曾研章　谢文光　陈文锋　冯王富　谭晓天

【摘要】 目的：探讨血清抗苗勒管激素（AMH）、抑制素B（INHB）与多囊卵巢综合征（PCOS）患者表型的关系。方法：选取2018年1月-2019年6月本院收治的87例PCOS患者的临床资料（PCOS组）进行回顾性分析，另选取同期于本院体检的月经规律且处于正常育龄期女性30例作为健康对照组。比较两组年龄、体质量指数（BMI）、AMH、INHB、稳态模型胰岛素抵抗指数（HOMA-IR）及性激素水平。根据是否存在高雄激素血症将PCOS组分为高雄组（n=56）与非高雄组（n=31），比较两组上述各指标。根据BMI将PCOS组分为超重组（n=59）与非超重组（n=28），比较两组上述各指标。分析AMH、INHB与各指标的相关性。结果：PCOS组BMI、AMH、INHB、促黄体激素（LH）、LH/促卵泡激素（FSH）、睾酮（T）及HOMA-IR均高于健康对照组（P<0.05）;高雄组BMI、AMH、INHB、T及HOMA-IR均高于非高雄组（P<0.05）;超重组BMI、INHB及HOMA-IR均高于非超重组（P<0.05）;Pearson相关性分析结果显示，AMH与LH、LH/FSH、T、HOMA-IR均呈正相關（P<0.05），INHB与BMI、FSH、T及HOMA-IR均呈正相关，与雌二醇（estradiol，E2）呈负相关（P<0.05）。结论：PCOS患者血清AMH与INHB水平显著升高，与激素的紊乱密切相关，高雄激素血症者存在高AMH、INHB水平，超重患者则存在高INHB水平。

【关键词】 抗苗勒管激素 抑制素B 多囊卵巢综合征 超重 高雄激素血症

[Abstract] Objective： To investigate the relationship between serum anti-mullerian hormone （AMH）， inhibin B （INHB） and the phenotype of patients with polycystic ovary syndrome （PCOS）. Method： The clinical data of 87 PCOS patients admitted to our hospital from January 2018 to June 2019 （PCOS group） were retrospectively analyzed. In addition， 30 women of normal childbearing age and regular menstruation had physical examination in our hospital during the same period were selected as the healthy control group. Age， body mass index （BMI）， AMH， INHB， homeostasis model insulin resistance index （HOMA-IR）， and sex hormone levels were compared between the two groups. PCOS group was divided into hyperandrogenism group （n=56） and non-hyperandrogenism group （n=31） according to the presence or absence of hyperandrogenism， and the above indicators were compared between two groups. According to BMI， PCOS group was divided into overweight group （n=59） and non-overweight group （n=28）， and the above indicators were compared between the two groups. The correlation between AMH， INHB and each index were analyzed. Result： BMI， AMH， INHB， LH， LH/follicle stimulating hormone （FSH）， testosterone （T） and HOMA-IR of PCOS group were higher than those of the healthy control group （P<0.05）. BMI， AMH， INHB， T and HOMA-IR of the hyperandrogenism group were higher than those of the non-hyperandrogenism group （P<0.05）. BMI， INHB and HOMA-IR of the overweight group were higher than those of the non-overweight group （P<0.05）. Pearson correlation analysis showed that AMH were positively correlated with LH， LH/FSH， T and HOMA-IR （P<0.05）， INHB were positively correlated with BMI， FSH， T and HOMA-IR， and negatively correlated with estradiol （E2） （P<0.05）. Conclusion： The levels of AMH and INHB in PCOS patients are significantly increased， which is closely related to hormone disorder. There are higher levels of AMH and INHB in hyperandrogenism patients， and higher levels of INHB in overweight patients.

[Key words] Anti-mullerian hormone Inhibin B Polycystic ovary syndrome Overweight Hyperandrogenism

First-authors address： Yangjiang Maternal and Child Health Hospital， Yangjiang 529500， China

doi：10.3969/j.issn.1674-4985.2021.03.005

多囊卵巢综合征（polycystic ovary syndrome，PCOS）是育龄期女性常见的生殖系统疾病，以慢性无排卵、高雄激素及卵巢多囊化为主要临床特征，其临床表现存在异质性，但普遍伴随着高雄激素血症与肥胖[1]。PCOS是导致女性不孕的常见疾病之一，尽早诊断与治疗对提高受孕率及降低PCOS所致肥胖及心血管疾病将具有重要意义[2]。PCOS发病机制涉及遗传与环境因素的相互作用，至今仍未能清楚地阐述，加之其临床表征的异质性与不确定性给其诊断带来了困难与争议[3]。抗苗勒管激素（anti-mullerian hormone，AMH）与抑制素B（inhibin B，INHB）属于转化生长因子β超家族成员，主要由窦卵泡分泌[4]。AMH目前临床上常用作于卵巢功能评价的敏感指标之一，诸多研究表明其在子宫内膜异位症与PCOS等疾病中呈现上升趋势[5-6]。……