Clinical Value of Serum Anti-Mullerian Hormone and Inhibin B in Prediction of Ovarian Response in Patients with Polycystic Ovary Syndrome

The present study aimed to investigate the clinical value of serum anti-mullerian hormone（AMH） and inhibin B（INHB） in predicting the ovarian response of patients with polycystic ovary syndrome（PCOS）. A total of 120 PCOS patients were enrolled and divided into three groups in terms of the ovarian response： a low-response group（n=36）, a normal-response group（n=44）, and a high-response group（n=40）. The serum AMH and INHB levels were measured by enzyme-linked immunosorbent assay（ELISA）. The follicle stimulating hormone（FSH）, luteinizing hormone（LH）, and estradiol（E2） levels were determined by chemiluminescence microparticle immunoassay. The correlation of the serum AMH and INHB levels with other indicators was analyzed. A receiver operating characteristic（ROC） curve was established to analyze the prediction of ovarian response by AMH and INHB. The results showed that there were significant differences in age, body mass index（BMI）, FSH, total gonadotropin-releasing hormone（Gn RH）, LH, E2, and antral follicle counts（AFCs） between the groups（P〈0.05）. The serum AMH and INHB levels were increased significantly with the ovarian response of PCOS patients increasing（P〈0.05）. The serum AMH and INHB levels were negatively correlated with the age, BMI, FSH level, Gn, and E2 levels（P〈0.05）. They were positively correlated with the LH levels and AFCs（P〈0.05）. ROC curve analysis of serum AMH and INHB in prediction of a low ovarian response showed that the area under the ROC curve（AUC） value of the serum AMH level was 0.817, with a cut-off value of 1.29 ng/m L. The sensitivity and specificity were 71.2% and 79.6%, respectively. The AUC value of serum INHB was 0.674, with a cut-off value of 38.65 ng/m L, and the sensitivity and specificity were 50.7% and 74.5%, respectively. ROC curve analysis showed when the serum AMH and INHB levels were used to predict a high ovarian response, the AUC value of the serum AMH level was 0.742, with a cut-off value of 2.84 ng/m L, and the sensitivity and specificity were 72.7% and 65.9%, respectively; the AUC value of the serum INHB level was 0.551 with a cut-off of 45.76 ng/m L, and the sensitivity and specificity were 76.3% and 40.2%, respectively. It was suggested the serum AMH and INHB levels have high clinical value in predicting the ovarian response of PCOS patients.

Anti-Mullerian Hormone and Follicle Counts as Predictors of Superovulatory Response and Embryo Production in Beef Cattle

This study evaluated Anti-Mullerian hormone (AMH) and/or follicle counts as predictors of subsequent superovulatory response and embryo production in 79 beef cows. Before superovulation, 3 to 5 mm follicles presented on the ovaries of donor cows were counted, and blood was collected for measure of serum AMH. Across cows, serum AMH ranged from 0.013 to 0.898 ng/mL, with a mean of 0.293 ng/mL. The distribution of both AMH concentrations and follicle counts were divided into quartiles (AMH Q1 through Q4, with Q1 the lowest and Q4 the highest) for analysis. Donor cows in AMH Q4 had a greater (P < 0.001) number of 3 to 5 mm follicles at the start of superovulation than did donors in either Q1 or Q2. At embryo collection, cows in AMH Q3 and 4 had more (P < 0.001) palpable corpora lutea (CL) than cows in AMH Q1. The mean number of embryos recovered from donor cows in AMH Q4 was greater (P < 0.001) than those recovered from cows in either AMH Q1 or 2, but similar to that of AMH Q3. Analysis indicated that AMH was positively correlated (P < 0.001) with mean follicles (r = 0.458), CL (r = 0.452) and embryos recovered (r = 0.430). Donor cows with higher follicle counts (F Q3 and 4) at the start of superovulation had more (P < 0.001) palpable CL at embryo collection than donor cows in F Q1 or 2. More (P < 0.001) embryos were recovered from cows with the highest follicle counts (F Q4) as compared with cows having lower (F Q1 and 2) follicle counts. Results confirm that relative AMH concentration was positively correlated with number of small antral follicles in the ovaries of cows;both AMH measure and antral follicle counts might be used to predict subsequent superovulatory response in beef cows.

