为PCOS临床诊断和促排卵疗效评估提供重要依据。

Objective:To investigate the value of serum anti-Mullerian hormone(AMH)in the clinical diagnosis of polycystic ovary syndrome (PCOS) and evaluation of the efficacy of ovulation induction. Methods: Eighty-five patients with PCOS treated in the Reproductive Medicine Center of Haikou Maternal and Child Health Hospital from January 2020 to September 2021 and 40 healthy women of the same age who came to the hospital for physical examination in the same period were recorded as a PCOS group and a healthy group, respectively, and the serum AMH level of the 2 groups were detected. The PCOS group received ovulation induction drug treatment, and according to the different effects of ovulation induction, they were divided into an ovulation group (n=67) and an anovulation group (n=18). The serum AMH level of the 2 groups before and after the treatment was detected and the decline rate of AMH was calculated. The correlations between serum AMH level and follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E_(2)), or testosterone (T) in patients with PCOS were analyzed. Receiver operating characteristic (ROC) curve was drawn to analyze the application value of serum AMH detection in the clinical diagnosis of PCOS and the efficacy of ovulation induction. Results: The levels of serum AMH, LH, and T in the PCOS group were higher than those in the healthy group (all P<0.05), and serum AMH was positively correlated with LH and T (r=0.692, 0.516, respectively, both P<0.05). The area under curve (AUC) of serum AMH in the diagnosis of PCOS was 0.814, the best cut-off value was 6.83 ng/mL, the sensitivity, specificity, and accuracy were 84.71%, 72.50%, and 80.80%, respectively. The serum AMH level in the PCOS group was significantly lower than that before the treatment (P<0.05), the serum AMH level in the ovulation group was lower than that in anovulation group before and after the treatment, and the decline rate of serum AMH was higher than that in the anovulation group (P<0.05). The AUC of the decrease rate of serum AMH in evaluating the effect of ovulation induction in PCOS patients was 0.877, which was significantly higher than the baseline value of serum AMH (P<0.05). The best cut-off value of the decrease rate of serum AMH in evaluating the effect of ovulation induction was 29.32%, and the sensitivity, specificity, and accuracy were 83.58%, 83.33%, and 83.53%, respectively. Conclusion: The expression of serum AMH in patients with PCOS increases abnormally and decreases significantly after ovulation induction treatment. The detection of serum AMH can provide an important basis for the clinical diagnosis of PCOS and the evaluation of ovulation induction efficacy.