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Интерпретация и значение определения антимюллерова гормона в практике гинеколога для несовершеннолетних
Интерпретация и значение определения антимюллерова гормона в практике гинеколога для несовершеннолетних
Кумыкова З.Х., Уварова Е.В., Батырова З.К. Интерпретация и значение определения антимюллерова гормона в практике гинеколога для несовершеннолетних. Гинекология. 2021; 23 (3): 231–235.
DOI: 10.26442/20795696.2021.3.200779
DOI: 10.26442/20795696.2021.3.200779
DOI: 10.26442/20795696.2021.3.200779
________________________________________________
DOI: 10.26442/20795696.2021.3.200779
Материалы доступны только для специалистов сферы здравоохранения. Авторизуйтесь или зарегистрируйтесь.
Аннотация
Представлены обзорные данные о физиологической роли антимюллерова гормона (АМГ) в жизни человека, колебаниях его значений от рождения до репродуктивного периода у женщин, значимости его определения в диагностике и прогнозировании исходов лечения многих гинекологических заболеваний. Продукция АМГ происходит преимущественно в преантральных и ранних антральных фолликулах и снижается в процессе финального созревания и лютеинизации. АМГ играет потенциальную роль в сохранении овариального резерва путем осуществления двойственных действий. АМГ ингибирует начальный рекрутинг фолликулов, предотвращая влияние стимулирующих факторов роста для рекрутирования (KIT-лиганд, основной фактор роста фибробластов). С момента полового созревания АМГ снижает чувствительность первичных фолликулов к фолликулостимулирующему гормону, уменьшая вероятность их циклического рекрутирования. Приведены данные систематического обзора, отражающие характеристики овариального резерва у здорового женского населения в возрасте от 0 до 19 лет. При рождении отмечены очень низкие значения АМГ с повышением его уровня в первые 3 мес жизни с последующим ежемесячным увеличением на 31%. Выявлено значительное увеличение секреции АМГ к началу пубертата, далее большинством авторов отмечен постоянный уровень сывороточного АМГ в подростковом периоде. Уровень АМГ в сыворотке крови снижается с увеличением хронологического возраста на 6–8% ежегодно и варьирует в течение менструального цикла. АМГ является важным диагностическим инструментом в педиатрической практике при дифференциации различных причин нарушений полового созревания, вирилизации и нарушений менструального цикла у девочек.
Ключевые слова: антимюллеров гормон, овариальный резерв, девочки-подростки
period in women, the significance of its determination in the diagnosis and prognosis of treatment outcomes for many gynecological diseases. AMH is produced mainly by
preantral and early antral follicles and decreases during the final maturation and luteinization. AMH plays a potential role in preserving the ovarian reserve by performing
dual actions. AMH inhibits the initial recruitment of follicles, preventing the influence of stimulating growth factors for recruitment (KIT-ligand, the main fibroblast growth
factor). From the moment of puberty, AMH reduces the sensitivity of primary follicles to the follicle-stimulating hormone, reducing the likelihood of their cyclic recruitment.
The systematic review data presented the characteristics of the ovarian reserve in a healthy female population aged 0 to 19 years. At birth, very low AMH values were noted with an increase in its level in the first 3 months of life, followed by a monthly increase of 31%. A significant increase in AMH secretion was revealed by the beginning of puberty,
then most authors noted a constant level of serum AMH in the adolescent period. The level of AMH in the blood serum decreases with an increase in chronological age by
6–8% annually and varies during the menstrual cycle. AMH is an important diagnostic tool in pediatric practice when differentiating various causes of puberty disorders,
virilization and menstrual cycle disorders in girls.
Keywords: anti-Mullerian hormone, ovarian reserve, adolescent girl
Ключевые слова: антимюллеров гормон, овариальный резерв, девочки-подростки
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period in women, the significance of its determination in the diagnosis and prognosis of treatment outcomes for many gynecological diseases. AMH is produced mainly by
preantral and early antral follicles and decreases during the final maturation and luteinization. AMH plays a potential role in preserving the ovarian reserve by performing
dual actions. AMH inhibits the initial recruitment of follicles, preventing the influence of stimulating growth factors for recruitment (KIT-ligand, the main fibroblast growth
factor). From the moment of puberty, AMH reduces the sensitivity of primary follicles to the follicle-stimulating hormone, reducing the likelihood of their cyclic recruitment.
