Obesity Group, Endocrinology and Nutrition Department, Hospital Clinic de Barcelona, Barcelona, Spain.
Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain.
Front Endocrinol (Lausanne). 2024 Mar 15;15:1284576. doi: 10.3389/fendo.2024.1284576. eCollection 2024.
A reduction in anti-müllerian hormone (AMH) levels at short-term after bariatric surgery (BS) has been previously described. However, an assessment of ovarian reserve at longer-follow up, and a comprehensive evaluation of the potentially implicated factors has not been reported.
Prospective cohort study.
Twenty women aged 18-40 years with BMI 43.95 kg/m2 undergoing BS were studied at baseline (BS0), and at 1 month (BS1), 4 months (BS2), 12 months (BS3), and 24-36 months (BS4) after the surgery. Anthropometrics, reproductive hormones (AMH, FSH, LH, estradiol, testosterone, SHBG, androstenedione), metabolic parameters (adiponectin, leptin, ghrelin, insulin), and nutritional blood parameters (markers of nutritional status, vitamins, and minerals) were obtained at each study time point. Antral follicular count (AFC) was assessed by ultrasonography at BS0, BS3, and BS4. Mixed models were used for analysis of longitudinal data.
The mean AMH level was 3.88 ng/mL at BS0, decreased at BS3 (mean= 2.59 ng/mL; p=0.009), and remained stable between BS3 and BS4 (mean= 2.96 ng/mL; p=0.409). We also observed a non-significant decrease in AFC at BS3 (mean=26.14 at BS0, mean 16.81 at BS3; p=0.088) that remained stable at BS4 (mean= 17.86; p=0.731). Mixed models analysis showed: (a) a decrease in 10 kg of body weight was associated with an average decrease of 0.357 ng/mL in AMH (p=0.014); (b) a decrease in 1 BMI point was associated with an average decrease of 0.109 ng/mL in AMH (p=0.005); (c) an increase in 1 µg/mL of adiponectin was associated with an average decrease of 0.091 ng/ml in AMH (p=0.041) Significant positive correlations were found between the AMH levels after BS and plasma concentrations of testosterone, free androgen index, insulin and HOMA index. No significant correlations were detected between AMH levels and nutritional parameters.
Our results were in line with previous observations, showing that AMH levels decreased significantly at 12 months after bariatric surgery, in parallel with a non-significant reduction in AFC. Both ovarian reserve markers showed a later stabilization up to the end of the study. Of note, postoperative AMH levels were positively correlated with key androgen and insulin resistance-related parameters.
先前已有研究表明，减重手术后短期内（BS）抗苗勒氏管激素（AMH）水平降低。然而，尚未报道在较长随访时间内评估卵巢储备情况，以及对潜在相关因素进行全面评估。
前瞻性队列研究。
本研究共纳入 20 名年龄在 18-40 岁之间、BMI 为 43.95 kg/m2 的女性，她们均接受了减重手术（BS）。在基线（BS0）、1 个月（BS1）、4 个月（BS2）、12 个月（BS3）和 24-36 个月（BS4）时，对患者进行研究。在每个研究时间点，获取患者的人体测量学、生殖激素（AMH、FSH、LH、雌二醇、睾酮、SHBG、雄烯二酮）、代谢参数（脂联素、瘦素、胃饥饿素、胰岛素）和营养血液参数（营养状况标志物、维生素和矿物质）。在 BS0、BS3 和 BS4 时，使用超声评估窦卵泡计数（AFC）。采用混合模型对纵向数据进行分析。
BS0 时 AMH 水平的平均值为 3.88ng/mL，BS3 时（平均值=2.59ng/mL；p=0.009）下降，BS3 和 BS4 之间保持稳定（平均值=2.96ng/mL；p=0.409）。我们还观察到，BS3 时 AFC 出现非显著性下降（BS0 时平均值=26.14，BS3 时平均值=16.81；p=0.088），但在 BS4 时保持稳定（平均值=17.86；p=0.731）。混合模型分析表明：（a）体重减轻 10kg 与 AMH 平均降低 0.357ng/mL 相关（p=0.014）；（b）BMI 降低 1 个点与 AMH 平均降低 0.109ng/mL 相关（p=0.005）；（c）脂联素增加 1µg/mL 与 AMH 平均降低 0.091ng/ml 相关（p=0.041）。BS 后 AMH 水平与血浆睾酮、游离雄激素指数、胰岛素和 HOMA 指数呈显著正相关。未检测到 AMH 水平与营养参数之间存在显著相关性。
我们的结果与之前的观察结果一致，表明减重手术后 12 个月 AMH 水平显著下降，同时 AFC 出现非显著性降低。两种卵巢储备标志物均在研究结束时表现出后期的稳定。值得注意的是，术后 AMH 水平与关键的雄激素和胰岛素抵抗相关参数呈正相关。
