Preoperative serum anti-Mullerian hormone level is a potential predictor of ovarian endometrioma severity and postoperative fertility
Preoperative serum anti-Mullerian hormone level is a potential predictor of ovarian endometrioma severity and postoperative fertility
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DOI：
10.1016/j.ejogrb.2019.06.024
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发表时间：
2019-09-01
影响因子：
2.6
通讯作者：
Sun, Pengming
中科院分区：
文献类型：
--
作者：
Dong, Zhenzhu;An, Jian;Sun, Pengming
目的：建立基于血清抗苗勒管激素（AMH）水平预测子宫内膜异位瘤术前修订的美国生殖医学学会（rASRM）评分的模型，并确定可能可靠预测子宫内膜异位瘤患者术后生育能力的因素。研究设计：研究人群由134名子宫内膜瘤患者、58名良性囊肿患者和115名非卵巢病变患者组成。比较三组患者术前血清AMH水平及临床参数。采用单因素相关分析和多元线性回归建模方法，逐步构建rASRM评分预测模型。然后采用Cox回归分析确定子宫内膜异位瘤手术治疗后自然妊娠的预测变量。结果：子宫内膜异位瘤组术前AMH水平明显低于其他两组（p < 0.001）。多因素线性回归分析显示，年龄（beta=-0.324, p < 0.001）、rASRM评分（beta=-0.298, p < 0.001）和血清CA125水平（beta= 0.176, p =0.026）与血清AMH水平独立且负相关。经手术切除的子宫内膜瘤妇女的Cox回归分析显示，年龄较大（每5年增加，HR: 0.517; 95% CI: 0.299-0.896）和较高的血清AMH水平（截断值：>3.68 ng/ml, HR: 2.383; 95% CI, 1.093-5.197）是术后生育的独立预测因素。结论：晚期子宫内膜异位症患者血清AMH水平较低，高龄患者血清AMH水平较低，易发生术后不孕症。因此，及时检测AMH水平以评估卵巢子宫内膜异位症的严重程度和术后妊娠成功的可能性是必要的，以确保能够提供最佳的药物治疗。(C) 2019 Elsevier B.V.版权所有
Objective: To establish a model for predicting revised American Society of Reproductive Medicine (rASRM) scores before endometrioma surgery based on serum anti-Mullerian hormone (AMH) level and to identify factors that might reliably predict postoperative fertility of women diagnosed with endometrioma.Study design: The study population was composed of 134 women with endometrioma, 58 with benign cyst, and 115 with non-ovarian lesion. Preoperative serum AMH level and clinical parameters were compared among three groups. Univariate correlation analyses and multivariate linear regression modeling with a stepwise method were performed for constructing an rASRM scores prediction model. Cox regression analysis was then used to identify predictive variables of spontaneous pregnancy following surgical treatment of endometrioma.Results: Preoperative AMH level were significantly lower in the endometrioma group than in the other two groups (p < 0.001). Multivariate linear regression analysis revealed that age (beta=-0.324, p < 0.001), rASRM scores (beta=-0.298, p < 0.001) and serum CA125 level (beta= 0.176, p =0.026) independently and negatively correlated with serum AMH level. Cox regression analysis of women with endometrioma who underwent surgical resection indicated that older age (per five-year increase, HR: 0.517; 95% CI, 0.299-0.896) and higher serum AMH level (cut-off value: >3.68 ng/ml, HR: 2.383; 95% CI, 1.093-5.197) were independent predictors for postoperative fertility.Conclusion: Patients with advanced staged endometriosis tended to have a lower serum AMH level while postoperative infertility was more likely to occur in older patients with a lower level of serum AMH. Thus, timely detection of AMH levels to assess the severity of ovarian endometriosis and possibility for postoperative pregnancy success is necessary to ensure that optimal medical treatment can be provided. (C) 2019 Elsevier B.V. All rights reserved.