The systematic review data presented the characteristics of the ovarian reserve in a healthy female population aged 0 to 19 years. At birth, very low AMH values were noted with an increase in its level in the first 3 months of life, followed by a monthly increase of 31%. A significant increase in AMH secretion was revealed by the beginning of puberty,
then most authors noted a constant level of serum AMH in the adolescent period. The level of AMH in the blood serum decreases with an increase in chronological age by
6–8% annually and varies during the menstrual cycle. AMH is an important diagnostic tool in pediatric practice when differentiating various causes of puberty disorders,
virilization and menstrual cycle disorders in girls.
Keywords: anti-Mullerian hormone, ovarian reserve, adolescent girl
Полный текст
Список литературы
1. Watanabe K, Clarke TR, Lane AH, et al. Endogenous expression of Mullerian inhibiting substance in early postnatal rat Sertoli cells requires multiple steroidogenic factor-1 and GATA-4-binding sites. Proc Nat Acad Sci USA. 2000;97(4):1624-9.
2. Lindhardt JM, Hagen CP, Johannsen TH, et al. Anti-mullerian hormone and its clinical use in pediatrics with special emphasis on disorders of sex development. Int J Endocrinol. 2013; 2013:198698.
3. Jeppesen JV, Anderson RA, Kelsey TW, et al. Which follicles make the most anti-MЁullerian hormone in humans? Evidence for an abrupt decline in AMH production at the time of follicle selection. Mol Hum Reprod. 2013;19(8):519-27.
4. Bizzarri C, Cappa M. Ontogeny of Hypothalamus-Pituitary Gonadal Axis and Minipuberty: An Ongoing Debate? Front Endocrinol (Lausanne). 2020;11:187.
5. Anderson RA, Nelson SM, Wallace WHB. Measuring anti-mullerian hormone for the assessment of ovarian reserve: when and for whom is it indicated? Maturitas. 2012;71(1):28-33.
6. Kalich-Philosoph L, Roness H, Carmely A, et al. Cyclophosphamide triggers follicle activation and “burnout”; AS101 prevents follicle loss and preserves fertility. Sci Transl Med. 2013;5(185):185ra62.
7. Jamil Z, Fatima SS, Ahmed K, Malik R. Anti-Mullerian Hormone: Above and Beyond Conventional Ovarian Reserve Markers. Dis Markers. 2016;2016:5246217.
8. Bhide P, Pundir J, Homburg R, Acharya G. Biomarkers of ovarian reserve in childhood and adolescence: A systematic review. Acta Obstet Gynecol Scand. 2019;98(5):563-72.
9. Hagen CP, Aksglaede L, Sørensen K, et al. Individual serum levels of anti-Müllerian hormone in healthy girls persist through childhood and adolescence: a longitudinal cohort study. Hum Reprod. 2012;27(3):861-6.
10. Lashen H, Dunger DB, Ness A, Ong KK. Peripubertal changes in circulating antimullerian hormone levels in girls. Fertil Steril. 2013;99(7):2071-5.
11. Madison TO, Lauren C, McGrath JA, et al. AMH is Higher Across the Menstrual Cycle in Early Postmenarchal Girls than in Ovulatory Women. J Clin Endocrinol Metab. 2020;105(4):e1762-71.
12. Hagen CP, Mouritsen A, Mieritz MG, et al. Circulating AMH reflects ovarian morphology by magnetic resonance imaging and 3D ultrasound in 121 healthy girls. J Clin Endocrinol Metab. 2015;100(3):880-90.
13. Lie Fong S, Visser JA, Welt CK, et al. Serumanti-müllerian hormone levels in healthy females: a nomogram ranging from infancy to adulthood. J Clin Endocrinol Metab. 2012;9712:4650-5.