Use of Anti-Mullerian Hormone (AMH) for Testing of Ovarian Reserve: A Survey of Fifteen (15) Fertility Centres in Ghana

Anti-Mullerian Hormone (AMH) is a dimeric glycoprotein with a molecular weight of 140 kD, encoded by a gene on the short arm of chromosome and a member of the transforming growth factor-beta (TGF-β) superfamily. The expression of AMH is markedly different in males and females, both in concentration and temporality. In males, Sertoli cells maintain a high concentration of AMH in utero which peaks shortly after birth and then drops precipitously at puberty. In females, granulosa cells produce very low levels of AMH in utero followed by a transient spike in the neonatal period. Concentrations of the hormone then rise steadily through adolescence to a peak in the mid-twenties and subsequently decline until becoming undetectable in menopause. The study aimed to understand how Clinicians and Clinical Embryologists used anti-mullerian hormone (AMH) test to assess ovarian reserve, direct patient selection and treatment regimens and guide in vitro fertilization (IVF) cycle management in all registered fertility hospitals in a West African country, Ghana. A web-based survey (questionnaire) using google forms was performed to solicit responses from all IVF hospitals that are registered with the Fertility Society of Ghana (FERSOG). This questionnaire consisted of fifteen (15) broader questions, ten (10) of which assessed the clinics’ use of AMH. Responses were screened for quality to verify that only one (1) survey was completed by each IVF centre. The study was conducted during May and June 2020 at the In Vitro Fertilization (IVF) Department of the Airport Women’s Hospital (AWH) in Accra, Ghana. Results are reported as the proportion of IVF cycles represented by a particular answer choice. Survey responses were completed from 15 IVF centres, representing 2504 IVF cycles performed annually. A good majority (73.3%) [1835 IVF cycles] of the respondent IVF hospitals reported to use AMH as a first line test and 93.3% reported it as the best test for evaluating ovarian reserve. Another 66.7% reported that AMH results were extremely relevant to clinical practice. However, in contrast, for predicting live birth rate, 60% reported age as the best predictor in their practice. Overall, our results indicate that AMH is considered a first line test for assessing ovarian reserve and is relevant to the clinical practice of majority of Assisted Reproductive Technologies (ART) providers in Ghana.

Expression of anti-Mullerian hormone receptor on the appendix testis in connection with urological disorders

The female internal sex organs develop from the paramesonephric （Mullerian） duct. In male embryos, the regression of the Mullerian duct is caused by the anti-Mullerian hormone （AMH）, which plays an important role in the process of testicular descent. The physiological remnant of the Mullerian duct in males is the appendix testis （AT）. In our previous study, we presented evidence for the decreased incidence of AT in cryptorchidism with intraoperative surgery. In this report, the expression of the anti-Mullerian hormone receptor type 2 （AMHR2）, the specific receptor of AMH, on the AT was investigated in connection with different urological disorders, such as hernia inguinalis, torsion of AT, cysta epididymis, varicocele, hydrocele testis and various forms of undescended testis. The correlation between the age of the patients and the expression of the AMHR2 was also examined. Reverse transcriptase-polymerase chain reaction （RT-PCR） and immunohistochemistry were used to detect the receptor＇s mRNA and protein levels, respectively. We demonstrate that AMHR2 is expressed in the ATs. Additionally, the presence of this receptor was proven at the mRNA and protein levels. The expression pattern of the receptor correlated with neither the examined urological disorders nor the age of the patients; therefore, the function of the AT remains obscure.

Relationship of Anti-Mullerian Hormone to Reproductive Traits in Katahdin Ewes Bred in Late Spring or Fall

Anti-Mullerian hormone (AMH) is an endocrine marker for fertility in many species. This study investigated possible correlations between serum AMH concentrations, mean number of lambs born (out-of-season in spring or fall), and estimated breeding values (EBVs) for number of lambs born (NLB), number of lambs weaned (NLW), maternal weaning weight (MWWT), weaning weight (WWT), and maternal index (determined by Sheep Genetics Australia). Blood was collected at breeding from Katahdin ewes between 0.7 and 7 years of age in 2015 (n = 163) for the analysis of serum concentrations of AMH. Anti-Mullerian hormone concentration was either expressed quantitatively or divided into quartiles (AMH Q1 through Q4, with Q1 the lowest and Q4 the highest, pg/ml). Data were analyzed by PROC CORR, GLM or chi-squared using SAS. Mean serum AMH was 182 ± 11 pg/ml and ranged from 0 to 1112 pg/ml. There was no correlation between serum AMH and EBVs for NLB, NLW, MWWT, WWT and the maternal index. Serum AMH concentration was similar in ewes in different age categories (P = 0.157). There was a correlation between EBV for NLB (0.29;P = 0.0002) and NLW (0.19;P = 0.013) with average number of lambs born. Ewes in the lowest AMH quartile (Q1) had a lower mean number of offspring born from spring breeding compared with ewes in other AMH quartiles (Q2, Q3, and Q4;P < 0.05). Further study is needed to determine the effectiveness of using serum AMH for selecting ewes for out-of-season (spring) breeding.

