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与女性生殖健康息息相关，AMH指标临床应用前景辽阔

2018-06-22 MedSci MedSci原创

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随着生殖医学的快速发展，女性生殖健康检测的方法和项目在不断丰富和完善。其中，抗缪勒管激素（AMH）在预测生育能力、评估早发性卵巢功能不全（POI）和多囊卵巢综合症（PCOS）等领域优于其它预测指标，是可靠、方便和敏感的激素检测。近日，在“2018全国实用妇科内分泌骨干力量大会暨首届鼓浪屿论坛”上，北京大学人民医院妇产科主任医师杨欣教授就AMH的临床应用新进展与现场600多位来自全国各地的妇科内分泌

随着生殖医学的快速发展，女性生殖健康检测的方法和项目在不断丰富和完善。其中，抗缪勒管激素（AMH）在预测生育能力、评估早发性卵巢功能不全（POI）和多囊卵巢综合症（PCOS）等领域优于其它预测指标，是可靠、方便和敏感的激素检测。


近日，在“2018全国实用妇科内分泌骨干力量大会暨首届鼓浪屿论坛”上，北京大学人民医院妇产科主任医师杨欣教授就AMH的临床应用新进展与现场600多位来自全国各地的妇科内分泌医生进行了深入探讨与分享。杨欣教授表示：“随着AMH指标在临床应用中的逐渐普及，国内外针对该指标的研究增多，其临床价值也得到多越来越多专家的肯定，最新出台的中国相关共识和指南都将AMH纳入主要参考指标。无论是对于普通女性，还是妇科患者，AMH在女性整个生育周期都具有很大的医学价值，值得引起我们的重视。”

AMH更早反映卵巢储备功能降低 指导肿瘤患者个体化生育计划

卵巢储备功能，即女性卵巢内存留卵泡的数量和质量，这在受孕时就已经决定，个体之间差异可达百倍，卵巢储备降低将影响生育潜能，导致生育力低下。1卵巢储备功能传统的检测指标包括年龄、促卵泡生成激素（FSH）、促黄体生成素（LH）、雌二醇（E2）、窦卵泡计数（AFC）等。

作为新兴女性生殖健康指标，AMH产生于卵泡发育过程中，由窦前卵泡和窦卵泡分泌，反映了周期募集前的卵泡存储量，在血清中的水平与卵巢中的原始卵泡数相关，是卵巢储备功能的一个直接量度。2，3,4研究发现，与FSH、LH和E2相比，AMH的分泌较少受到下丘脑-垂体-性腺轴的影响；与AFC相比，不受操作者人为因素的影响。同时，AMH水平在月经周期变化不大，可在周期任一天进行检测。5

针对肿瘤患者，AMH检测可衡量不同治疗方案的性腺毒性，从而帮助医生选择更好的辅助治疗方案及个体化保留生育功能策略，尤其是儿童肿瘤患者生育力的保留。数据显示，育龄肿瘤妇女患者受到治疗方案影响，卵巢储备功能显着下降。早期检测癌症生存者的卵巢功能受损情况将有助于确定生育计划的窗口，并预估患者更年期症状管理的激素治疗和骨骼健康情况。6

同时，在辅助生殖技术中，AMH的预测作用能够对患者进行正确评估，制定理想的个体化治疗方案，在一定程度上可提高妊娠率，降低并发症危险因素。有多项研究显示，AMH是低卵巢反应和过度卵巢反应的强大预测因子，能够识别有卵巢过度刺激综合征（OHSS）风险的女性。7,8,9，10

AMH：妇科内分泌疾病诊疗的重要诊断指标

除了评估生育能力，AMH检测还能够用于辅助诊断由于女性性腺激素异常而引起的各类妇科内分泌疾病，例如卵巢功能减退（DOR）、POI、卵巢早衰（POF）和PCOS等。
在去年发布的《早发性卵巢功能不全的中国临床诊疗专家共识》中，增加了对DOR的定义：卵巢内卵母细胞的数量减少和（或）质量下降，同时伴有AMH水平降低、AFC减少，FSH水平升高。患者生育能力降低，但不强调年龄、病因和月经状态。共识中同时指出，当血清AMH≤7.85 pmol/L（即1.1 ng/mL），青春期前或青春期女性AMH水平低于同龄女性2倍标准差，提示POI的风险增加。11