14. Zhu J, Li T, Xing W, et al. Chronological age vs biological age: a retrospective analysis on age-specific serum anti-Müllerian hormone levels for 3280 females in reproductive center clinic. Gynecol Endocrinol. 2018;34(10):890-4.
15. Lambert-Messerlian G, Plante B, Eklund EE, et al. Levels of antimüllerian hormone in serum during the normal menstrual cycle. Fertil Steril. 2016;105(1):208-13.e1.
DOI:10.1016/j.fertnstert.2015.09.033
16. Savas-Erdeve S, Sagsak E, Keskin M, et al. AMH levels in girls with various pubertal problems. J Pediatr Endocrinol Metab. 2017;30(3):333-5.
17. Karkanaki A, Vosnakis C, Panidis D. The clinical significance of anti-müllerian hormone evaluation in gynecological endocrinology. Hormones. 2011;10(2):95-103.
18. Visser JA, Hokken-Koelega ACS, Zandwijken GRJ, et al. Anti-Müllerian hormone levels in girls and adolescents with Turner syndrome are related to karyotype, pubertal development and growth hormone treatment. Hum Reprod. 2013;28(7):1899-907.
19. Sahin NM, Bayramoğlu E, Özcan HN, et al. Antimüllerian Hormone Levels of Infants with Premature Thelarche. J Clin Res Pediatr Endocrinol. 2019;11(3):287-92.
20. Chen T, Wu H, Xie R, et al. Serum Anti-Müllerian Hormone and Inhibin B as Potential Markers for Progressive Central Precocious Puberty in Girls. J Pediatr Adolesc Gynecol. 2017;30(3):362-6.
21. Oh SR, Choe SY, Cho YJ. Clinical application of serum anti-Mullerian hormone in women. Clin Exp Reprod Med. 2019;46(2):50-9.
2. Lindhardt JM, Hagen CP, Johannsen TH, et al. Anti-mullerian hormone and its clinical use in pediatrics with special emphasis on disorders of sex development. Int J Endocrinol. 2013; 2013:198698.
3. Jeppesen JV, Anderson RA, Kelsey TW, et al. Which follicles make the most anti-MЁullerian hormone in humans? Evidence for an abrupt decline in AMH production at the time of follicle selection. Mol Hum Reprod. 2013;19(8):519-27.
4. Bizzarri C, Cappa M. Ontogeny of Hypothalamus-Pituitary Gonadal Axis and Minipuberty: An Ongoing Debate? Front Endocrinol (Lausanne). 2020;11:187.
5. Anderson RA, Nelson SM, Wallace WHB. Measuring anti-mullerian hormone for the assessment of ovarian reserve: when and for whom is it indicated? Maturitas. 2012;71(1):28-33.
6. Kalich-Philosoph L, Roness H, Carmely A, et al. Cyclophosphamide triggers follicle activation and “burnout”; AS101 prevents follicle loss and preserves fertility. Sci Transl Med. 2013;5(185):185ra62.
7. Jamil Z, Fatima SS, Ahmed K, Malik R. Anti-Mullerian Hormone: Above and Beyond Conventional Ovarian Reserve Markers. Dis Markers. 2016;2016:5246217.
8. Bhide P, Pundir J, Homburg R, Acharya G. Biomarkers of ovarian reserve in childhood and adolescence: A systematic review. Acta Obstet Gynecol Scand. 2019;98(5):563-72.
9. Hagen CP, Aksglaede L, Sørensen K, et al. Individual serum levels of anti-Müllerian hormone in healthy girls persist through childhood and adolescence: a longitudinal cohort study. Hum Reprod. 2012;27(3):861-6.
10. Lashen H, Dunger DB, Ness A, Ong KK. Peripubertal changes in circulating antimullerian hormone levels in girls. Fertil Steril. 2013;99(7):2071-5.
