标题：单侧卵巢子宫内膜异位囊肿剥除术后患者血清抗苗勒管激素的变化及临床意义

      作者：刘慧敏 1，李筱薇 1，李会芳 2    1.深圳市宝安区福永人民医院妇产科，广东 深圳 518103；2.深圳市龙岗区横岗人民医院妇产科，广东 深圳 518103

      卷次： 2020年31卷18期

      【摘要】 目的 探讨单侧卵巢子宫内膜异位囊肿剥除术后患者血清抗苗勒管激素(AMH)水平的变化及其临床意义。方法 选择2016年1月至2018年2月在深圳市宝安区福永人民医院妇产科因子宫内膜异位囊肿接受腹腔镜囊肿剥除术患者80例为研究对象，术前检查囊肿具体位置、大小及数量。比较术前、术后第1个月、3个月、6个月经周期月经第3天血清卵巢雌激素(FSH)、血清雌二醇(E2)和AMH水平以及窦状卵泡(AFC)数目；同时比较不同年龄、囊肿类型及大小、不同美国生殖医学协会子宫内膜异位症分期(r-AFS)患者术后第 6个月经周期AMH下降率，以及术后妊娠成功与失败患者AMH水平。结果 所有患者术后第 1个月经周期AMH、FSH、E2、AFC明显下降，与术前比较差异均具有统计学意义(P<0.05)；术后第3个月经周期FSH、E2、AFC逐渐恢复正常，与术前比较差异均无统计学意义(P>0.05)，但AMH与术前比较差异仍有统计学意义(P<0.05)；术后第6个月经周期FSH、E2、AFC水平恢复正常，与术前比较差异均无统计学意义(P>0.05)，但AMH与术前比较差异仍具有统计学意义(P<0.05)；年龄35岁以上患者术后AMH下降率为(40.09±6.21)%，明显高于年龄小于35岁患者的(25.91±5.01)%，差异有统计学意义(P<0.05)；不同囊肿类型、囊肿大小、r-AFS分期患者AMH下降率比较差异均无统计学意义(P>0.05)；经随访2年，62例有妊娠需求的患者中，妊娠成功40例，妊娠失败22例，妊娠成功患者的AMH水平为(7.98±2.11) ng/mL，明显高于妊娠失败者的(5.01±1.21) ng/mL，差异具有统计学意义(P<0.05)。结论 子宫内膜异位囊肿剥除术后患者血清AMH水平显著下降，较好地反映了卵巢储备功能，可作为评价卵巢早衰的参考指标。
      【关键词】 子宫内膜异位囊肿；血清抗苗勒管激素；腹腔镜；剥除术；变化；妊娠
      【中图分类号】 R713.6 【文献标识码】 A 【文章编号】 1003—6350（2020）18—2366—04

Changes and clinical significance of serum anti-Mullerian hormone in patients with unilateral ovarianendometriosis cyst after cystectomy.
LIU Hui-min 1, LI Xiao-wei 1, LI Hui-fang 2. 1.Department of Obstetrics andGynecology, Fuyong People's Hospital of Bao'an District of Shenzhen, Shenzhen 518103, Guangdong, CHINA; 2. Departmentof Obstetrics and Gynecology, Henggang People's Hospital of Longgang District of Shenzhen, Shenzhen 518103, Guangdong,CHINA
【Abstract】 Objective To explore the changes and clinical significance of serum anti-Mullerian hormone(AMH) in patients with unilateral ovarian endometriosis cyst after cystectomy. Methods A total of 80 patients, whoadmitted to Department of Obstetrics and Gynecology, Fuyong People's Hospital of Bao'an District of Shenzhen fromJanuary 2016 to February 2018 for unilateral ovarian endometriosis cyst exfoliation. Location, size and number ofcysts were detected before the operation. The serum levels of follicle stimulating hormone (FSH), estradiol (E2), AMHand antral follicle count (AFC) were compared before operation and the 1st, 3rd, 6th menstrual cycle after operation. TheAMH of different age groups, types and sizes of cysts, different stages of R-AFS and 6th menstrual cycle after operationwere compared. Results AMH, FSH, E2 and AFC decreased significantly one week after operation (all P<0.05); FSH,E2, AFC gradually recovered to preoperative level 3rd menstrual cycle after operation (P>0.05), but the difference inAMH between before and after operation was statistically significant (P<0.05); the decrease rate of AMH in patientsover 35 years old was (40.09±6.21)%, which was significantly higher than (25.91±5.01)% in patients under 35 years old(P<0.05). There was no significant difference in AMH reduction rate among different cyst types, cyst size and R-AFSstages (P>0.05); after 2 years of follow-up, of the 62 patients with pregnancy needs, 40 patients were pregnant success-fully, and 22 patients were failed. The AMH level of patients with pregnancy success was (7.98±2.11) ng/mL, which wassignificantly higher than (5.01±1.21) ng/mL in patients with pregnancy failure (P<0.05). Conclusion The serum AMHlevel decreased significantly after the removal of endometrial cyst, which reflected the ovarian reserve function well andcould be used as a reference index to evaluate the premature ovarian failure.
      【Key words】 Endometriosis cyst; Serum anti-Mullerian hormone; Laparoscopy; Exfoliation; Change; Pregnancy