Anti-Mullerian Hormone: Establishing the Ovarian Reserve Range with Age in Rivers State Women, Niger Delta Region of Nigeria

Background: The measurement of circulating anti-Mullerian hormone (AMH) in the plasma of adult women has been used as a tool in the assessment of ovarian reserve. This is based on its ability to reflect the number of growing follicles in the ovaries and knowing the level of AMH in a woman’s blood is generally a good indicator of her ovarian reserve and this can be achieved by making reference to a decision values. Objective: The purpose of this study was to measure the level of this hormone in normal, apparently healthy subjects in Rivers State, Nigeria with respect to age. The percentage of women, at their reproductive age with infertility problems in the state is in the increase and the essence was to establish a reference range for the hormone because of its clinical application in women fertility. Materials/method: A total of one thousand and sixty two apparently healthy women divided into four age groups were recruited for this study;this comprised of 300 each in age group of 20 - 30, 31 - 40, 41 - 50 respectively and 162 in 51 - 60 years age group from May 2014 to June 2017. They were randomly selected after filling a questionnaire form that has the information of age, tribe, last date of menses and whether on medication for any infertility problems. Excluded from the study were subjects identified with different endocrine dysfunction and/or on drugs for different types of anovulatory dysfunction. The Enzyme linked Immunoassay method was used in the measurement of the AMH. Results: The result from the measurement of plasma AMH levels showed a Mean ± SD value of 3.193 ± 0.943, 1.644 ± 0.691, 0.516 ± 0.276 and 0.135 ± 0.081 ng/ml respectively for the 1st, 2nd, 3rd and 4th age groups respectively. The mean value for the AMH decreases with increasing age and was statistically significant at the different age group levels (P &minus;2.250 - 4.136;0.953 - 2.350;0.240 - 0.792 and 0.054 - 0.216 respectively for the age groups. This study summarizes the findings concerning AMH and its role as a marker for the quantitative aspect of ovarian reserve, ovarian aging, as well as ovarian dysfunction in this region of the country.

Clinical efficacy of anti-Mullerian hormone inspection in supporting diagnosis for climacteric disorders

The diagnosis of climacteric disorders in gynecology is performed on the basis of symptoms rather than hormonal levels. Generally, the follicle-stimulating hormone (FSH) level increases when the 17β-estradiol (E2) level decreases in menopause. However, the problem of these hormones should be determined by strict timing of sampling, and there are individual specificities of decreases of hormone levels. We considered that anti-Mullerian hormone (AMH) can be measured at any time of the menstrual cycle and that it shows ovary functional decline earlier than FSH/E2, and we examined whether AMH would possibly become a good index for climacteric disorders. The subjects were 163 healthy females and 21 patients with climacteric disorders between 20 and 59 years old. We examined AMH, FSH and E2 at the same time. It is understood that in healthy females, AMH decreases with age and a decline in ovary function occurs at a relatively early age. Patients visiting clinics for climacteric disorders often have normal-range serum FSH/E2 levels, and it is clear that these values could not serve as indices of menopause at these inspections. Upon measurement of AMH in patients with climacteric disorders, most showed less than normal range (< 14 pmol/L), suggesting a decline in ovarian function. In addition, AMH was low in females with climacteric disorders compared with those without them. In conclusion, AMH was suggested as an objective index for climacteric disorders and possibly as a new diagnostic marker.

The Effect of Uterine Artery Occlusion with Tourniquet on Ovarian Reserve during Open Myomectomy at a University Teaching Hospital in Southern Nigeria

