育龄女性月经周期内及周期间血清抗苗勒管激素水平的变化研究

摘要

Objective:We aimed to study the intra and inter-cycle changes of serum AMH levels of the reproductive-aged women,to understand if AMH test can be performed at random day of menstrual cycle.Methods:21-45 years old,ovulating,healthy women were recruited.Peripheral serum samples were collected at early follicular phase,ovulating phase and mid-luteal phase to measure AMH and reproductive hormones [estradiol (E 2),progesterone (P),prolactin (PRL),follicle stimulating hormone (FSH),lutein izing hormone (LH),testosterone(T),dehydroepiandrosterone sulfate (DHEAS),sex hormone binding globulin (SHBG) and androstenedione (AND)].The differences of AMH levels at several time points,as well as the correlation between AMH and other parameters were analyzed.Results:46 women completed sample collection at 3 time points within one menstrual cycle,the serum AMH level at the early follicular phase,the ovulating phase,and the mid-luteal phase were 2.9ng/ml,2.74ng/ml and 2.72ng/ml,respectively[median(range)].There was no significant difference of AMH levels among the 3 time points(P ＞ 0.05).29 out of 46 women completed sample collection at 6 time points of two consecutive cycles.Serum AMH levels were 2.41 ng/ml,2.33ng/ml,2.39ng/ml,2.29ng/ml,2.57ng/ml and 2.45ng/ml respectively(median).There was no significant difference of AMH levels among the 6 time points(P＞0.05).The serum AMH levels were significantly negatively correlated with T and E2 levels at the early follicular phase of the women aged 30 and below (r =-0.436,P ＜ 0.05;r =-0.499,P ＜ 0.01);and the early-follicular-phase AMH levels were significantly negatively correlated with the age of women over 30 years of age (r =-0.570.P ＜ 0.05).Conclusions:Serum AMH level remains stable within and between menstrual cvcles.So it can be measured at any time of menstrual cycle.Ovarian reserve function of reproductive-aged women can be better assessed by using a combination of age,serum AMH and basal reproductive hormone levels.%目的:探讨育龄女性血清抗苗勒管激素(AMH)水平在同一月经周期内和连续两个周期间的变化.方法:选择本院21 ～45岁,排卵规律的健康女性46例,于早卵泡期、排卵期和黄体中期分别抽取外周血,使用化学发光法对不同时间点血清AMH水平进行检测,评估月经周期内和周期间的血清AMH水平的稳定性,并且分析年龄、体质量指数(BMI)和性激素水平与血清AMH水平的相关性.结果:46例完成了1个月经周期3个时间点的检测,早卵泡期、月经中期和黄体期的血清AMH水平分别为2.90 ng/ml、2.74 ng/ml、2.72 ng/ml;3个时间点的AMH水平比较,差异无统计学意义(P＞0.05).其中29例完成了连续2个周期6个时间点的检测,血清AMH水平分别为2.41 ng/ml、2.33 ng/ml、2.39 ng/ml、2.29 ng/ml、2.57 ng/ml和2.45 ng/ml;6个时间点的AMH水平比较,差异无统计学意义(P＞0.05).30岁及以下女性早卵泡期AMH水平与睾酮(T)和雌二醇(E 2)水平显著负相关(r=-0.436,P＜0.05;r=-0.499,P＜0.01);30岁以上女性早卵泡期AMH水平与年龄显著负相关(r=-0.570,P＜0.05).结论:血清AMH水平在月经周期内和周期间维持稳定,可在月经周期任一天进行检测.综合年龄、AMH水平和基础性激素水平可帮助临床更好的评估育龄女性的卵巢储备功能.