数据显示，11% POF患者的FSH水平没有超过40IU/L的诊断界值，即漏诊率高达11%；而所有POI患者的AMH水平都低于正常排卵女性的第5百分位数，用AMH作为检测指标，只有1%的POF患者AMH水平超过了0.086 ng/ml。12杨欣教授指出：“AMH指标相较于FSH更敏感、具有更高的特异性，在临床中能够帮助临床更早地发现POI和POF患者。如果能尽早地发现卵巢功能下降，那么就可以及时干预，帮助患者早期获益。”

今年最新发布的《多囊卵巢综合征中国诊疗指南》指出，PCOS患者的血清AMH水平较正常明显增高。研究证实，PCOS患者血清AMH水平高于正常女性2-3倍。13,14AMH值越高，临床诊断PCOS的准确性也越高。当AMH值大于14ng/mL，可以诊断为PCOS15

AMH检测经过近三十年的实践，已经由手工检测法发展到了全自动化学发光免疫检测。作为国内最先上市的全自动AMH检测，罗氏诊断Elecsys®  AMH检测采用电化学发光法，不受样本类型、储存温度及储存时间的影响，其重复性和一致性在全球范围内均得到了广泛认可。该检测无需空腹，仅需2ml血液，18分钟便可得到准确、可靠的检测结果。

长按二维码，关注罗氏诊断微信公众号



1、Nadine M.P. Daan， Bart C.J.M. Fauser. Maturitas. 2015， 82：257-265

2、The Practice Committee of the American Society for Reproductive Medicine. Fertil Steril 2011；98：1407–1415.

3、Hansen KR et al. Fertil Steril 2011；95：170–175.

4、Dewailly D et al. Hum Reprod Update 2014；20：370–385.

5、La Marca et al， Human Reproduction Update， Vol.16， No.2， 2010

6、Fertil Steril 2012；97：134–40

7、Arce JC， et al. Fertil Steril 2013；99：1644–1653.

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9、Nelson SM， et al. Hum Reprod 2007；22：2414–2421.

10、Nakhuda GS， et al. Fertil Steril 2006；85：1541–1543.

11、中华妇产科杂志2017 年9月第52 卷第9期： 577-581

12、Knauff et al. J Clin Endocrinol Metab， March 2009， 94 (3)：786 –792

13、Human Reproduction Update， Vol.20， No.3 pp. 370–385， 2014

14、La Marca et al. Hum Reprod， 2009

15、Tal R, et al. Am J Obstet Gynecol 2014;210

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    2018-11-15 fengyi812

    #AMH#

    0

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    2019-04-09 mhm289

    #应用前景#

    0

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    2018-10-30 clmlylxy

    #临床应用#

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=2062438, encodeId=9d9e20624380b, content=<a href='/topic/show?id=4c3d241806' target=_blank style='color:#2F92EE;'>#AMH#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2418, encryptionId=4c3d241806, topicName=AMH)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a35a460, createdName=fengyi812, createdTime=Thu Nov 15 04:49:00 CST 2018, time=2018-11-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1943061, encodeId=98b019430617f, content=<a href='/topic/show?id=f5bd4931673' target=_blank style='color:#2F92EE;'>#应用前景#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=49316, encryptionId=f5bd4931673, topicName=应用前景)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=af60254, createdName=mhm289, createdTime=Tue Apr 09 09:49:00 CST 2019, time=2019-04-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1835755, encodeId=27451835e552e, content=<a href='/topic/show?id=cfdc22e893f' target=_blank style='color:#2F92EE;'>#临床应用#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22789, encryptionId=cfdc22e893f, topicName=临床应用)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=fc8528, createdName=clmlylxy, createdTime=Tue Oct 30 06:49:00 CST 2018, time=2018-10-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1304888, encodeId=65e41304888c9, content=<a href='/topic/show?id=c35069068ee' target=_blank style='color:#2F92EE;'>#生殖健康#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69068, encryptionId=c35069068ee, topicName=生殖健康)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2fe4321, createdName=lifangping, createdTime=Sun Jun 24 08:49:00 CST 2018, time=2018-06-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1531901, encodeId=dd45153190182, content=<a href='/topic/show?id=0579446550d' target=_blank style='color:#2F92EE;'>#女性生殖#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=44655, encryptionId=0579446550d, topicName=女性生殖)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=39cc12287476, createdName=slcumt, createdTime=Sun Jun 24 08:49:00 CST 2018, time=2018-06-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=326203, encodeId=f6dd32620351, content=好文.值得点赞!认真学习.应用于实践!谢谢分享给广大同好!, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Fri Jun 22 23:17:35 CST 2018, time=2018-06-22, status=1, ipAttribution=)]
    2018-06-24 lifangping