Background: The most common surgical treatment for symptomatic uterine fibroids, particularly in women with fertility concerns, is open myomectomy. Given the high vascularity of the uterus, haemorrhage during the procedure is a serious risk that is often mitigated with a uterine tourniquet. Aim and Objectives: To evaluate the effect of uterine artery occlusion with a tourniquet during open myomectomy on ovarian reserve using serial anti-Mullerian hormone (AMH) measurements. Materials and Methods: This was a prospective longitudinal study with a quasi-experimental design and a convenient sampling technique. The study enrolled 47 women who had abdominal myomectomy between September 1, 2021, and March 31, 2022, at the University of Port Harcourt Teaching Hospital. Blood samples were collected before anaesthesia was administered in theatre, on day two, and three months after open abdominal myomectomy for anti-Mullerian hormone assay. The data was collected using a semi-structured proforma, entered into an Excel spreadsheet, and analyzed using SPSS version 25.0 with a 95% confidence interval. Statistical significance level was set at 0.05. Results: The pre-surgery AMH mean value was 1.67 ± 1.44 ng/ml, while the values after using a uterine tourniquet at myomectomy on the second day and three months later were 1.22 ± 1.24 ng/ml and 1.59 ± 1.43 ng/ml, respectively. There was no statistically significant change in AMH levels, and there was no statistically significant relationship between blood loss and tourniquet time and AMH after open abdominal myomectomy. Conclusion: The use of a uterine tourniquet and blood loss during open myomectomy has no effect on ovarian reserve.

早发性卵巢功能不全患者外周血Tfh占比、功能相关细胞因子表达变化及其与性激素水平的相关性

目的观察早发性卵巢功能不全(POI)患者外周血滤泡辅助性T细胞(Tfh)占比、功能相关细胞因子表达变化,并分析其与性激素水平的相关性。方法POI患者29例(观察组),同期健康体检者31例(对照组),采用流式细胞术检测全血Tfh占比,免疫印迹实验检测外周血单个核细胞(PBMC)CXCR5、BCL-6蛋白,酶联免疫吸附法检测血清IL-6、IL-21,电化学发光法检测血清促卵泡刺激素(FSH)、促黄体生成素(LH)、泌乳素、孕酮、睾酮、雌二醇(E_(2))、抗缪勒管激素(AMH)水平,Spearman相关分析法分析Tfh、CXCR5蛋白、BCL-6蛋白、IL-6、IL-21与性激素的相关性。结果与对照组比较,观察组全血Tfh占比增加,血清IL-6、IL-21水平升高,PBMC CXCR5、BCL-6蛋白表达升高,血清FSH、LH水平升高,血清E_(2)、AMH水平降低,P均<0.05。全血Tfh占比与血清FSH、LH水平呈正相关(r分别为0.75、0.63,P均<0.05),与血清E_(2)、AMH水平呈负相关(r分别为-0.35、-0.82,P均<0.05);血清IL-6水平与血清FSH、LH水平呈正相关(r分别为0.75、0.62,P均<0.05),与血清E_(2)、AMH水平呈负相关(r分别为-0.47、-0.77,P均<0.05);血清IL-12水平与血清FSH、LH水平呈正相关(r分别为0.68、0.56,P均<0.05),与血清E_(2)、AMH水平呈负相关(r分别为-0.25、-0.73,P均<0.05);PBMC BCL-6蛋白表达与血清FSH、LH水平呈正相关(r分别为0.73、0.60,P均<0.05),与血清E_(2)、AMH水平呈负相关(r分别为-0.27、-0.76,P均<0.05);PBMC CXCR5蛋白表达与血清FSH、LH水平呈正相关(r分别为0.72、0.58,P均<0.05),与血清E_(2)、AMH水平呈负相关(r分别为-0.27、-0.70,P均<0.05)。结论POI患者全血Tfh占比增加,PBMC CXCR5、BCL-6蛋白表达升高,血清IL-6、IL-21、FSH、LH水平升高及E_(2)、AMH水平降低,Tfh及其相关因子与性激素呈正相关或负相关,Tfh及其相关因子可能参与了POI发生过程。

基于卵巢颗粒细胞功能探讨调周法治疗卵巢储备功能减退的临床研究

目的:基于卵巢颗粒细胞功能探讨中医药调周法对卵巢储备功能减退(diminished ovarian reserve,DOR)患者体内抗穆勒氏管激素(anti-mullerian hormone,AMH)水平的影响及临床疗效。方法:对60例DOR肾虚证患者给予中医药调周法治疗,观察治疗前后患者血清性激素各项水平[AMH、雌二醇(estradiol,E_(2))、黄体生成素(luteinizing hormone,LH)、卵泡刺激素(follicle stimulating hormone,FSH)]和临床疗效。结果:治疗前后E_(2)、LH、FSH水平比较差异无统计学意义(P>0.05);治疗后AMH水平较治疗前升高(P<0.05),中医证候积分较治疗前减少(P<0.05),总有效率为86.7%(52/60);治疗期间均无明显不良反应。结论:中药调周法通过提高AMH、FSH水平来提升DOR肾虚证患者卵巢储备功能,调整月经周期,增加月经量,改善临床症状。

Regulation of anti-Mullerian hormone(AMH)in males and the associations of serum AMH with the disorders of male fertility

