Mulders Annemarie G M G J, Laven Joop S E, Eijkemans Marinus J C, de Jong Frank H, Themmen Axel P N, Fauser Bart C J M
Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Erasmus MC, Rotterdam, The Netherlands.
Hum Reprod. 2004 Sep;19(9):2036-42. doi: 10.1093/humrep/deh373. Epub 2004 Jun 24.
Anti-Müllerian hormone (AMH), produced by growing pre-antral and early antral ovarian follicles, has been shown to be a useful marker for ovarian ageing. Serum AMH concentrations are elevated during reproductive life in anovulatory women, especially in those patients exhibiting polycystic ovaries (PCO). The current study was designed to investigate whether the decrease in AMH serum concentrations over time is different comparing women with normogonadotrophic anovulation [World Health Organization (WHO) group 2 (including polycystic ovary syndrome (PCOS)] and normo-ovulatory controls.
AMH serum levels were assessed on two occasions in 98 patients suffering from WHO 2 anovulatory infertility as well as in 41 normo-ovulatory premenopausal women. Median time interval between both visits was 2.6 years (range 0.3-9.0) for WHO 2 patients compared with 1.6 years (range 1.0-7.3) in controls. Serum AMH concentrations were significantly (P < 0.0001) elevated on both occasions in WHO 2 patients (AMH1, median = 7.5 microg/l, range 0.1-35.8; and AMH2, median = 6.7 microg/l, range 0.0-30.6) compared with controls (AMH1, median = 2.1 microg/l, range 0.1-7.4; and AMH2, median = 1.3 microg/l, range 0.0-5.0). Regression analysis, corrected for age, indicated a significant relative decrease in serum AMH concentrations over time for both groups (P < 0.001). However, the decline in serum AMH in WHO 2 patients was significantly less compared with controls (P = 0.03).
The present longitudinal study shows that serum AMH concentrations decrease over time both in women presenting with WHO 2 anovulatory infertility and in normo-ovulatory controls. The decrease in WHO 2 patients is less pronounced despite distinctly elevated concentrations. This observation may suggest retarded ovarian ageing and hence a sustained reproductive life span in these patients.
抗苗勒管激素（AMH）由生长中的窦前卵泡和早期窦卵泡产生，已被证明是卵巢衰老的一个有用标志物。无排卵女性在生殖期血清AMH浓度升高，尤其是那些表现为多囊卵巢（PCO）的患者。本研究旨在调查与正常促性腺激素性无排卵女性[世界卫生组织（WHO）2组（包括多囊卵巢综合征（PCOS））]和正常排卵对照组相比，随时间推移血清AMH浓度的下降是否存在差异。
对98例WHO 2型无排卵性不孕症患者和41例正常排卵的绝经前女性进行了两次血清AMH水平评估。WHO 2组患者两次就诊的中位时间间隔为2.6年（范围0.3 - 9.0年），而对照组为1.6年（范围1.0 - 7.3年）。WHO 2组患者两次血清AMH浓度均显著升高（P < 0.0001）（AMH1，中位数 = 7.5μg/L，范围0.1 - 35.8；AMH2，中位数 = 6.7μg/L，范围0.0 - 30.6），而对照组（AMH1，中位数 = 2.1μg/L，范围0.1 - 7.4；AMH2，中位数 = 1.3μg/L，范围0.0 - 5.0）。校正年龄后的回归分析表明，两组血清AMH浓度均随时间显著相对下降（P < 0.001）。然而，WHO 2组患者血清AMH的下降显著低于对照组（P = 0.03）。
本纵向研究表明，WHO 2型无排卵性不孕症女性和正常排卵对照组的血清AMH浓度均随时间下降。尽管WHO 2组患者的浓度明显升高，但其下降不太明显。这一观察结果可能提示这些患者的卵巢衰老延迟，从而延长了生殖寿命。