11. Madison TO, Lauren C, McGrath JA, et al. AMH is Higher Across the Menstrual Cycle in Early Postmenarchal Girls than in Ovulatory Women. J Clin Endocrinol Metab. 2020;105(4):e1762-71.
12. Hagen CP, Mouritsen A, Mieritz MG, et al. Circulating AMH reflects ovarian morphology by magnetic resonance imaging and 3D ultrasound in 121 healthy girls. J Clin Endocrinol Metab. 2015;100(3):880-90.
13. Lie Fong S, Visser JA, Welt CK, et al. Serumanti-müllerian hormone levels in healthy females: a nomogram ranging from infancy to adulthood. J Clin Endocrinol Metab. 2012;9712:4650-5.
14. Zhu J, Li T, Xing W, et al. Chronological age vs biological age: a retrospective analysis on age-specific serum anti-Müllerian hormone levels for 3280 females in reproductive center clinic. Gynecol Endocrinol. 2018;34(10):890-4.
15. Lambert-Messerlian G, Plante B, Eklund EE, et al. Levels of antimüllerian hormone in serum during the normal menstrual cycle. Fertil Steril. 2016;105(1):208-13.e1.
DOI:10.1016/j.fertnstert.2015.09.033
16. Savas-Erdeve S, Sagsak E, Keskin M, et al. AMH levels in girls with various pubertal problems. J Pediatr Endocrinol Metab. 2017;30(3):333-5.
17. Karkanaki A, Vosnakis C, Panidis D. The clinical significance of anti-müllerian hormone evaluation in gynecological endocrinology. Hormones. 2011;10(2):95-103.
18. Visser JA, Hokken-Koelega ACS, Zandwijken GRJ, et al. Anti-Müllerian hormone levels in girls and adolescents with Turner syndrome are related to karyotype, pubertal development and growth hormone treatment. Hum Reprod. 2013;28(7):1899-907.
19. Sahin NM, Bayramoğlu E, Özcan HN, et al. Antimüllerian Hormone Levels of Infants with Premature Thelarche. J Clin Res Pediatr Endocrinol. 2019;11(3):287-92.
20. Chen T, Wu H, Xie R, et al. Serum Anti-Müllerian Hormone and Inhibin B as Potential Markers for Progressive Central Precocious Puberty in Girls. J Pediatr Adolesc Gynecol. 2017;30(3):362-6.
21. Oh SR, Choe SY, Cho YJ. Clinical application of serum anti-Mullerian hormone in women. Clin Exp Reprod Med. 2019;46(2):50-9.
2. Lindhardt JM, Hagen CP, Johannsen TH, et al. Anti-mullerian hormone and its clinical use in pediatrics with special emphasis on disorders of sex development. Int J Endocrinol. 2013; 2013:198698.
3. Jeppesen JV, Anderson RA, Kelsey TW, et al. Which follicles make the most anti-MЁullerian hormone in humans? Evidence for an abrupt decline in AMH production at the time of follicle selection. Mol Hum Reprod. 2013;19(8):519-27.
4. Bizzarri C, Cappa M. Ontogeny of Hypothalamus-Pituitary Gonadal Axis and Minipuberty: An Ongoing Debate? Front Endocrinol (Lausanne). 2020;11:187.
5. Anderson RA, Nelson SM, Wallace WHB. Measuring anti-mullerian hormone for the assessment of ovarian reserve: when and for whom is it indicated? Maturitas. 2012;71(1):28-33.
6. Kalich-Philosoph L, Roness H, Carmely A, et al. Cyclophosphamide triggers follicle activation and “burnout”; AS101 prevents follicle loss and preserves fertility. Sci Transl Med. 2013;5(185):185ra62.
7. Jamil Z, Fatima SS, Ahmed K, Malik R. Anti-Mullerian Hormone: Above and Beyond Conventional Ovarian Reserve Markers. Dis Markers. 2016;2016:5246217.
8. Bhide P, Pundir J, Homburg R, Acharya G. Biomarkers of ovarian reserve in childhood and adolescence: A systematic review. Acta Obstet Gynecol Scand. 2019;98(5):563-72.
