多囊卵巢综合征患者血清抗缪勒管激素水平与卵巢间质血流的相关性分析

Correlation analysis of serum anti-Mullerian hormone level and ovarian interstitial blood flow in patients with polycystic ovary syndrome Xu Qunyan

目的探讨多囊卵巢综合征(PCOS)患者血清抗缪勒管激素(AMH)水平与卵巢间质血流的相关性。方法回顾性选择2019年6月至2022年6月在江山市中医院治疗的88例PCOS患者(PCOS组)和同期行健康体检的50例同龄女性(健康对照组)为研究对象。其中PCOS组依据稳态模型胰岛素抵抗指数(HOMA-IR)分为两个亚组,50例HOMA-IR≥2.69者为胰岛素抵抗亚组(PCOS-IR亚组),38例HOMA-IR<2.69者为非胰岛素抵抗亚组(PCOS-NIR亚组)。以电化学发光法检测血清AMH水平,采用彩色多普勒超声仪监测卵巢间质血流指标,包括峰值血流速度(PSV)、搏动指数(PI)和阻力指数(RI)。采用Pearson相关性检验分析PCOS患者血清AMH水平与胰岛素抵抗程度、卵巢间质血流的相关性,采用Logistic线性回归模型分析影响PCOS患者卵巢间质血流的危险因素。结果PCOS组AMH、HOMA-IR、PSV水平高于正常对照组[(2.13±0.84)μg/L比(0.84±0.29)μg/L、4.6(2.0,8.4)比1.8(0.5,3.9)、(10.05±1.52)cm/s比(6.78±0.89)cm/s],PI、RI水平低于健康对照组[(1.14±0.26)%比(2.01±0.53)%、(0.37±0.18)%比(0.85±0.33)%],差异有统计学意义(P<0.05)。PCOS-IR亚组AMH、PSV、HOMA-IR水平高于PCOS-NIR亚组[(2.68±0.81)μg/L比(1.59±0.43)μg/L、(10.74±2.32)cm/s比(7.93±1.90)cm/s、7.2(3.1,15.8)比2.1(0.6,5.3)],PI、RI水平低于PCOS-NIR亚组[(0.88±0.35)%比(1.52±0.50)%、(0.29±0.04)%比(0.51±0.05)%],差异有统计学意义(P<0.05)。Pearson相关分析结果表明,PCOS患者血清AMH水平与PSV、HOMA-IR呈正相关(r=0.694、0.540,P<0.05),与PI、RI呈负相关(r=-0.687、-0.692,P<0.05)。Logistic多元线性回归分析表明,AMH、HOMA-IR是影响PCOS患者卵巢间质血流的危险因素(P<0.05)。结论PCOS患者血清AMH水平升高,并伴随胰岛素抵抗增加,同时血清AMH水平升高是PCOS患者卵巢间质血流异常增多的危险因素。

Objective To investigate the correlation between the level of anti Mullerian hormone(AMH)in serum and ovarian interstitial blood flow in patients with polycystic ovary syndrome(PCOS).Methods The clinical data of 88 patients with PCOS(PCOS group)admitted to Jiangshan Hospital of Traditional Chinese Medicine from June 2019 to June 2022 and 50 women of the same age who underwent physical examination during the same period(normal control group)were collected retrospectively.The patients in the PCOS group were divided into two subgroups according to the homeostatic model assessment for insulin resistance index(HOMA-IR)evaluated by the steady-state model.Among them,patients with HOMA-IR≥2.69 were divided into the insulin resistance subgroup(PCOS-IR subgroup,50 cases),and patients with HOMA-IR<2.69 were divided into the non-insulin resistance subgroup(PCOS-NIR subgroup,38 cases).The level of AMH were measured by electrochemiluminescence,and ovarian interstitial blood flow indicators,including peak blood flow velocity(PSV),pulsation index(PI),and resistance index(RI)were monitored.Pearson correlation test was used to analyze the correlation between serum AMH and insulin resistance and ovarian interstitial blood flow.Meanwhile,Logistic linear regression model was used to analyze the influencing factors of ovarian interstitial blood flow in patients with PCOS.Results The levels of AMH,HOMA-IR and PSV in the PCOS group were higher than those in the normal control group:(2.13±0.84)μg/L vs.(0.84±0.29)μg/L,4.6(2.0,8.4)vs.1.8(0.5,3.9),(10.05±1.52)cm/s vs.(6.78±0.89)cm/s;the PI and RI in the PCOS group were lower than those in the control group:(1.14±0.26)%vs.(2.01±0.53)%,(0.37±0.18)%vs.(0.85±0.33)%,there were statistical differences(P<0.05).The levels of AMH,HOMA-IR and PSV in the PCOS-IR subgroup were higher than those in the PCOS-NIR subgroup:(2.68±0.81)μg/L vs.(1.59±0.43)μg/L,(10.74±2.32)cm/s vs.(7.93±1.90)cm/s,7.2(3.1,15.8)vs.2.1(0.6,5.3);the PI and RI in the PCOS-IR subgroup were lower than those in the PCOS-NIR subgroup:(0.88±0.35)%vs.(1.52±0.50)%,(0.29±0.04)%vs.(0.51±0.05)%,there were statistical differences(P<0.05).Pearson correlation analysis showed that the level of AMH were positively correlated with PSV and HOMA-IR(r=0.694 and 0.540,P<0.05),but negatively correlated with PI and RI(r=-0.687 and-0.692,P<0.05).Logistic linear regression model analysis showed that AMH and HOMA-IR were risk factors for ovarian interstitial blood flow in patients with PCOS(P<0.05).Conclusions The serum AMH level in patients with PCOS is abnormally high and increases with insulin resistance.At the same time,the imbalance of AMH expression plays an important role in the increase of abnormal ovarian interstitial blood flow.