Does anti-Mullerian hormone predict menopause in the general population? Results of a prospective ongoing cohort study
Does anti-Mullerian hormone predict menopause in the general population? Results of a prospective ongoing cohort study
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DOI：
10.1093/humrep/dew112
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发表时间：
2016-07-01
影响因子：
6.1
通讯作者：
Broekmans, F. J. M.
中科院分区：
文献类型：
--
作者：
Depmann, M.;Eijkemans, M. J. C.;Broekmans, F. J. M.
研究问题：在一组月经周期正常的健康女性中，卵巢储备试验（ORT）是否能预测自然绝经年龄（ANM）？简要回答：在研究的ORT中，抗苗勒管激素（AMH）单独预测绝经年龄。然而，其预测值随着妇女年龄的增加而下降，预测区间较宽，绝经期的极端年龄无法预测。已知的是：假设ANM和自然生育能力丧失的年龄之间存在固定的区间。因此，如果有可能预测ANM，就可以确定绝经期提前的妇女，从而提高与年龄相关的生育能力低下的风险。研究设计、研究规模和持续时间：进行了一项长期、扩展的随访研究，第一轮随访结果已发表。在1992年至2001年期间，纳入了265名正常排卵的妇女（21-46岁），其中49名妇女（18.5%）无法在目前的随访round.Participants，设置，方法：265名健康的正常排卵的妇女，在学术医院招募。我们测量了基线AMH，卵泡刺激素和窦卵泡计数（AFC）。在随访时（2009年和2013年），通过问卷调查确定绝经状态。考克斯回归分析使用年龄和ORT计算绝经时间（TTM）。进行AMH预测效应的（非）比例性检查。一个威布尔生存模型，以预测个人ANM.Main结果和机会的作用：总共有155名妇女可用于分析。81名妇女（37.5%）在随访期间已绝经。单因素考克斯回归分析显示年龄和ORT与TTM显著相关。多变量考克斯回归分析，调整基线年龄和吸烟;然而，证明AMH单独是TTM的独立预测因子（风险比0.70，95%置信区间0.56-0.86，P值
STUDY QUESTION: Do ovarian reserve tests (ORTs) predict age at natural menopause (ANM) in a cohort of healthy women with a regular menstrual cycle?SUMMARY ANSWER: Of the ORTs researched, anti-Mullerian hormone (AMH) alone predicts age at menopause. However, its predictive value decreased with increasing age of the woman, prediction intervals were broad and extreme ages at menopause could not be predicted.WHAT IS KNOWN ALREADY: A fixed interval is hypothesized to exist between ANM and age at loss of natural fertility. Therefore, if it is possible to predict ANM, one could identify women destined for early menopause and thus at higher risk for age-related subfertility. Of ORTs researched in the prediction of ANM, AMH is the most promising one.STUDY DESIGN, STUDY SIZE AND DURATION: A long-term, extended follow-up study was conducted, results of the first follow-up round were previously published. Two hundred and sixty-five normo-ovulatory women (21-46 years) were included between 1992 and 2001, 49 women (18.5%) could not be reached in the current follow-up round.PARTICIPANTS, SETTING, METHODS: Two hundred and sixty-five healthy normo-ovulatory women were included, recruited in an Academic hospital. We measured baseline AMH, follicle-stimulating hormone and the antral follicle count (AFC). At follow-up (2009 and 2013), menopausal status was determined via questionnaires. Cox regression analysis calculated time to menopause (TTM) using age and ORT. A check of (non-) proportionality of the predictive effect of AMH was performed. A Weibull survival model was used in order to predict individual ANM.MAIN RESULTS AND THE ROLE OF CHANCE: In total, 155 women were available for analyses. Eighty-one women(37.5%) had become post-menopausal during follow-up. Univariable Cox regression analysis demonstrated age and ORTs to be significantly correlated with TTM. Multivariable Cox regression analysis, adjusting for baseline age and smoking; however, demonstrated AMH alone to be an independent predictor of TTM (Hazard Ratio 0.70, 95% Confidence Interval 0.56-0.86, P-value