9. Hagen CP, Aksglaede L, Sørensen K, et al. Individual serum levels of anti-Müllerian hormone in healthy girls persist through childhood and adolescence: a longitudinal cohort study. Hum Reprod. 2012;27(3):861-6.
10. Lashen H, Dunger DB, Ness A, Ong KK. Peripubertal changes in circulating antimullerian hormone levels in girls. Fertil Steril. 2013;99(7):2071-5.
11. Madison TO, Lauren C, McGrath JA, et al. AMH is Higher Across the Menstrual Cycle in Early Postmenarchal Girls than in Ovulatory Women. J Clin Endocrinol Metab. 2020;105(4):e1762-71.
12. Hagen CP, Mouritsen A, Mieritz MG, et al. Circulating AMH reflects ovarian morphology by magnetic resonance imaging and 3D ultrasound in 121 healthy girls. J Clin Endocrinol Metab. 2015;100(3):880-90.
13. Lie Fong S, Visser JA, Welt CK, et al. Serumanti-müllerian hormone levels in healthy females: a nomogram ranging from infancy to adulthood. J Clin Endocrinol Metab. 2012;9712:4650-5.
14. Zhu J, Li T, Xing W, et al. Chronological age vs biological age: a retrospective analysis on age-specific serum anti-Müllerian hormone levels for 3280 females in reproductive center clinic. Gynecol Endocrinol. 2018;34(10):890-4.
15. Lambert-Messerlian G, Plante B, Eklund EE, et al. Levels of antimüllerian hormone in serum during the normal menstrual cycle. Fertil Steril. 2016;105(1):208-13.e1.
DOI:10.1016/j.fertnstert.2015.09.033
16. Savas-Erdeve S, Sagsak E, Keskin M, et al. AMH levels in girls with various pubertal problems. J Pediatr Endocrinol Metab. 2017;30(3):333-5.
17. Karkanaki A, Vosnakis C, Panidis D. The clinical significance of anti-müllerian hormone evaluation in gynecological endocrinology. Hormones. 2011;10(2):95-103.
18. Visser JA, Hokken-Koelega ACS, Zandwijken GRJ, et al. Anti-Müllerian hormone levels in girls and adolescents with Turner syndrome are related to karyotype, pubertal development and growth hormone treatment. Hum Reprod. 2013;28(7):1899-907.
19. Sahin NM, Bayramoğlu E, Özcan HN, et al. Antimüllerian Hormone Levels of Infants with Premature Thelarche. J Clin Res Pediatr Endocrinol. 2019;11(3):287-92.
20. Chen T, Wu H, Xie R, et al. Serum Anti-Müllerian Hormone and Inhibin B as Potential Markers for Progressive Central Precocious Puberty in Girls. J Pediatr Adolesc Gynecol. 2017;30(3):362-6.
21. Oh SR, Choe SY, Cho YJ. Clinical application of serum anti-Mullerian hormone in women. Clin Exp Reprod Med. 2019;46(2):50-9.
________________________________________________
2. Lindhardt JM, Hagen CP, Johannsen TH, et al. Anti-mullerian hormone and its clinical use in pediatrics with special emphasis on disorders of sex development. Int J Endocrinol. 2013; 2013:198698.
3. Jeppesen JV, Anderson RA, Kelsey TW, et al. Which follicles make the most anti-MЁullerian hormone in humans? Evidence for an abrupt decline in AMH production at the time of follicle selection. Mol Hum Reprod. 2013;19(8):519-27.
4. Bizzarri C, Cappa M. Ontogeny of Hypothalamus-Pituitary Gonadal Axis and Minipuberty: An Ongoing Debate? Front Endocrinol (Lausanne). 2020;11:187.
5. Anderson RA, Nelson SM, Wallace WHB. Measuring anti-mullerian hormone for the assessment of ovarian reserve: when and for whom is it indicated? Maturitas. 2012;71(1):28-33.