Anti-Mullerian hormone(AMH)is a functional marker of fetal Sertoli cells.The germ cell number in adults depends on the number of Sertoli cells produced duri ng peri natal development.Rece ntly,AMH has received increasi ng attenti on in research of disorders related to male fertility.This paper reviews and summarizes the articles on the regulation of AMH in males and the serum levels of AMH in male fertility-related disorders.We have determined that follicle-stimulating hormone(FSH)promotes AMH transcription in the absenee of androgen signaling.Testosterone inhibits the transcriptional activation of AMH.The undetectable levels of serum AMH and testosterone levels indicate a lack of functional testicular tissue,for example,that in patients with anorchia or severe Klinefelter syndrome suffering from impaired spermatogenesis.The normal serum testosterone level and undetectable AMH are highly suggestive of persistent Mullerian duct syndrome(PMDS),combined with clinical manifestations.The levels of both AMH and testosterone are always subnormal in patients with mixed disorders of sex development(DSD).Mixed DSD is an early-onset complete type of disorder with fetal hypogonadism resulting from the dysfunction of both Leydig and Sertoli cells.Serum AMH levels are varying in patients with male fertility-related disorders,in cludi ng pubertal delay,severe con genital hypog on adotropic hypogonadism,nonobstructive azoospermia,Klinefelter syndrome,varicocele,McCune-Albright syndrome,and male senescence.

血清AMH、Hcy水平诊断PCOS价值及与不孕治疗结局关系

目的:分析血清抗缪勒氏管激素(AMH)和同型半胱氨酸(Hcy)水平诊断多囊卵巢综合征(PCOS)价值及与不孕治疗结局关系。方法:选择北京市垂杨柳医院和内蒙古自治区人民医院2021年9月-2022年3月收治的81例PCOS和卵巢功能减退(DOR)不孕患者临床资料,其中PCOS 42例为PCOS组,DOR 39例为DOR组,选择健康体检女性40例为对照组;比较3组血清AMH和Hcy水平,采用logistics回归模型分析2指标联合应用诊断PCOS模型,采用Spearman相关性检验分析AMH和Hcy水平与PCOS患者不孕治疗1年后结局关系。结果:PCOS组、DOR组、对照组血清AMH和Hcy水平存在差异,其中PCOS组AMH和Hcy水平最高(P<0.05);采用logistics回归模型构建的PCOS诊断模型为Log(P)=0.675×AMH+0.701×Hcy+0.644(P<0.05);AMH和Hcy联合应用诊断PCOS的曲线下面积(0.970)高于AMH(0.850)、Hcy(0.895)单独应用(P<0.05);PCOS组随访1年,妊娠患者血清AMH(12.03±1.21 ng/ml)和Hcy(11.79±1.31μmol/L)水平均低于未妊娠患者(15.12±2.31 ng/ml、14.11±1.89μmol/L),且二者水平均与PCOS患者不孕妊娠结局呈正相关(均P<0.05)。结论:血清AMH和Hcy水平联合联合检测有效诊断PCOS,且两指标与PCOS患者治疗不孕结局呈正相关。

超声检查SA/TA及卵巢间质血流动力学指标联合AMH在多囊卵巢综合征诊疗中的应用分析

目的:研究超声检查卵巢间质面积/卵巢总面积比(SA/TA)及卵巢间质血流动力学指标联合抗苗勒管激素(AMH)在多囊卵巢综合征(PCOS)诊疗中的应用。方法:选取本院2020年8月至2022年1月临床诊断的PCOS患者50例作为PCOS组,单纯多囊性卵巢(PCO)患者50例作为PCO组,以及正常女性50例作为对照组。对所有受试者均开展超声检查,对比三组SA/TA及卵巢间质血流动力学指标水平,血清AMH及生化指标水平,以Pearson相关性分析明确各项指标相关性。通过受试者工作特征曲线(ROC)分析明确SA/TA及卵巢间质血流动力学指标水平与实验室生化指标的相关性。结果:PCOS组及PCO组SA/TA、PSV、EDV水平均高于对照组,PCOS组上述指标水平均高于PCO组;PCOS组及PCO组PI、RI均低于对照组,且PCOS组PI、RI均低于PCO组(均P<0.05)。PCOS组、PCO组FPG、TG、FINS以及血清AMH水平均高于对照组,且PCOS组高于PCO组(均P<0.05)。经Pearson相关性分析发现:SA/TA、PSV、EDV水平与FPG、TG、FINS、血清AMH水平均呈正相关,而PI、RI与FPG、TG、FINS、血清AMH水平均呈负相关(均P<0.05)。经ROC曲线分析发现,SA/TA及卵巢间质血流动力学指标与血清AMH水平联合诊断PCOS的效能优于上述指标单独检测(均P<0.05)。结论:超声检查SA/TA及卵巢间质血流动力学指标联合AMH在PCOS诊疗中的应用效果较好。

