抗苗勒管激素在接受枸橼酸氯米酚治疗的多囊卵巢综合征患者中的预测价值：一项前瞻性观察性研究。

The predictive value of circulating anti-Müllerian hormone in women with polycystic ovarian syndrome receiving clomiphene citrate: a prospective observational study.

机构信息

MSc, MD, MRCOG, AssociateUniversity of Nottingham, Department of Obstetrics and Gynaecology, Royal Derby Hospital, Uttoxeter Road, Derby, Derbyshire DE23 3XW, United Kingdom.

出版信息

J Clin Endocrinol Metab. 2013 Oct;98(10):4170-5. doi: 10.1210/jc.2013-2193. Epub 2013 Aug 26.

DOI:10.1210/jc.2013-2193

PMID:23979947

Abstract

CONTEXT

Elevated serum anti-Müllerian hormone (AMH) concentration in women with polycystic ovarian syndrome (PCOS) is known to lower sensitivity of ovarian follicles to circulating FSH. This effect may compromise the outcome of clomiphene citrate (CC) ovulation induction.

OBJECTIVE

The objective of the study was to investigate the impact of high circulating AMH on the outcome of CC ovulation induction in women with PCOS.

DESIGN

This was a prospective cohort observational study.

SETTING

The study was conducted at the Fertility Unit, Derby, United Kingdom.

PATIENTS

Sixty anovulatory women with PCOS participated in the study.

INTERVENTIONS

Serum AMH concentrations were measured on cycle day 2 during 187 CC cycles. These concentrations were compared between responders and nonresponders. The receiver-operating characteristic curve was used to evaluate the prognostic value of circulating AMH. The success rates of CC were compared between patients with high vs low AMH levels. The dose of CC required to achieve ovulation was correlated with serum AMH concentrations.

MAIN OUTCOME MEASURES

Ovulation and pregnancy rates were measured.

RESULTS

Serum AMH concentrations were significantly (P < .001) lower in responders (achieving ovulation) vs nonresponders (mean ± SEM, 2.5 ± 0.1 vs 5.8 ± 0.7 ng/mL, respectively). Similarly, serum AMH concentrations were significantly (P = .046) lower in pregnant (3.0 ± 0.4 ng/mL) vs nonpregnant patients (4.4 ± 0.5 ng/mL). There was a significant (P = .02) gradient increase of serum AMH levels with the increasing dose of CC required to achieve ovulation. The receiver-operating characteristic curve showed AMH to be a useful predictor of no ovulation (area under the curve, 0.809; P < .001) with a useful cutoff level of 3.4 ng/mL. Ovulation and pregnancy rates were significantly higher (97%, P < .001, and 46%, P = .034) in patients with low AMH (<3.4 ng/mL) vs women with AMH 3.4 ng/mL or greater (48% and 19%).

CONCLUSION

PCOS women with high circulating AMH (≥ 3.4 ng/mL) seem to be resistant to CC and may require a higher starting dose.

摘要

背景

已知多囊卵巢综合征（PCOS）妇女血清抗苗勒管激素（AMH）浓度升高会降低卵巢卵泡对循环促卵泡激素（FSH）的敏感性。这种影响可能会影响克罗米芬枸橼酸盐（CC）诱导排卵的结果。

目的

本研究旨在探讨高循环 AMH 对 PCOS 妇女 CC 诱导排卵结局的影响。

设计

这是一项前瞻性队列观察研究。

地点

英国德比生育单位。

患者

60 名患有 PCOS 的排卵障碍妇女参加了这项研究。

干预措施

在 187 个 CC 周期的第 2 天测量血清 AMH 浓度。比较反应者和非反应者之间的浓度。使用接收者操作特性曲线评估循环 AMH 的预后价值。比较高 AMH 与低 AMH 水平患者的 CC 成功率。将达到排卵所需的 CC 剂量与血清 AMH 浓度相关联。

主要观察指标

排卵和妊娠率。

结果

反应者（排卵）与非反应者（分别为 2.5 ± 0.1 和 5.8 ± 0.7 ng/mL，P <.001）的血清 AMH 浓度显著（P <.001）降低。同样，血清 AMH 浓度在妊娠（3.0 ± 0.4 ng/mL）和未妊娠患者（4.4 ± 0.5 ng/mL）中显著（P =.046）降低。随着达到排卵所需的 CC 剂量的增加，血清 AMH 水平呈显著（P =.02）梯度升高。接收者操作特性曲线显示 AMH 是无排卵的有用预测指标（曲线下面积，0.809；P <.001），有用的截断值为 3.4 ng/mL。低 AMH（<3.4 ng/mL）患者的排卵和妊娠率显著高于 AMH 3.4 ng/mL 或更高（97%，P <.001 和 46%，P =.034）的妇女（48%和 19%）。