子宫内膜异位症患者卵巢储备功能影响因素分析
Analysis of factors influencing ovarian reserve in patients with endometriosis.
作者信息
Feng Huiyan, Li Wenwei, Zhan Caini, Li Xiaomao, Ye Qingjian
机构信息
The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Sun Yat-sen University, Guangzhou, China.
出版信息
Arch Gynecol Obstet. 2025 Jul 14. doi: 10.1007/s00404-025-08114-3.
BACKGROUND
To discover the related factors of ovarian reserve function and explore the relationship between AFC and AMH.
METHODS
In this study, a retrospective analysis of endometriosis cases from January 2022 to December 2023 was performed with DIE ultrasound or surgical procedures. The association of AFC and AMH with age, single or bilateral cysts, healthy or affected side, cyst size, BMI, pregnancy history, recurrence, standard medication, comorbidities, four ultrasound sliding signs, presence or absence of deep nodules, and size of deep nodules were analyzed, and then multivariate analysis was performed.
RESULT
Correlation analysis results show significant factors influencing: Total AFC with age (R = -0.242, P < 0.001), Unilateral/bilateral (Z = -4.095, P < 0.001), the largest cyst diameter on the left side (R = -0.181, P = 0.004), the largest cyst diameter on the right side (R = -0.286, P < 0.001), AMH (R = 0.543, P < 0.001), recurrence (R = -2.007, P = 0.038), associated adenomyosis (R = -2.667, P = 0.007), posterior uterine wall sliding sign (R = -4.324, P < 0.001), rectouterine pouch sliding sign (R = -2.098,P = 0.036), largest diameter of deep nodules (Z = -0.175, P = 0.023). AMH shared associations with age (R = -0.432, P < 0.001), BMI (Z = -0.203, P < 0.001), left AFC, right AFC, total AFC, gravidity (R = -0.795, P < 0.001), recurrence (R = -2.203, P = 0.028), associated adenomyosis (R = -4.518, P < 0.001), associated uterine fibroids (R = -3.504, P < 0.001), posterior uterine wall sliding sign (R = -2.927, P = 0.003), and rectouterine pouch sliding sign (R = -1.995, P = 0.046). AFC on the healthy side was significantly higher than that on the affected side (Z = -9.786, P < 0.001). The results of the multivariate analyses showed the following: Larger cyst diameters on the left side were associated with lower left AFC (OR = -0.547, P < 0.001). Larger cyst diameters on the right side were associated with lower right AFC (OR = -0.601, P < 0.001). Higher AMH levels were associated with higher left AFC (OR = 0.775, P < 0.001), right AFC (OR = 0.778, P < 0.001), and total AFC (OR = 0.667, P < 0.001). AMH levels were influenced only by a history of recurrence (OR = 1.436, P = 0.047).
CONCLUSION
In OEM, compared to AMH, AFC may serve as a more suitable marker for assessing ovarian reserve.
背景
探索卵巢储备功能的相关因素，并探讨窦卵泡计数（AFC）与抗缪勒管激素（AMH）之间的关系。
方法
本研究对2022年1月至2023年12月的子宫内膜异位症病例进行回顾性分析，采用深部浸润型子宫内膜异位症（DIE）超声检查或手术方法。分析AFC和AMH与年龄、单双侧囊肿、健康侧或患侧、囊肿大小、体重指数（BMI）、妊娠史、复发情况、标准用药、合并症、四个超声滑动征、深部结节的有无及深部结节大小的相关性，然后进行多因素分析。
结果
相关性分析结果显示影响因素有：总AFC与年龄（R = -0.242，P < 0.001）、单侧/双侧（Z = -4.095，P < 0.001）、左侧最大囊肿直径（R = -0.181，P = 0.004）、右侧最大囊肿直径（R = -0.286，P < 0.001）、AMH（R = 0.543，P < 0.001）、复发（R = -2.007，P = 0.038）、合并子宫腺肌病（R = -2.667，P = 0.007）、子宫后壁滑动征（R = -4.324，P < 0.001）、直肠子宫陷凹滑动征（R = -2.098，P = 0.036）、深部结节最大直径（Z = -0.175，P = 0.023）。AMH与年龄（R = -0.432，P < 0.001）、BMI（Z = -0.203，P < 0.001）、左侧AFC、右侧AFC、总AFC、妊娠次数（R = -0.795，P < 0.001）、复发（R = -2.203，P = 0.028）、合并子宫腺肌病（R = -4.518，P < 0.001）、合并子宫肌瘤（R = -3.504，P < 0.001）、子宫后壁滑动征（R = -2.927，P = 0.003）及直肠子宫陷凹滑动征（R = -1.995，P = 0.046）相关。健康侧的AFC显著高于患侧（Z = -9.786，P < 0.001）。多因素分析结果显示：左侧较大的囊肿直径与较低的左侧AFC相关（OR = -0.547，P < 0.001）。右侧较大的囊肿直径与较低的右侧AFC相关（OR = -0.601，P < 0.001）。较高的AMH水平与较高的左侧AFC（OR = 0.775，P < 0.001）、右侧AFC（OR = 0.778，P < 0.001）及总AFC（OR = 0.667，P < 0.001）相关。AMH水平仅受复发史影响（OR = 1.436，P = 0.047）。
结论
在卵巢子宫内膜异位症中，与AMH相比，AFC可能是评估卵巢储备更合适的指标。
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