背景:已知抗苗勒管激素(AMH)的水平与生活方式决定因素有关,例如吸烟和口服避孕药(OC)的使用。在临床实践中测量AMH时,有必要了解哪些因素可能影响循环水平或总体卵巢储备。
目标:迄今为止,对于AMH与可改变的生活方式因素之间的关系的性质和程度,没有系统评价或总结共识.这篇综述的目的是系统地评估生活方式行为与循环AMH水平相关的证据。
方法:我们对Embase和PubMed关于生活方式因素BMI的出版物进行了预先注册的系统综述,吸烟,OC使用,酒精消费,咖啡因消费,身体活动,和腰臀比(WHR)与截至2023年11月1日的循环AMH水平的关系。搜索策略包括“抗苗勒管激素”等术语,\'生活方式\',和“女人”。如果在成年女性中评估了至少一种感兴趣的生活方式因素与AMH之间的关联,则认为研究合格。纳入研究的质量使用国家心脏的研究质量评估工具进行评估,肺,血液研究所。结果以最常用的关联度量的范围表示,这些研究发现了同一方向的显着关联。
结果:共确定了15072条记录,其中65项研究符合纳入条件,66.2%的研究采用横断面设计。大多数调查BMI的研究,吸烟,OC使用,体力活动报告与AMH水平呈显著负相关。对于WHR,酒精,和咖啡因的使用,大多数研究未发现与AMH相关.对于所有决定因素,所报告的关联的效应量度是异质的.在发现显着的负相关的研究中,BMI每单位增加的AMH水平的平均差异在-0.015至-0.2ng/ml之间。当前吸烟者与非吸烟者的AMH水平的平均差异为-0.4至-1.1ng/ml,和-4%到-44%,分别。对于当前使用的OC,结果包括AMH水平的相对平均差异范围为-17%至-31.1%,除了减少11个年龄标准化百分位数,使用OC9周后平均下降1.97ng/ml。在患有多囊卵巢综合征或久坐的生活方式的女性中,运动干预导致12周后AMH水平降低2.8pmol/l至13.2pmol/l。
结论:生活方式因素与AMH水平的差异相关,因此在解释个体AMH测量时应予以考虑。此外,AMH水平可以受到生活方式行为改变的影响。虽然这可能是临床和生活方式咨询的有用工具,观察到的AMH差异与真实卵巢储备之间的关系性质尚待评估.
背景:PROSPERO注册ID:CRD42022322575。
BACKGROUND: Levels of anti-Müllerian hormone (AMH) are known to be associated with lifestyle determinants such as smoking and oral contraception (OC) use. When measuring AMH in clinical practice, it is essential to know which factors may influence circulating levels or ovarian reserve in general.
OBJECTIVE: To date, there is no systematic
review or summarizing consensus of the nature and magnitude of the relation between AMH and modifiable lifestyle factors. The purpose of this
review was to systematically assess the evidence on association of lifestyle behaviors with circulating AMH levels.
METHODS: We performed a pre-registered systematic
review of publications in Embase and PubMed on the lifestyle factors BMI, smoking, OC use, alcohol consumption, caffeine consumption, physical activity, and waist-hip ratio (WHR) in relation to circulating AMH levels up to 1 November 2023. The search strategy included terms such as \'Anti-Mullerian hormone\', \'lifestyle\', and \'women\'. Studies were considered eligible if the association between at least one of the lifestyle factors of interest and AMH was assessed in adult women. The quality of included studies was assessed using the Study Quality Assessment Tools of the National Heart, Lung, and Blood Institute. The results were presented as ranges of the most frequently used association measure for studies that found a significant association in the same direction.
RESULTS: A total of 15 072 records were identified, of which 65 studies were eligible for inclusion, and 66.2% of the studies used a cross-sectional design. The majority of studies investigating BMI, smoking, OC use, and physical activity reported significant inverse associations with AMH levels. For WHR, alcohol, and caffeine use, the majority of studies did not find an association with AMH. For all determinants, the effect measures of the reported associations were heterogeneous. The mean difference in AMH levels per unit increase in BMI ranged from -0.015 to -0.2 ng/ml in studies that found a significant inverse association. The mean difference in AMH levels for current smokers versus non-smokers ranged from -0.4 to -1.1 ng/ml, and -4% to -44%, respectively. For current OC use, results included a range in relative mean differences in AMH levels of -17% to -31.1%, in addition to a decrease of 11 age-standardized percentiles, and an average decrease of 1.97 ng/ml after 9 weeks of OC use. Exercise interventions led to a decrease in AMH levels of 2.8 pmol/l to 13.2 pmol/l after 12 weeks in women with polycystic ovary syndrome or a sedentary lifestyle.
CONCLUSIONS: Lifestyle factors are associated with differences in AMH levels and thus should be taken into account when interpreting individual AMH measurements. Furthermore, AMH levels can be influenced by the alteration of lifestyle behaviors. While this can be a helpful tool for clinical and lifestyle counseling, the nature of the relation between the observed differences in AMH and the true ovarian reserve remains to be assessed.
BACKGROUND: PROSPERO registration ID: CRD42022322575.