6. Kalich-Philosoph L, Roness H, Carmely A, et al. Cyclophosphamide triggers follicle activation and “burnout”; AS101 prevents follicle loss and preserves fertility. Sci Transl Med. 2013;5(185):185ra62.
7. Jamil Z, Fatima SS, Ahmed K, Malik R. Anti-Mullerian Hormone: Above and Beyond Conventional Ovarian Reserve Markers. Dis Markers. 2016;2016:5246217.
8. Bhide P, Pundir J, Homburg R, Acharya G. Biomarkers of ovarian reserve in childhood and adolescence: A systematic review. Acta Obstet Gynecol Scand. 2019;98(5):563-72.
9. Hagen CP, Aksglaede L, Sørensen K, et al. Individual serum levels of anti-Müllerian hormone in healthy girls persist through childhood and adolescence: a longitudinal cohort study. Hum Reprod. 2012;27(3):861-6.
10. Lashen H, Dunger DB, Ness A, Ong KK. Peripubertal changes in circulating antimullerian hormone levels in girls. Fertil Steril. 2013;99(7):2071-5.
11. Madison TO, Lauren C, McGrath JA, et al. AMH is Higher Across the Menstrual Cycle in Early Postmenarchal Girls than in Ovulatory Women. J Clin Endocrinol Metab. 2020;105(4):e1762-71.
12. Hagen CP, Mouritsen A, Mieritz MG, et al. Circulating AMH reflects ovarian morphology by magnetic resonance imaging and 3D ultrasound in 121 healthy girls. J Clin Endocrinol Metab. 2015;100(3):880-90.
13. Lie Fong S, Visser JA, Welt CK, et al. Serumanti-müllerian hormone levels in healthy females: a nomogram ranging from infancy to adulthood. J Clin Endocrinol Metab. 2012;9712:4650-5.
14. Zhu J, Li T, Xing W, et al. Chronological age vs biological age: a retrospective analysis on age-specific serum anti-Müllerian hormone levels for 3280 females in reproductive center clinic. Gynecol Endocrinol. 2018;34(10):890-4.
15. Lambert-Messerlian G, Plante B, Eklund EE, et al. Levels of antimüllerian hormone in serum during the normal menstrual cycle. Fertil Steril. 2016;105(1):208-13.e1.
DOI:10.1016/j.fertnstert.2015.09.033
16. Savas-Erdeve S, Sagsak E, Keskin M, et al. AMH levels in girls with various pubertal problems. J Pediatr Endocrinol Metab. 2017;30(3):333-5.
17. Karkanaki A, Vosnakis C, Panidis D. The clinical significance of anti-müllerian hormone evaluation in gynecological endocrinology. Hormones. 2011;10(2):95-103.
18. Visser JA, Hokken-Koelega ACS, Zandwijken GRJ, et al. Anti-Müllerian hormone levels in girls and adolescents with Turner syndrome are related to karyotype, pubertal development and growth hormone treatment. Hum Reprod. 2013;28(7):1899-907.
19. Sahin NM, Bayramoğlu E, Özcan HN, et al. Antimüllerian Hormone Levels of Infants with Premature Thelarche. J Clin Res Pediatr Endocrinol. 2019;11(3):287-92.
20. Chen T, Wu H, Xie R, et al. Serum Anti-Müllerian Hormone and Inhibin B as Potential Markers for Progressive Central Precocious Puberty in Girls. J Pediatr Adolesc Gynecol. 2017;30(3):362-6.
21. Oh SR, Choe SY, Cho YJ. Clinical application of serum anti-Mullerian hormone in women. Clin Exp Reprod Med. 2019;46(2):50-9.
Авторы
З.Х. Кумыкова*, Е.В. Уварова, З.К. Батырова
ФГБУ «Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии имени академика В.И. Кулакова» Минздрава России, Москва, Россия
*zai-kumykova@yandex.ru
Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russia
*zai-kumykova@yandex.ru
ФГБУ «Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии имени академика В.И. Кулакова» Минздрава России, Москва, Россия
*zai-kumykova@yandex.ru
________________________________________________
Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russia
*zai-kumykova@yandex.ru
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