摘要目的 比较不同血清黄体生成素(LH)与卵泡刺激素(FSH)比值(LH/FSH)的多囊卵巢综合征(PCOS)患者的抗苗勒管激素(AMH)分泌特点及卵泡发育障碍机制.方法 以LH/FSH为标准,将95例PCOS患者分为高比值组(49例,LH/FSH≥2),常比值组(46例,LH/FSH<2),以62例月经周期规则的输卵管性不孕患者为对照(对照组).3组患者均测定体质指数(BMI);采用酶联免疫吸附试验(ELISA)测定血清AMH水平;采用化学发光法测定血清生殖激素、空腹血糖、胰岛素及血脂水平;采用单因素方差分析法比较各组间生化代谢指标的差异;并运用简单相关分析法和多重线性回归法分析AMH水平与各生化代谢指标的关系.结果 (1)血清AMH水平:高比值组为(7.2±4.3)μg/L,常比值组为(5.2±3.8)μg/L,对照组为(3.7±2.2)μg/L,3组分别比较,差异均有统计学意义(P<0.01).(2)血清AMH水平与生化代谢指标的相关性:高比值组患者血清AMH水平与雌二醇水平呈负相关关系(r=-0.318);常比值组患者血清AMH水平与BMI、空腹血糖、稳态模型胰岛索抵抗指数(HOMA-IR)呈正相关关系(r=0.493、0.362、0.303).控制其他因素影响后,高比值组患者血清AMH水平与LH/FSH呈正相关关系(r=0.301),与雌二醇水平呈负相关关系(r=-0.429);常比值组患者血清AMH水平与BMI呈正相关关系(r=0.493).结论 高LH/FSH的PCOS患者卵泡发育障碍机制可能以下丘脑-垂体功能障碍为主,正常LH/FSH的PCOS患者则以代谢紊乱为主.

abstractsObjective To investigate characteristics of anti-Müllerian hormone (AMH) secretion and mechanism of aberrant folliculogenesis by the ratio of luteinizing hormone (LH)/follicle-stimulating hormone(FSH) in polycystic ovarian syndrome (PCOS) patients. Methods Base on the ratio of LH/FSH,total 95 patients with PCOS were divided into two groups,including 49 cases in higher ratio group (LH/FSH≥2) and 46 cases in normal ratio group (LH/FSH < 2) matched with 62 infertile cases with tubal factor and regular menstruation as control group. Body mass index (BMI) were calculated in all objectives. The serum AMH were detected by enzyme linked immunosorbent assay(ELISA). Ovarian sexual hormones,fasting blood glucose, insulin and lipid were measured by chemiluminescence method. The correlation between AMH and metabolic index was analyzed by multilinear regression. Results (1) AMH: the serum level of AMH were (7.2±4. 3) μg/L in higher LH/FSH group, (5. 2±3. 8) μg/L in normal LH/FSH group and (3.7 ±2. 2) μg/L in control group, which all reached significant difference among those 3 groups(P < 0. 01). (2) The correlation between AMH and biological metabolic index: estradiol (E2) was negatively correlated with serum level of AMH in higher LH/FSH ratio group (r = -0. 318). The serum level of AMH were positively correlated with BMI, fasting glucose, homeostasis model assessment insulin resistance index (HOMA-IR) in normal LH/FSH ratio group (r = 0. 493,0. 362,0.303). After controlling affect factors, serum levels of AMH were positively correlated with LH/FSH in higher LH/FSH ratio group (r = 0. 301), but negatively correlated with E2 (r = -0. 429). However, in normal LH/FSH group, serum level of AMH was only positively correlated with BMI (r = 0. 428). Conclusion The PCOS patients with higher LH/FSH ratio are primarily caused by hypothalamic-pituitary dysfunction, while the PCOS patients with normal LH/FSH ratio are mainly caused by metabolic disorders.