Division of Gastroenterology and Hepatology, University of California, San Francisco, San Francisco, California.
Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of California, San Francisco, San Francisco, California.
Clin Gastroenterol Hepatol. 2024 Feb;22(2):339-346.e5. doi: 10.1016/j.cgh.2023.08.020. Epub 2023 Sep 9.
BACKGROUND & AIMS: Antimüllerian hormone (AMH) is a marker of ovarian reserve with emerging data linking lower levels to some metabolic and inflammatory diseases in women. Whether AMH levels influence nonalcoholic fatty liver disease (NAFLD) is unknown.
Leveraging the NASH Clinical Research Network we determined the association of AMH levels within 6 months of liver biopsy with presence and severity of histologic measures of NAFLD in premenopausal women. Outcomes included presence of nonalcoholic steatohepatitis (NASH), presence and severity of fibrosis, and NAFLD Activity Score and its components. Logistic and ordinal logistic regression models were adjusted for age, race/ethnicity, homeostatic model assessment for insulin resistance, body mass index, dyslipidemia, polycystic ovary syndrome, estrogen-progestin use, and menstrual cyclicity.
Median cohort age was 35 years; 73% were white and 24% Hispanic. Thirty-three percent had diabetes, 81% had obesity, and 95% had dyslipidemia. On biopsy 71% had NASH, 68% had any fibrosis, and 15% had advanced fibrosis. On adjusted analysis (n = 205), higher AMH quartiles were inversely associated with NAFLD histology including prevalent NASH (adjusted odds ratio [AOR], 0.64; 95% confidence interval [CI], 0.41-1.00), NAFLD Activity Score ≥5 (AOR, 0.52; 95% CI, 0.35-0.77), Mallory hyaline (AOR, 0.54; 95% CI, 0.35-0.82), and higher fibrosis stage (AOR, 0.70; 95% CI, 0.51-0.98). The protective effects of AMH were more pronounced among women without polycystic ovary syndrome (n = 164), including lower odds of NASH (AOR, 0.53; 95% CI, 0.32-0.90) and any NASH fibrosis (AOR, 0.54; 95% CI, 0.32-0.93).
AMH may reflect a unique biomarker of NASH in premenopausal women and findings suggest a novel link between reproductive aging and histologic severity of NAFLD in women.
抗缪勒管激素（AMH）是卵巢储备的标志物，有新数据表明其水平较低与女性的一些代谢和炎症性疾病有关。AMH 水平是否影响非酒精性脂肪性肝病（NAFLD）尚不清楚。
利用 NASH 临床研究网络，我们确定了肝活检前 6 个月内 AMH 水平与绝经前妇女肝组织学 NAFLD 指标的存在和严重程度之间的关系。结果包括非酒精性脂肪性肝炎（NASH）的存在、纤维化的存在和严重程度，以及 NAFLD 活动评分及其组成部分。逻辑和有序逻辑回归模型调整了年龄、种族/民族、胰岛素抵抗的稳态模型评估、体重指数、血脂异常、多囊卵巢综合征、雌激素孕激素使用和月经周期。
队列的中位年龄为 35 岁；73%为白人，24%为西班牙裔。33%患有糖尿病，81%患有肥胖症，95%患有血脂异常。肝活检 71%有 NASH，68%有任何纤维化，15%有晚期纤维化。在调整分析（n=205）中，较高的 AMH 四分位组与 NAFLD 组织学呈负相关，包括常见的 NASH（调整后的比值比[OR]，0.64；95%置信区间[CI]，0.41-1.00）、NAFLD 活动评分≥5（OR，0.52；95%CI，0.35-0.77）、Mallory 透明体（OR，0.54；95%CI，0.35-0.82）和更高的纤维化阶段（OR，0.70；95%CI，0.51-0.98）。在没有多囊卵巢综合征的女性中（n=164），AMH 的保护作用更为明显，包括 NASH 的几率较低（OR，0.53；95%CI，0.32-0.90）和任何 NASH 纤维化（OR，0.54；95%CI，0.32-0.93）。
AMH 可能反映了绝经前妇女 NASH 的独特生物标志物，研究结果表明，生殖衰老与女性 NAFLD 的组织学严重程度之间存在新的联系。