血清CTRP9、AMH对多囊卵巢综合征患者IVF-ET助孕结局的预测价值

目的探讨行体外受精-胚胎移植(in vitro fertilization and embryo transfer,IVF-ET)助孕的多囊卵巢综合征(polycystic ovary syndrome,PCOS)患者血清中补体C1q/肿瘤坏死因子相关蛋白9(complement C1q/tumour necrosis factor-related protein 9,CTRP9)、抗苗勒管激素(anti-mullerian hormone,AMH)对治疗结果的预测价值。方法选取2022年3月—2023年7月于重庆医科大学附属第一医院生殖中心行IVF-ET的85例PCOS患者。根据妊娠结局分为临床妊娠组43例与临床未妊娠组42例。记录2组患者的一般资料,测定血清CTRP9和AMH水平,分析其与妊娠结局的关系。结果临床未妊娠组血清CTRP9为(290.19±58.97)ng/mL,AMH为3.39(2.09,5.42)ng/mL,均低于临床妊娠组的(413.63±89.56)ng/mL、7.42(5.45,9.90)ng/mL(P<0.05)。血清CTRP9、AMH水平、优胚数是PCOS患者IVF-ET妊娠成功的保护因素(P<0.05)。血清CTRP9预测行IVF-ET的PCOS患者妊娠成功的敏感度与特异度为74.40%和90.50%,曲线下面积(area under the curve,AUC)值为0.836;血清AMH预测敏感度与特异度为83.70%和73.80%,AUC值为0.859;血清CTRP9和AMH联合预测的敏感度和特异度分别为88.40%和92.90%,AUC值为0.924,高于单独使用CTRP9或AMH预测的价值。结论血清CTRP9、AMH与PCOS患者IVF-ET治疗结局密切相关,且与单一指标检测比较,两者联合检测可提高预测价值。

上皮性卵巢癌患者肿瘤细胞减灭术术后复发的影响因素

目的 探讨术前新辅助化疗联合肿瘤细胞减灭术(CRS)治疗卵巢癌患者术后1年内复发的影响因素。方法 选取行CRS治疗的卵巢癌患者90例作为研究对象。化疗结束后随访1年,以是否复发将卵巢癌患者分为复发组(n=54)和无复发组(n=36)。比较2组的一般资料(年龄、分期等)、术式(开腹、腹腔镜等)等情况,然后利用多元回归分析来对上皮性卵巢癌患者CRS化疗结束后随访1年复发的独立危险因素进行分析,并以相关危险因素建立卵巢癌CRS治疗预后的预测模型。结果 术前,复发组高分期患者占比高于未复发组,差异有统计学意义(P<0.05)。未复发组患者清扫淋巴结比例高于复发组,差异有统计学意义(P<0.05)。复发组的血清糖类抗原125(CA125)、人附睾蛋白4(HE4)、癌胚抗原(CEA)及抗缪勒氏管激素(AMH)水平均高于无复发组,差异有统计学意义(P<0.05)。多元回归分析结果显示,年龄、术前分期、清扫淋巴结及术前血清CA125、HE4、CEA、AMH均为上皮性卵巢癌患者CRS术后1年复发的影响因素(因果关系)或关联影响因素(果因关系)(P<0.05)。上皮性卵巢癌患者CRS术后1年内复发的预测价值分析结果显示,术前血清CA125、HE4、CEA和AMH单独及联合预测的曲线下面积(AUC,95%CI)分别为0.740(0.516~0.937)、0.730(0.467~0.990)、0.731(0.477~0.977)、0.743(0.515~0.967)和0.884(0.829~0.924)。结论 上皮性卵巢癌患者在术前新辅助化疗时,应对血清CA125、HE4、CEA和AMH水平进行监测。术前血清CA125、HE4、CEA、AMH联合预测的AUC高于上述指标单独预测,构建预估风险模型可以提高对上皮性卵巢癌患者CRS术后1年内复发的预测价值。

