Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
J Clin Endocrinol Metab. 2020 May 1;105(5). doi: 10.1210/clinem/dgaa083.
Several statistical models were introduced for the prediction of age at menopause using a single measurement of anti-müllerian hormone (AMH); however, individual prediction is challenging and needs to be improved.
The objective of this study was to determine whether multiple AMH measurements can improve the prediction of age at menopause.
All eligible reproductive-age women (n = 959) were selected from the Tehran Lipid and Glucose Study. The serum concentration of AMH was measured at the time of recruitment and twice after that at an average of 6-year intervals. An accelerated failure-time model with Weibull distribution was used to predict age at menopause, using a single AMH value vs a model that included the annual AMH decline rate. The adequacy of these models was assessed using C statistics.
The median follow-up period was 14 years, and 529 women reached menopause. Adding the annual decline rate to the model that included single AMH improved the model's discrimination adequacy from 70% (95% CI: 67% to 71%) to 78% (95% CI: 75% to 80%) in terms of C statistics. The median of differences between actual and predicted age at menopause for the first model was -0.48 years and decreased to -0.21 in the model that included the decline rate. The predicted age at menopause for women with the same amount of age-specific AMH but an annual AMH decline rate of 95 percentiles was about one decade lower than in those with a decline rate of 5 percentiles.
Prediction of age at menopause could be improved by multiple AMH measurements; it will be useful in identifying women at risk of early menopause.
已经有几种统计模型被提出，用于通过单次抗缪勒氏管激素（AMH）测量来预测绝经年龄；然而，个体预测具有挑战性，需要进一步改进。
本研究旨在确定多次 AMH 测量是否可以提高绝经年龄的预测准确性。
所有符合条件的育龄妇女（n=959）均选自德黑兰血脂和血糖研究。在招募时测量 AMH 的血清浓度，并在平均 6 年的时间间隔后再测量两次。使用具有 Weibull 分布的加速失效时间模型，使用单次 AMH 值与包含 AMH 年下降率的模型来预测绝经年龄。使用 C 统计量评估这些模型的适当性。
中位随访期为 14 年，529 名女性达到绝经。将年下降率添加到包含单次 AMH 的模型中，提高了模型的区分度，从 C 统计量的 70%（95%CI：67%至 71%）提高到 78%（95%CI：75%至 80%）。第一个模型中实际与预测绝经年龄中位数的差异为-0.48 岁，在包含下降率的模型中降至-0.21。具有相同年龄特异性 AMH 但 AMH 年下降率为 95%分位数的女性的预测绝经年龄比下降率为 5%分位数的女性低约十年。
通过多次 AMH 测量可以提高绝经年龄的预测准确性；这将有助于识别有早期绝经风险的女性。
