AMH在PCOS患者中评估卵巢储备及诊断价值

近年研究发现血清抗苗勒管激素(AMH)水平作为评估卵巢储备能力及辅助生殖技术(ART结局的指标已显示出其优越性,且AMH与多囊卵巢综合征(PCOS)的关系引起了学者们的关注。PCOS患者的卵巢储备异于同年龄非PCOS者,其实际年龄不等同于卵巢生育年龄,存在生育年龄后移情况,且在卵巢储备方面优于同年龄非PCOS者。AMH在PCOS患者的表达及变化有其特殊性,其在PCOS患者中异常升高,且随着年龄的下降速率较同年龄妇女更快。AMH水平与PCOS患者的基础窦卵泡数(AFC)及控制性超促排卵(COS)过程中的获卵数呈正相关,但与体外受精-胚胎移植(IVF-ET)妊娠结局的相关性存在争议。AMH对PCOS的诊断效能良好,但因AMH的升高与PCOS患者的具体表型及种族差异有关,故其截断值波动范围较大,目前尚无统一定论。

Evaluation of Ovarian Reserve Function by AMH in Patients with PCOS and Its Diagnostic Value

The level of serum AMH has been used as an indicator of ovarian reserve and ART outcome. The relationship between AMH and polycystic ovary syndrome (PCOS) has also attracted more and more attention. The ovarian reserve of PCOS patients is different from that of non-PCOS patients of the same age, and the actual age is not the same as the ovarian fertility age in PCOS patients. The mean fertility age of PCOS patients is actually postponed, and the ovarian reserve is better than that of non-PCOS patients of the same age. PCOS patients have their own characteristics of the expression and change of AMH. AMH is abnormally increased in PCOS patients, and the decline of AMH with age is faster than that in non-PCOS patients. There is a strong positive correlation between AMH level and AFC or the follicle number of controlled ovarian stimulation (COS) in PCOS patients. However, there is a controversy correlation between AMH level and IVF-ET pregnancy outcome in PCOS patients. The diagnostic efficacy of AMH for PCOS is good. Because the increase of AMH is related to the specific phenotype and ethnic difference of PCOS patients, the cutoff value of AMH fluctuates widely. Understandably, there is not a unified conclusion on this cutoff value at present.