MRI联合血清AMH、AFP水平在剖宫产术后早期子宫瘢痕妊娠诊断中的临床价值分析

目的 探讨核磁共振(MRI)联合血清抗苗勒管激素(AMH)、甲胎蛋白(AFP)对剖宫产术后早期子宫瘢痕妊娠(CSP)的诊断价值。方法 选取2020年2月-2022年3月期间本院收治的疑似CSP患者133例为研究对象。收集其基本资料(年龄、距上次剖宫产时间、停经天数、剖宫产史等),所有CSP患者均接受MRI检查。酶联免疫吸附法(ELISA)测定血清AMH、 AFP水平;受试者工作特征(ROC)曲线分析血清AMH、AFP水平对CSP的诊断效能;采用Kappa检验分析MRI单独及联合血清AMH、AFP诊断CSP与金标准病理结果的一致性;采用四线格分析并比较MRI、血清AMH、AFP单独及联合对CSP的诊断效能。结果本研究经MRI确诊81例CSP孕妇,52例非CSP孕妇。以手术病理诊断结果作为参考,MRI诊断CSP的灵敏度为78.72%,特异度为82.05%。CSP组血清AMH水平显著低于非CS P组,AF P水平显著高于非CSP组(P<0.05);血清AMH、AFP诊断CSP的AUC分别为0.785、0.824,特异度分别为84.62%、87.18%,灵敏度分别为76.60%、78.72%。MRI、血清AM H、血清AFP单独诊断CS P的Kappa值为0.554、0.547、0.592,三者联合诊断CSP的Kappa值最高,为0.746(P<0.05)。MRI联合血清AMH、AFP诊断CSP的灵敏度及阴性预测值明显高于MRI、血清AMH、AFP单独诊断,准确度明显高于MRI、血清AMH单独诊断(P<0.05)。结论 CSP患者血清AMH低表达,血清AFP高表达,MRI联合血清AMH、AFP对早期CSP进行综合诊断弥补了单一MRI诊断的不足,具有较高临床应用价值。

经阴道超声血流参数联合血清抗苗勒管激素对多囊卵巢综合征不孕症体外受精-胚胎移植妊娠失败的预测价值

目的探讨经阴道超声血流参数联合血清抗苗勒管激素(AMH)对多囊卵巢综合征(PCOS)不孕症体外受精-胚胎移植(IVF-ET)妊娠失败的预测价值。方法选取行IVF-ET的173例PCOS不孕症患者为研究对象,其中脱落12例。根据胚胎移植后第28天阴道B超结果将161例患者分为妊娠失败组(n=96)与妊娠成功组(n=65)。比较2组阻力指数(RI)、搏动指数(PI)、收缩与舒张末期最大血流速度比值(S/D)和血清AMH水平。采用多因素Logistic回归分析法分析PCOS不孕症IVF-ET妊娠失败的影响因素。绘制受试者工作特征(ROC)曲线,分析RI、PI、S/D、血清AMH水平单独及联合评估对PCOS不孕症患者IVF-ET妊娠失败的预测价值。结果妊娠失败组血清AMH水平低于妊娠成功组,血流RI、PI、S/D高于妊娠成功组,差异有统计学意义(P<0.001)。RI(OR=4.688,95%CI:2.878~6.498)、PI(OR=4.332,95%CI:2.277~6.387)、S/D(OR=3.773,95%CI:1.856~5.691)、月经第3天黄体生成素(LH)/促卵泡生成素(FSH)值(OR=2.998,95%CI:1.236~4.760)高是PCOS不孕症IVF-ET妊娠失败的危险因素(P<0.05);月经第3天FSH水平高(OR=0.579,95%CI:0.416~0.806)、血清AMH水平高(OR=0.722,95%CI:0.533~0.911)及人绒毛膜促性腺激素(hCG)日子宫内膜厚(OR=0.632,95%CI:0.421~0.843)是PCOS不孕症IVF-ET妊娠失败的保护因素(P<0.05)。RI、PI、S/D联合血清AMH水平预测PCOS不孕症IVF-ET妊娠失败的灵敏度、特异度、曲线下面积(AUC)分别为95.83%、80.00%、0.933。结论超声血流参数联合AMH对PCOS不孕症IVF-ET妊娠失败具有较好的预测价值。

Clinical Applications of Serum Anti-Mullerian Hormone€Measurements in Both Males and Females:An Update

