AMH能诊断和预测绝经/卵巢功能不全吗？

近期《Human Reproduction Update》杂志发表了一篇题为《Anti-Müllerian hormone for the diagnosis and prediction of menopause: a systematic review》的文章，旨在确定是否有证据支持单独使用AMH或与其他标志物联合用于诊断绝经，预测绝经，或预测和/或诊断卵巢功能不全（POI)。

本篇内容由翻译志愿者成贇医生翻译，蔡贺博士审校，供大家学习交流！

BACKGROUND

背景

The early onset of menopause is associated with increased risks of cardiovascular disease and osteoporosis. As a woman’s circulating anti-Müllerian hormone (AMH) concentration reflects the number of follicles remaining in the ovary and declines towards the menopause, serum AMH may be of value in the early diagnosis and prediction of age at menopause.

早发绝经与心血管疾病和骨质疏松的风险增加有关。血清抗苗勒管激素(AMH)水平反映卵巢中剩余卵泡的数量，并随着绝经而下降，因此在早期诊断和预测绝经年龄方面可能具有价值。

OBJECTIVE AND RATIONALE

目的和理由

This systematic review was undertaken to determine whether there is evidence to support the use of AMH alone, or in conjunction with other markers, to diagnose menopause, to predict menopause, or to predict and/or diagnose premature ovarian insufficiency (POI).

本系统评价旨在确定是否有证据支持单独使用AMH或与其他标志物联合用于诊断绝经，预测绝经，或预测和/或诊断卵巢功能不全（POI)。

SEARCH METHODS

检索方法

A systematic literature search for publications reporting on AMH in relation to menopause or POI was conducted in PubMed®, Embase®, and the Cochrane Central Register of Controlled Trials up to 31 May 2022. Data were extracted and synthesized using the Synthesis Without Meta-analysis for diagnosis of menopause, prediction of menopause, prediction of menopause with a single/repeat measurement of AMH, validation of prediction models, short-term prediction in perimenopausal women, and diagnosis and prediction of POI. Risk-of-bias was evaluated using the Tool to Assess Risk of Bias in Cohort Studies protocol and studies at high risk of bias were excluded.

系统检索PubMed 、Embase 和Cochrane Central Register of Controlled Trials截至2022年5月31日发表的关于AMH与绝经或POI相关的文献。采用综合无meta分析方法对数据进行提取和整合，包括绝经的诊断、绝经的预测、单次/重复测定AMH预测绝经、预测模型验证、对围绝经期女性的短期预测、POI的诊断和预测。采用队列研究偏倚风险评估工具进行偏倚风险评估，排除偏倚风险高的研究。

OUTCOMES

结果

A total of 3207 studies were identified, and 41, including 28 858 women, were deemed relevant and included. Of the three studies that assessed AMH for the diagnosis of menopause, one showed that undetectable AMH had equivalent diagnostic accuracy to elevated FSH (>22.3 mIU/ml). No study assessed whether AMH could be used to shorten the 12 months of amenorrhoea required for a formal diagnosis of menopause. Studies assessing AMH with the onset of menopause (27 publications [n = 23 835 women]) generally indicated that lower age-specific AMH concentrations are associated with an earlier age at menopause. However, AMH alone could not be used to predict age at menopause with precision (with estimates and CIs ranging from 2 to 12 years for women aged <40 years). The predictive value of AMH increased with age, as the interval of prediction (time to menopause) shortened. There was evidence that undetectable, or extremely low AMH, may aid early diagnosis of POI in young women with a family history of POI, and women presenting with primary or secondary amenorrhoea (11 studies [n = 4537]).

共确定了3,207项研究，其中41项(包括28 858名女性)被认为相关并纳入研究。在评估AMH对绝经期诊断的三项研究中，一项研究显示AMH水平低于检测下限与FSH升高（≥22.3 mIU/ml)具有相同的诊断准确性。没有研究评估AMH是否可以用于缩短诊断绝经所需的12个月的闭经。研究评估AMH与绝经的开始(27个研究，[n＝23 835])一般表明，较低年龄特异性的AMH水平与较早的绝经年龄相关。然而，AMH不能单独用于精确预测绝经年龄(40岁以下女性的CI范围从2到12年)。AMH的预测价值随着年龄的增加和预测间隔(至绝经时间)的缩短而增加。有证据表明，在有POI家族史的年轻女性和原发性或继发性闭经的女性中，检测不到或极低的AMH可能有助于POI的早期诊断(11项研究[n＝4537])。

WIDER IMPLICATIONS

更广泛的影响

The findings of this systematic review support the use of serum AMH to study the age of menopause in population studies. The increased sensitivity of current AMH assays provides improved accuracy for the prediction of imminent menopause, but diagnostic use for individual patients has not been rigorously examined. Prediction of age at menopause remains imprecise when it is not imminent, although the finding of very low AMH values in young women is both of clinical value in indicating an increased risk of developing POI and may facilitate timely diagnosis.

本系统综述的结果支持在人群研究中使用血清AMH来研究绝经年龄。目前AMH检测法灵敏度的增加提高了预测即将绝经的准确性，但尚未对个体患者的诊断应用进行严格检查。虽然在年轻女性中发现非常低的AMH值既具有临床价值，表明发生POI的风险增加，也可能有助于及时诊断，但对于非临近的绝经年龄的预测仍然不准确。

文章来源：

Scott M Nelson, Susan R Davis, Sophia Kalantaridou, Mary Ann Lumsden, Nick Panay, Richard A Anderson, Anti-Müllerian hormone for the diagnosis and prediction of menopause: a systematic review, Human Reproduction Update, Volume 29, Issue 3, May-June 2023, Pages 327–346, https://doi.org/10.1093/humupd/dmac045