Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Eulji University, Daejeon, South Korea.
Menopause. 2011 Feb;18(2):138-45.
Recent studies suggest that ovarian volume and antral follicle counts (AFCs) may be useful indicators of menopause status. In this study, we examined several sonographic and endocrine markers of ovarian aging for their ability to discriminate between premenopausal and late menopausal transition (LMT) status.
A total of 40 women aged 40 to 55 years were enrolled in this cross-sectional study. Premenopausal women (n = 21) were required to have regular menstrual cycles (24 to 35 days), and women in LMT (n = 19) must have experienced 3 to 11 months of amenorrhea. Participants underwent a transvaginal ultrasound to determine ovarian volume and AFCs; provided blood for the measurement of antimüllerian hormone (AMH), follicle stimulating hormone (FSH), luteinizing hormone, and estradiol; and completed a questionnaire. The correlation between ovarian aging markers and AFCs was investigated. The area under the receiver operating characteristic curve (ROC AUC) was calculated as a measure of diagnostic accuracy.
Serum AMH levels were more strongly correlated with AFCs than were serum levels of FSH, luteinizing hormone, and estradiol. Serum levels of AMH and FSH had the highest diagnostic accuracy (ROC AUC, 0.893 and 0.890, respectively) for LMT. The inclusion of FSH to AMH in a multivariable model improved the diagnostic accuracy (ROC AUC, 0.932); however, FSH did not have a statistically significant relationship with LMT, whereas AMH tended to be significant (P = 0.017). The ROC curves for sonographic makers (AFC and ovarian volume) and AMH in determining LMT differed significantly (z = 1.76, P G 0.05; z = 1.86, P G 0.05, respectively).
AMH alone or in combination with FSH may be a useful indicator of LMT. These data suggest that sonographic markers cannot be substituted for AMH in determining LMT. However, we cannot definitively say that endocrine markers (especially AMH as a single indicator) are better than sonographic markers for determining LMT because serum AMH levels have a strong correlation with AFCs.
最近的研究表明，卵巢体积和窦卵泡计数（AFC）可能是绝经状态的有用指标。在这项研究中，我们检查了几种超声和内分泌卵巢老化标志物，以确定它们区分绝经前和晚期绝经过渡（LMT）状态的能力。
本横断面研究共纳入 40 名 40 至 55 岁的女性。要求绝经前女性（n=21）的月经周期规律（24 至 35 天），而处于 LMT 的女性（n=19）必须经历 3 至 11 个月的闭经。参与者接受阴道超声检查以确定卵巢体积和 AFC；提供血液用于测量抗缪勒管激素（AMH）、卵泡刺激素（FSH）、黄体生成素和雌二醇；并完成问卷。研究了卵巢老化标志物与 AFC 的相关性。计算了受试者工作特征曲线（ROC）下面积（AUC）作为诊断准确性的衡量标准。
血清 AMH 水平与 AFC 的相关性强于 FSH、黄体生成素和雌二醇。血清 AMH 和 FSH 对 LMT 的诊断准确性最高（AUC，分别为 0.893 和 0.890）。在多变量模型中加入 FSH 可提高 AMH 的诊断准确性（AUC，0.932）；然而，FSH 与 LMT 无统计学显著关系，而 AMH 则具有显著趋势（P=0.017）。用于确定 LMT 的超声标志物（AFC 和卵巢体积）和 AMH 的 ROC 曲线差异有统计学意义（z=1.76，P G 0.05；z=1.86，P G 0.05，分别）。
AMH 单独或与 FSH 联合使用可能是 LMT 的有用指标。这些数据表明，在确定 LMT 时，超声标志物不能替代 AMH。然而，我们不能确定地说内分泌标志物（尤其是 AMH 作为单一指标）在确定 LMT 方面优于超声标志物，因为血清 AMH 水平与 AFC 有很强的相关性。