Infertility is one of the most common non-communicable diseases,affecting both men and women equally.Ovarian reserve,the number of primordial follicles in the ovaries is believed to be the most important determinants for female fertility.Anti-Mullerian hormone(AMH)secreted from granulosa cells of growing follicles is recognized as the most important biomarker for ovarian reserve.Ovarian reserve models have been developed using AMH and other hormonal indicators,thus childbearing plans and reproductive choices could be arranged by women.In assisted reproductive technology cycles,measurement of AMH helps to predict ovarian response and guide recombinant follicle-stimulating hormone dosing in women.Serum AMH level is increasingly being recognized as a potential surrogate marker for polycystic ovarian morphology,one of the criteria for diagnosis of polycystic ovarian syndrome.AMH is also secreted by Sertoli cells of testes in men,and AMH measurements in the prediction of surgical sperm recovery rate in men have also been investigated.AMH levels are significantly higher in boys than in girls before puberty.Therefore,serum levels of AMH in combination with testosterone is used for the differential diagnosis of disorders of sex development,anorchia,non-obstructive azoospermia,and persistent Mullerian duct syndrome.Recently,serum AMH measurements have also been used in fertility preservation programs in oncofertility,screening for granulosa cell tumors,and prediction of menopause applications.In this review,we will focus on clinical application of AMH in fertility assessments for healthy men and women,as well as for cancer patients.

保留输卵管系膜的输卵管切除术对卵巢储备功能的影响

目的探讨保留输卵管系膜的输卵管切除术对卵巢储备功能的影响。方法收集2020年1月—2021年3月收治的输卵管疾病患者281例为研究对象,按照治疗方式的不同分为传统双侧切除组(n=53,行传统双侧输卵管切除术)、传统单侧切除组(n=56,行传统单侧输卵管切除术)、保留双侧切除组(n=60,行保留输卵管系膜的双侧输卵管切除术)、保留单侧切除组(n=54,行保留输卵管系膜的单侧输卵管切除术)、对照组[n=58,无输卵管切除术史的体外受精-胚胎移植(IVF-ET)患者]。比较各组患者手术时间、术中出血量和术后排气时间。患者术后2个月行IVF-ET并检测卵泡数量、卵子数量、妊娠率和受精率。IVF-ET后检测患者外周血抗苗勒氏管激素(AMH)、促卵泡生成素(FSH)、雌二醇(E_(2))、黄体生成素(LH)水平。随访至2023年3月,记录5组患者妊娠成功率。结果传统双侧切除组、传统单侧切除组、保留双侧切除组、保留单侧切除组患者围术期手术时间、术中出血量和术后排气时间比较,差异无统计学意义(P>0.05)。行IVF-ET后,5组患者AMH、FSH、E_(2)和LH水平比较,差异有统计学意义(P<0.05),AMH和E_(2)水平由低到高为传统双侧切除组、传统单侧切除组、保留双侧切除组、保留单侧切除组、对照组,FSH和LH水平由高到低为传统双侧切除组、传统单侧切除组、保留双侧切除组、保留单侧切除组、对照组。随访至2023年3月,传统双侧切除组、传统单侧切除组、保留双侧切除组、保留单侧切除组和对照组妊娠成功率分别为45.28%、50.00%、53.33%、59.26%、58.62%,5组患者行IVF-ET后妊娠成功率比较,差异无统计学意义(χ^(2)=3.044,P=0.551)。结论与传统的输卵管切除术比较,保留输卵管系膜的输卵管切除术对卵巢储备功能影响较小。

抗缪勒氏管激素与性激素水平在卵巢储备功能评估中的价值

目的分析在卵巢储备功能中抗缪勒氏管激素(Anti-mullerian Hormone,AMH)与性激素水平的评估价值。方法选取2022年3—8月宜兴市中医医院收治的100例妇科患者为研究对象,依据卵巢储备功能的不同将患者分成3组,甲组33例(卵巢储备功能正常),乙组33例(卵巢储备功能减退),丙组34例(卵巢储备功能早衰),检测所有患者AMH、卵泡刺激素(Follicle Stimulating Hormone,FSH)、黄体生成素(Luteinizing Hormone,LH)及雌二醇(Estradiol,E2)指标水平。对比3组患者上述指标检测水平、AMH分别和FSH、LH、E2联合检测的预估值。结果甲组AMH、E2高于乙组、丙组,FSH、LH低于乙组、丙组,差异有统计学意义(P均<0.05)。乙组AMH、E2高于丙组,FSH、LH低于丙组,差异有统计学意义(P均<0.05)。对乙组和丙组患者进行检测,AMH的血浆浓度时间曲线下面积(Area Under the Curve,AUC)、灵敏度、特异度大于FSH、LH、E2;AMH+FSH、AMH+LH、AMH+E2的AUC、灵敏度、特异度分别大于FSH、LH、E2。结论AMH与性激素指标可以作为临床评估卵巢储备功能参考指标,联合检测后预估价值更高。