抗苗勒管激素与多囊卵巢综合征患者各临床特征的相关性

Correlation analysis of antimullerian hormone and clinical characteristics of polycystic ovary syndrome

目的检测多囊卵巢综合征(PCOS)患者血清抗苗勒管激素(AMH)、性激素及代谢指标水平,分析AMH与PCOS各临床特征的相关性,并分析各临床特征对AMH的交互作用。方法选取2016年8月—2017年10月在广东省生殖医院和东莞市桥头医院门诊就诊的152例PCOS患者为观察组,另选取同期在该院检查月经规律且有正常生育史的女性35例为对照组。收集调查对象基本信息,测量所有参与者的身高、体质量,阴道B超下双侧卵巢窦卵泡计数,空腹抽血检查AMH、血糖、空腹胰岛素(FINS)、卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E_(2))及睾酮(T)等指标水平。分析两组研究对象血清AMH浓度和内分泌指标特点,分析AMH与两组研究对象各临床特征的相关性,分析高雄激素血症(HA)、胰岛素抵抗(IR)及BMI等单独或多因素对AMH的交互作用。结果两组研究对象BMI、LH、LH/FSH、T、HOMA-IR、AMH、FINS及FPG水平比较[观察组(23.13±3.72)kg/m^(2)、(7.83±4.53)mIU/ml、(1.73±1.82)、(2.40±1.42)nmol/L、(3.92±2.24)、(9.21±4.77)ng/ml、(15.13±7.59)μIU/ml及(5.66±1.26)mmol/L,对照组(21.31±3.08)kg/m2、(4.50±1.88)mIU/ml、(0.93±0.42)、(1.47±0.87)nmol/L、(1.71±0.48)、(5.44±3.01)ng/ml、(7.57±2.25)μIU/ml及(5.11±0.62)mmol/L],差异均有统计学意义(t=-2.757、-6.904、-4.887、-5.061、-10.540、-10.296、-10.419及-3.753,均P<0.05);两组研究对象年龄、FSH、E2及PRL水平比较,差异均无统计学意义(均P>0.05)。在观察组中,AMH与T和HOMA-IR均呈正相关关系(r=0.276、0.342,均P<0.05);AMH与BMI无相关性(r=0.095,P>0.05)。在对照组中,AMH与T和BMI均呈正相关关系(r=0.792、0.441均P<0.05);AMH与HOMA-IR无相关性(r=0.047,P>0.05)。在观察组中,HA组与非HA组AMH水平比较,差异无统计学意义(P>0.05);IR组与非IR组AMH水平比较,差异有统计学意义(P<0.05);超重组与非超重组AMH水平比较,差异无统计学意义(P>0.05)。采用三因素方差分析HA、IR及肥胖对AMH水平的影响,结果显示,HA、IR及肥胖对AMH水平的影响不存在三因素交互作用[F(1,138)=0.041,P>0.05]。两因素交互作用结果显示,HA、IR对AMH水平的影响存在两因素交互作用[F(1,138)=4.136,P<0.05];HA、肥胖对AMH水平的影响不存在两因素交互作用[F(1,138)=1.308,P>0.05];IR、肥胖对AMH水平的影响不存在两因素交互作用[F(1,138)=0.052,P>0.05]。单独效应分析显示,在无HA的PCOS人群中,是否有IR患者的AMH水平比较,差异无统计学意义(P>0.05);在有HA的PCOS人群中,伴有IR患者的AMH水平显著高于无IR患者,差异有统计学意义(P<0.05)。结论在PCOS人群和正常人群中,血清AMH与不同的临床特征相关,AMH升高的病理生理基础是HA,而IR可协同促进HA作用。

Objective To detect the serum levels of antimullerian hormone(AMH),sex hormone and metabolic indexes in patients with polycystic ovary syndrome(PCOS),analyze the correlation and its interaction between clinical characteristics of PCOS and AMH.Methods A total of 152 PCOS patients treated in the outpatient department of Guangdong Reproductive Hospital and Dongguan Qiaotou Hospital from August 2016 to October 2017 were selected as the observation group.In addition,35 women with regular menstruation and normal fertility history were selected as the control group.Basic information was collected,include height,body mass,bilateral ovarian sinus follicle count under vaginal B-ultrasound,AMH,blood glucose,fasting insulin(FINS),follicle stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E_(2))and testosterone(T).The characteristics of serum AMH concentration and endocrine indexes in the two groups were analyzed.The correlation between AMH and clinical characteristics of the two groups was analyzed.The interaction of hyperandrogenemia(HA),insulin resistance(IR),BMI and other single or muliple factors on AMH was analyzed.Results There were statistically significant differences between the case group and the control group in BMI,LH,LH/FSH,T,HOMA-IR,AMH,FINS and FPG Lthe index ofcasegroup respectively were(23.13±3.772)kg/m^(2),(7.83±4.53)mlU/ml,(1.73±1.82),(2.40±1.42)nmol/L,(3.92±2.24),(9.21±4.77)ng/ml,(15.13±7.59)μIU/ml,(5.66±1.26)mmol/L;the index of control group respectively were(21.31±3.08)kg/m²,(4.50±1.88)mlU/ml,(0.93±0.42),(1.47±0.87)nmol/L,(1.71±0.48),(5.44±3.01)ng/ml,(7.57±2.25)μIU/ml,(5.11±0.62)mmol/L;t=-2.757,,-6.904,-4.887,-5.061,-10.54,-10.296,-10.419,-3.753,all P<0.05].The differences in age,FSH,E2,PRL were not statistically significant(all P>0.05).In the case group,the AMH value was positively correlated with T and HOMA-IR(r=0.276,0.342,all P<0.05);but not correlated with BMI(r=0.095,P>0.05).In the control group,AMH was positively correlated with T and BMI(r=0.792,0.441,all P<0.05).There was no correlation between AMH and HOMA-IR(r=0.047,P>0.05).In the observation group,there was no statistical significance in AMH level between HA group and non-HA group(P>0.05).The AMH level between IR group and non-IR group was statistically significant(P<0.05).There was no significant difference in AMH level between superrecombinant and non-superrecombinant(P>0.05).The effects of HA,IR and obesity on AMH levels were analyzed by three-factor variance,and the results showed that there was no interaction of three factors on the effects of HA,IR and obesity on AMH levels[F(1,138)=0.041,P>0.05].The results of interaction between the two factors showed that there was interaction between HA and IR on AMH level[F(1,138)=4.136,P<0.05].There was no interaction between HA and obesity on AMH level[F(1,138)=1.308,P>0.05].There was no interaction between IR and obesity on AMH level[F(1,138)=0.052,P>0.05].Single effect analysis showed that in PCOS without HA,there was no statistical significance in AMH level in IR patients(P>0.05).In PCOS with HA,AMH level in patients with IR was significantly higher than that in patients without IR,and the difference was statistically significant(P<0.05).Conclusion In PCOS and normal populations,serum AMH was associated with different clinical characteristics;the pathophysiological basis of elevated AMH was HA;and IR can synergistically promote the role of HA.