摘要
目的探讨多囊卵巢综合征(PCOS)患者外周血抗苗勒管激素(AMH)水平与基础窦卵泡数量(AFC)的相关性。方法回顾性分析2020年1月至2024年5月于我院就诊的PCOS不孕症患者及作为对照的单纯输卵管因素不孕症患者的临床资料,通过倾向评分匹配法平衡组间混杂因素的差异,共获得1192例患者作为研究对象,其中PCOS组和对照组各596例。比较两组患者外周血AMH及基础性激素水平,分析外周血AMH与性激素相关性。进一步采用单因素分析外周血AMH与AFC的关系,并结合阈值、交互作用分析,研究PCOS患者外周血AMH水平与AFC之间关系及效应值变化。结果PCOS组外周血AMH、黄体生成素(LH)、睾酮(T)水平均显著高于对照组(P<0.05)。相关性分析可知,PCOS患者外周血AMH水平与LH(r=0.740)、T(r=0.728)水平呈正相关(P<0.05);调整性激素水平等其他混杂因素,单因素分析结果显示,PCOS组患者AMH、AFC及体质量指数(BMI)均显著增加(P<0.05)。交互作用分析结果显示,PCOS患者外周血AMH与BMI对AFC存在协同效应(P<0.05)。阈值效应分析显示,随着AMH增加,AFC呈上升趋势;在对照组中,当AMH≥3.9 ng/ml时,AFC显著增加(P<0.05);而AMH<3.9 ng/ml时,AMH与AFC未显示明显的相关性;在PCOS组,AMH水平与AFC呈线性正相关。随着BMI增加,AFC呈上升趋势。在对照组中,当BMI≥23.5 kg/m^(2)时,AFC明显增加(P<0.05);而BMI<23.5 kg/m^(2)时,BMI与AFC未显示明显的相关性。在PCOS组,BMI与AFC呈线性正相关。结论外周血AMH水平与AFC呈正相关,尤其是PCOS人群,随着AMH水平增加,AFC增多;而在非PCOS人群中,当AMH低于一定水平时(3.9 ng/ml),AFC与外周血AMH水平并无显著相关性,当AMH高于一定水平时(3.9 ng/ml),随着AMH水平增加,AFC增多。
Objective:To investigate the correlation between the level of anti-Müllerian hormone(AMH)in peripheral blood and the number of basal antral follicles in patients with PCOS.Methods:The clinical data of 597 infertility patients with PCOS and 3004 infertility patients due to tubal factors in Nanjing Drum Tower Hospital from January 2020 to May 2024 were retrospectively analyzed.The differences in confounding factors between groups were balanced by propensity score matching,and a total of 1192 patients were obtained as research subjects,including 596 patients in the PCOS group and 596 patients in the control group.The levels of AMH and sex hormones were compared between the two groups,and the correlation between AMH and sex hormones in peripheral blood was analyzed.A univariate analysis was conducted to explore the relationship between peripheral blood AMH level and antral follicle count(AFC),with threshold and interaction analysis to evaluate the relationship and effect value changes between peripheral blood AMH level and AFC.Results:The levels of AMH,LH,and testosterone(T)in the peripheral blood of the PCOS group were higher than those in the control group(P<0.05).The correlation analysis showed that the peripheral blood level of AMH in PCOS patients was positively correlated with the LH level(r=0.740,P<0.05)and the T level(r=0.728,P<0.05).The PCOS group had higher AFC and body mass index(BMI)than the control group(P<0.05).After adjusting for other confounding factors such as hormone levels,the univariate analysis results showed that the AMH level,AFC,and BMI in the PCOS group were significantly increased(P<0.05).The interaction analysis results showed that there was a synergistic effect of the AMH level in peripheral blood and BMI on AFC among patients with PCOS(P<0.05).The analysis of threshold effect showed that AFC increased with the increase of the AMH level.In the control group,AFC significantly increased when the AMH level was not less than 3.9 ng/ml(P<0.05),and there was no significant correlation between the AMH level and AFC when the AMH level was less than 3.9 ng/ml.In the PCOS group,the AMH level was positively correlated with AFC.AFC increased with the increase of BMI.In the control group,the AFC increased significantly when BMI was not less than 23.50 kg/m^(2)(P<0.05),and there was no significant correlation between BMI and AFC when BMI was less than 23.50 kg/m^(2).In the PCOS group,BMI was positively correlated with AFC.Conclusions:The level of AMH in peripheral blood is positively correlated with AFC,especially in PCOS patients.As the level of AMH increases,the AFC increases.However,in non-PCOS patients,when the AMH level is below a certain level(3.9 ng/ml),there is no significant correlation between AFC and the level of AMH in peripheral blood.When the AMH level is above a certain level(3.9 ng/ml),the AFC increases as the AMH level increases.
作者
蒋如煜
黄晨阳
陈磊
王珊珊
JIANG Ru-yu;HUANG Chen-yang;CHEN Lei;WANG Shan-shan(Department of Reproductive Medicine,Drum Tower Hospital,Affiliated to Nanjing University Medical School,Nanjing 210031)
出处
《生殖医学杂志》
2025年第6期735-740,共6页
Journal of Reproductive Medicine
基金
南京鼓楼医院临床研究专项资金培育项目(2021-LCYJ-PY-08)。
