Increased Body Mass Index Is Associated With A Nondilutional Reduction in Antimullerian Hormone
Increased Body Mass Index Is Associated With A Nondilutional Reduction in Antimullerian Hormone
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DOI：
10.1210/clinem/dgaa436
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发表时间：
2020-10-01
影响因子：
5.8
通讯作者：
Huddleston, Heather G.
中科院分区：
文献类型：
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作者：
Jaswa, Eleni Greenwood;Rios, Julie S.;Huddleston, Heather G.
背景：关于体重指数 (BMI) 是否以及如何影响患有或不患有多囊卵巢综合征 (PCOS) 的女性的抗苗勒管激素 (AMH) 存在争议。了解 BMI-AMH 关系对于实验室值的临床解释具有重要意义，并且可以阐明潜在的卵巢生理学。目的：测试以下假设：(1) BMI 与 PCOS 和排卵控制 (OVA) 中 AMH 降低相关，以及 (2) AMH 降低不是由稀释效应引起的。设计/设置：多中心队列。参与者：来自 2 个临床人群的 25 至 40 岁女性：640 名 PCOS 患者， 921 名女性作为 OVA。主要结果指标：卵巢储备指数：AMH、窦卵泡计数 (AFC) 和 AMH 与 AFC 比率 (AMH/AFC)，作为每个卵泡 AMH 产生的标志。结果：在多元回归模型中调整年龄、种族、吸烟和地点后，在两个队列中，BMI 和腰围的增加与 AMH 和 AMH/AFC 的减少相关。 BMI 增加与 PCOS 患者 AFC 减少相关，但与 OVA 无关。与 BMI 不同，体表面积 (BSA) 与血浆容量成正比，添加体表面积 (BSA) 是为了研究体型对 AMH 浓度的潜在稀释效应。在控制 BSA 后，两个队列中的 BMI 均与 AMH 保持独立关联； BSA 不再与 AMH 相关。结论：在一项调整后的分析中，BMI（而非 BSA）与 AMH 降低相关；这些数据不支持血液稀释在调节体型增大和 AMH 降低之间关系中的作用。随着 BMI 的增加，卵泡单位 AMH 产生的减少可能是 AMH 减少的原因。
Context: Controversy exists regarding if and how body mass index (BMI) impacts antimullerian hormone (AMH) in women with and without polycystic ovary syndrome (PCOS). Understanding the BMI-AMH relationship has critical implications for clinical interpretation of laboratory values and could illuminate underlying ovarian physiology.Objective: To test the hypotheses that (1) BMI is associated with reduced AMH in PCOS and ovulatory controls (OVAs) and (2) the reduction in AMH is not accounted for by dilutional effects.Design/Setting: Multicenter cohort.Participants: Women aged 25 to 40 years from 2 clinical populations: 640 with PCOS, 921 women as OVAs.Main Outcome Measures: Ovarian reserve indices: AMH, antral follicle count (AFC), and AMH to AFC ratio (AMH/AFC) as a marker of per-follicle AMH production.Results: In both cohorts, increasing BMI and waist circumference were associated with reductions in AMH and AMH/AFC, after adjusting for age, race, smoking, and site in multivariate regression models. Increasing BMI was associated with reduced AFC in PCOS but not OVAs. Body surface area (BSA), which unlike BMI is strongly proportional to plasma volume, was added to investigate a potential dilutive effect of body size on AMH concentrations. After controlling for BSA, BMI retained independent associations with AMH in both cohorts; BSA no longer associated with AMH.Conclusions: In an adjusted analysis, BMI, but not BSA, was associated with reduced AMH; these data do not support a role for hemodilution in mediating the relationship between increased body size and reduced AMH. Decreased AMH production by the follicle unit may be responsible for reduced AMH with increasing BMI.