抗米勒管激素水平与多囊卵巢综合征患者雄激素及糖脂代谢水平的相关性分析  

Correlation of anti-Mullerian hormone level with androgen and glucolipid metabolism levels in patients with polycystic ovary syndrome

作　　者：翁瑞文 刘义 张蔚[2] 刘恒炜 WENG Ruiwen;LIU Yi;ZHANG Wei;LIU Hengwei(Department of Obstetrics and Gynecology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei 430022,China;Department of Obstetrics and Gynecology,Zhongnan Hospital of Wuhan University,Wuhan,Hubei 430071,China)

机构地区：[1]华中科技大学同济医学院附属协和医院妇产科,武汉430022 [2]武汉大学中南医院妇产科,武汉430071

出　　处：《重庆医学》2022年第19期3241-3246,3252,共7页Chongqing medicine

基　　金：国家自然科学基金青年基金项目(82001524,81974242);湖北省自然科学基金青年项目(2020CFB310)。

摘　　要：目的分析多囊卵巢综合征(PCOS)患者体内抗米勒管激素(AMH)水平与雄激素、胰岛素抵抗及糖脂代谢的关系。方法回顾性分析2019年6月至2020年12月在华中科技大学同济医学院附属协和医院就诊的450例PCOS患者性激素、75 g口服糖耐量试验、胰岛素释放试验结果等临床资料,计算体重指数(BMI)、游离雄激素指数(FAI)和稳态模型胰岛素抵抗指数(HOMA-IR),分析AMH与激素、血脂、血糖、胰岛素水平及HOMA-IR的相关性。根据AMH水平和FAI高低将PCOS患者分为4组,比较组间雄激素与糖、脂代谢相关指标的差异。AMH和多种代谢因子的相关性分析采用Spearman相关分析。结果血清AMH水平与总睾酮、雄烯二酮、性激素结合球蛋白水平呈正相关(r=0.3420、0.3199、0.1896,P<0.001),血清AMH水平与糖脂代谢指标及胰岛素抵抗多呈负相关。两正常雄激素组的代谢异常患者百分比相对较低,高FAI的PCOS患者具有不良的代谢特征,包括肥胖、高低密度脂蛋白胆固醇(LDL-C)或甘油三酯(TG)水平、2型糖尿病和胰岛素抵抗。结论PCOS患者AMH水平与雄激素分泌和糖脂代谢均有不同程度的相关性,糖脂代谢因子与AMH之间的整体相关性较弱,血清AMH水平和FAI结合有助于评估PCOS代谢紊乱的严重程度。Objective To analyze the correlation of anti-Müllerian hormone(AMH)level with androgen,insulin resistance,glucose and glucolipid metabolism in the patients with polycystic ovary syndrome(PCOS).Methods The clinical data of 450 patients with PCOS treated in the Union Hospital Affiliated to Tongji Medical College,Huazhong University of Science and Technology from June 2019 to December 2020 were retrospectively analyzed,including sex hormones,results of 75 g glucose tolerance test and insulin release test.The body mass index(BMI),free androgen index(FAI)and homeostasis model assessment insulin resistance index(HOMA-IR)were calculated.The correlations of AMH level with hormones levels,blood lipids and glucose levels,insulin level and HOMA-IR were analyzed.According to the AMH level and FAI,the patients with PCOS were divided into four groups.The differences in androgen and glucose and lipid metabolic related indicators were compared among the groups.The Spearman correlation was used to analyze the relationship between AMH level and various metabolic factors.Results Serum AMH level was positively correlated with total testoterone,androstenedione and sex hormone binding globulin(r=0.3420,0.3199,0.1896,P<0.001).Serum AMH level was negatively correlated with most of glucolipid metabolism indicators levels and insulin resistance.The percentage of the patients with metabolic abnormality in the two normal androgen groups was relatively low.The PCOS patients with high FAI had adverse metabolic characteristics,including obesity,high low-density lipoprotein cholesterol(LDL-C)or triglyceride(TG)levels,type 2 diabetes mellitus and insulin resistance.Conclusion The AMH level in PCOS patients is correlated with the androgen secretion and glucolipid metabolism to different degrees,however the overall correlation between glucolipid metabolic factors and AMH is weak.The combination of serum AMH level and FAI could help to assess the severity of PCOS metabolic disorders.

关 键 词：多囊卵巢综合征 抗米勒管激素 雄激素 胰岛素抵抗 代谢 相关性 

分 类 号：R711.75[医药卫生—妇产科学]