    #生殖健康#

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=2062438, encodeId=9d9e20624380b, content=<a href='/topic/show?id=4c3d241806' target=_blank style='color:#2F92EE;'>#AMH#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2418, encryptionId=4c3d241806, topicName=AMH)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a35a460, createdName=fengyi812, createdTime=Thu Nov 15 04:49:00 CST 2018, time=2018-11-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1943061, encodeId=98b019430617f, content=<a href='/topic/show?id=f5bd4931673' target=_blank style='color:#2F92EE;'>#应用前景#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=49316, encryptionId=f5bd4931673, topicName=应用前景)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=af60254, createdName=mhm289, createdTime=Tue Apr 09 09:49:00 CST 2019, time=2019-04-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1835755, encodeId=27451835e552e, content=<a href='/topic/show?id=cfdc22e893f' target=_blank style='color:#2F92EE;'>#临床应用#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22789, encryptionId=cfdc22e893f, topicName=临床应用)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=fc8528, createdName=clmlylxy, createdTime=Tue Oct 30 06:49:00 CST 2018, time=2018-10-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1304888, encodeId=65e41304888c9, content=<a href='/topic/show?id=c35069068ee' target=_blank style='color:#2F92EE;'>#生殖健康#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69068, encryptionId=c35069068ee, topicName=生殖健康)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2fe4321, createdName=lifangping, createdTime=Sun Jun 24 08:49:00 CST 2018, time=2018-06-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1531901, encodeId=dd45153190182, content=<a href='/topic/show?id=0579446550d' target=_blank style='color:#2F92EE;'>#女性生殖#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=44655, encryptionId=0579446550d, topicName=女性生殖)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=39cc12287476, createdName=slcumt, createdTime=Sun Jun 24 08:49:00 CST 2018, time=2018-06-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=326203, encodeId=f6dd32620351, content=好文.值得点赞!认真学习.应用于实践!谢谢分享给广大同好!, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Fri Jun 22 23:17:35 CST 2018, time=2018-06-22, status=1, ipAttribution=)]
    2018-06-24 slcumt

    #女性生殖#

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=2062438, encodeId=9d9e20624380b, content=<a href='/topic/show?id=4c3d241806' target=_blank style='color:#2F92EE;'>#AMH#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2418, encryptionId=4c3d241806, topicName=AMH)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a35a460, createdName=fengyi812, createdTime=Thu Nov 15 04:49:00 CST 2018, time=2018-11-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1943061, encodeId=98b019430617f, content=<a href='/topic/show?id=f5bd4931673' target=_blank style='color:#2F92EE;'>#应用前景#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=49316, encryptionId=f5bd4931673, topicName=应用前景)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=af60254, createdName=mhm289, createdTime=Tue Apr 09 09:49:00 CST 2019, time=2019-04-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1835755, encodeId=27451835e552e, content=<a href='/topic/show?id=cfdc22e893f' target=_blank style='color:#2F92EE;'>#临床应用#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22789, encryptionId=cfdc22e893f, topicName=临床应用)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=fc8528, createdName=clmlylxy, createdTime=Tue Oct 30 06:49:00 CST 2018, time=2018-10-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1304888, encodeId=65e41304888c9, content=<a href='/topic/show?id=c35069068ee' target=_blank style='color:#2F92EE;'>#生殖健康#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69068, encryptionId=c35069068ee, topicName=生殖健康)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2fe4321, createdName=lifangping, createdTime=Sun Jun 24 08:49:00 CST 2018, time=2018-06-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1531901, encodeId=dd45153190182, content=<a href='/topic/show?id=0579446550d' target=_blank style='color:#2F92EE;'>#女性生殖#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=44655, encryptionId=0579446550d, topicName=女性生殖)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=39cc12287476, createdName=slcumt, createdTime=Sun Jun 24 08:49:00 CST 2018, time=2018-06-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=326203, encodeId=f6dd32620351, content=好文.值得点赞!认真学习.应用于实践!谢谢分享给广大同好!, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Fri Jun 22 23:17:35 CST 2018, time=2018-06-22, status=1, ipAttribution=)]
    2018-06-22 虈亣靌

    好文.值得点赞!认真学习.应用于实践!谢谢分享给广大同好!

    0