抗苗勒管激素在腹膜型子宫内膜异位症患者卵巢储备功能评估中的价值研究

摘要

目的 探讨不合并卵巢子宫内膜异位囊肿的子宫内膜异位症(EMS)患者血清抗苗勒管激素(AMH)水平是否受腹腔液AMH水平的影响,以及AMH评估腹膜型EMS患者卵巢储备功能的价值.方法 选择经腹腔镜确诊为单纯腹膜型EMS的18例患者为A组,同期因子宫肌瘤行腹腔镜剔除术且无不良孕产史的12例患者为B组.采用EHSA法检测2组患者在术前和术后1、3、6个月的腹腔液及血清AMH水平,分析A组患者在各个时间点血清和腹腔液的AMH水平变化,比较2组患者的腹腔液及血清AMH水平差异.结果 A组腹膜型EMS患者在术前和术后1、3、6个月的腹腔液AMH水平均高于血清AMH水平(P均＜0.05);与术前比较,血清AMH水平在术后1个月下降,后呈逐渐上升趋势,但术后3个月仍未恢复,术后6个月仍处于较低水平(P均＜0.008),而腹腔液AMH在术后1个月下降(P＜0.008),其后相邻2个时间点间比较差异无统计学意义(P均＞0.008).A组患者在术后1、3、6个月的血清AMH水平均低于B组(P均＜0.05),与此同时A组的腹腔液AMH水平均高于B组(P均＜0.05).结论 腹膜型EMS患者腹腔内AMH与血清AMH水平无相互影响.血清AMH是评价腹膜型EMS患者卵巢储备功能的良好指标.%Objective To investigate whether the serum level of anti-Müllerian hormone (AMH) was affected by the AMH level in the intraperitoneal fluid in patients diagnosed with endometriosis (EMS) without ovarian endometriosis cyst,and analyze the value of AMH in the evaluation of ovarian reserve in patients with peritoneal EMS.Methods Eighteen patients who were diagnosed with simple peritoneal EMS by laparoscope were assigned into group A,and 12 hysteromyoma patients undergoing laparoscopic resection and without history of adverse pregnancy were allocated into group B.The AMH levels of the intraperitoneal fluid and serumwere quantitatively measured by ELISA before and at 1,3 and 6 months after surgery in all patients.The changes in the serum and intraperitoneal fluid levels of AMH at each time point in group A were analyzed.The intraperitoneal fluid and serum levels of AMH were statistically compared between two groups.Results In group A,the AMH levels in the intraperitoneal fluid were significantly higher compared with those in the serum samples at all time points (all P ＜ 0.05).The serum level of AMH at postoperative 1 month was considerably lower than preoperative level,which tended to gradually elevate,whereas it did not restore to preoperative level at postoperative 3 months.The serum level of AMH at postoperative 6 months was still relatively low (all P ＜ 0.008).The AMH level in the intraperitoneal fluid was significantly down-regulated at postoperative 1 month (P ＜ 0.008),and no statistical significance was noted between postoperative 3 and 6 months (both P ＞ 0.008).In group A,the serum levels of AMH at postoperative 1,3 and 6 months were significantly lower than those in group B (all P ＞ 0.05),whereas the AMH levels in the intraperitoneal fluid were dramatically higher compared with those in group B (all P ＜ 0.05).Conclusions No mutual effect is observed between the AMH levels in the intraperitoneal fluid and serum samples of peritoneal EMS patients.Serum AMH level is a sensitive and reliable parameter to evaluate the ovarian reserve of patients with peritoneal EMS.