AMH联合卵巢超声影像学参数对早发性卵巢功能不全的预测价值  

Predictive value of AMH combined with ovarian ultrasound parameters for premature ovarian insufficiency

作　　者：王丽[1] 毛文军[1] 白娥[1] WANG Li;MAO Wenjun;BAI E(Department of Gynecology and Obstetrics,The First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China)

机构地区：[1]西安交通大学第一附属医院妇产科,陕西西安710061

出　　处：《西安交通大学学报（医学版）》2024年第4期560-566,共7页Journal of Xi’an Jiaotong University（Medical Sciences）

基　　金：陕西省重点研发计划社会发展领域资助项目(No.2022SF-163)。

摘　　要：目的 探讨育龄期女性不同年龄的性激素、抗苗勒氏管激素(anti-Müllerian hormone, AMH)水平和卵巢超声影像学参数的变化,分析其对早发性卵巢功能不全(premature ovarian insufficiency, POI)的预测价值并建立预测模型。方法 选择2018年2月至2022年6月就诊于西安交通大学第一附属医院的1 968名育龄期女性为研究对象,检测其性激素、AMH、窦卵泡计数(antral follicle count, AFC)、卵巢总体积、卵巢皮质体积、卵巢髓质体积、卵巢总面积、卵巢皮质面积、卵巢髓质面积,分析不同年龄各项指标的变化及其对POI的预测价值,采用AMH联合卵巢超声影像学参数建立预测POI的模型。结果 1 968名研究对象中POI患病率为3.10%,30~39岁年龄组POI的患病率显著高于20~29岁年龄组(P<0.05)。30~34岁组血清AMH水平显著低于20~24岁组和25~29岁组(P<0.05),35~39岁组血清卵泡刺激素(follicle stimulating hormone, FSH)、黄体生成素(luteinizing hormone, LH)水平显著高于30~34岁组(P<0.05),而血清雌二醇(estradiol, E2)和AMH水平、AFC、卵巢体积、卵巢皮质体积、卵巢面积、卵巢皮质面积均显著低于30~34岁组(P<0.05)。POI组患者的血清FSH、LH水平显著高于同龄女性卵巢功能正常者(P<0.05),而血清E2、AMH水平显著低于同龄女性卵巢功能正常者(P<0.05)。POI组患者的AFC、卵巢体积、卵巢皮质体积、卵巢髓质体积、卵巢面积、卵巢皮质面积和卵巢髓质面积均显著低于同龄女性卵巢功能正常者(P<0.05)。对POI的预测价值分析结果显示,激素水平中AMH的预测价值最高(AUC=0.957),其次为E2(AUC=0.840)。超声影像学参数中AFC的预测价值最高(AUC=0.867),其次为卵巢皮质体积(AUC=0.835)。AMH联合卵巢超声影像学参数建立的模型对POI具有较好的预测价值,其灵敏度为94.86%,特异度为91.23%,AUC为0.960,截断值为12分。结论 育龄期女性中30~39岁年龄组POI的患病率较高,AMH联合卵巢超声影像Objective To investigate the changes of sex hormones,anti-Müllerian hormone(AMH)level and ovarian ultrasound imaging parameters in women of childbearing age,so as to analyze their predictive value for premature ovarian insufficiency(POI)and establish the predictive model.Methods A total of 1968 women of childbearing age in The First Affiliated Hospital of Xi’an Jiaotong University from 2018 to June 2022 were selected as research subjects.Their sex hormones and AMH levels were detected,and ultrasonographic features of the ovary were detected,including antral follicle count(AFC),ovarian volume,ovarian cortical volume,ovarian medulla volume,the total area,ovarian cortical area,and ovarian medulla area.The changes in ovarian function status at different age were analyzed,and their predictive value for POI was explored.AMH combined with ovarian ultrasound imaging parameters was used to establish a model for predicting POI.Results Among the 1968 subjects,the prevalence rate of POI was 3.10%.The prevalence rate of POI was significantly higher in 30-39 years old group than in 20-29 years old group(P<0.05).The serum AMH level in 30-34 years old group was significantly lower than that in 20-24 years old group and 25-29 years old group(P<0.05),and the serum follicle stimulating hormone(FSH)and luteinizing hormone(LH)levels were significantly higher in 35-39 years old group than in 30-34 years old group(P<0.05).The serum estradiol(E 2)and AMH levels,AFC,ovarian volume,ovarian cortical volume,ovarian area,and ovarian cortical area were significantly lower than those in the 30-34 years old group(P<0.05).The serum FSH and LH levels in POI group were significantly higher than women of the same age with normal ovarian function(P<0.05),while the serum E 2 and AMH levels were significantly lower than women of the same age with normal ovarian function(P<0.05).The AFC,ovarian volume,ovarian cortical volume,ovarian medullary volume,ovarian area,ovarian cortical area,and ovarian medullary area in POI group were significantly lower t

关 键 词：育龄期女性 早发性卵巢功能不全 抗苗勒氏管激素(AMH) 超声影像学 预测价值 

分 类 号：R711.75[医药卫生—妇产科学]