Changes In The Levels Of Anti-Mullerian Hormone And Its Relationship With Sex Hormones In Different Developmental Stages

ObjectiveAt present,Anti-Mullerian Hormone(AMH)is a reliable indicator to evaluate the function of ovarian reserve and plays an incomparable role in the diagnosis of children’s endocrine diseases.It is of great value to analyze the changes of AMH levels in different developmental stages for the diagnosis of children’s sexual development and related diseases in the future.The aim of this study is to analyze the relationships between AMH and other indicators of sexual development,so as to better evaluate the development stages of girls comprehensively,and to provide guidance for the evaluation of preadolescent abnormal development,and to make more timely intervention and management of preadolescent abnormal problems.MethodsThe research samples were choosed from pediatric endocrine clinic of Yangzhou University Clinical Medical College(Subei People’s Hospital),after checked the basic information according to inclusion criteria,1146 girls were included in the study.The samples were divided into mini-puberty group(148 cases),peripheral precocious puberty group(123 cases),central precocious puberty group(168 cases)(Gn RH provocation tests had been done in all patients at this group),slowly progressive early puberty group(318 cases),early and fast puberty group(176 cases),normal puberty group(213 cases).The following data were collected: AMH,age and bone age,volume of ovarian(Vov),volume of uterine(Vut),luteinizing hormone(LH),follicle Stimulating hormone(FSH),estradiol(E2).According to different types of data,the following statistic methods were used by SPSS 26 software :Kolmogorov-Smirnov test,non-parametric Wilcoxon sign rank sum test,Mann-Whitney U test,Kruskal-Wallis H test,Spearman correlation analysis and so on.The variation trend and value range of AMH level at each developmental stage were campared,and the relationship between AMH level and other developmental indicators was also analyzed.Results1.There was a significant difference in the distribution of AMH at each developmental stage(P < 0.05),and the values were shown as follows: represented by the median(P 2.5,P 97.5),1.84(0.43-7.37)ng/ml at mini-puberty,3.29(0.58-9.15)ng/ml at peripheral precocious puberty,3.38(0.54-9.09)ng/ml at central precocious puberty,3.93(1.30-11.53)ng/ml at slowly progressive early puberty,2.52(0.62-9.34)ng/ml at early and fast puberty,and 3.51(0.78-11.75)ng/ml at normal puberty.The levels of AMH in early and fast puberty are lowest in other stages of sexual development at similar ages.2.AMH concentration of 1.84(0.43-7.37)ng/ml in the mini-puberty group was higher than that in the reference range of healthy girls of the same age 1.37(0.24-5.99)g/L.AMH level was positively correlated with age,BA and Vut(r = 0.326,0.345,0.259,respectively),and negatively correlated with FSH(r =-0.566)(P < 0.05).There was no statistical correlation with Vov,LH,E2(P > 0.05).3.AMH concentration in the peripheral precocious puberty group was positively correlated with age,BA,Vov,Vut(r = 0.251,0.194,0.240,0.427,respectively),and negatively correlated with FSH(r =-0.269)(P< 0.05),There was no statistical correlation with LH and E2(P> 0.05).4.There was no statistically significant difference in the distribution of AMH in the central precocious puberty and peripheral precocious puberty groups,but the distribution of AMH in the progressive central precocious puberty group was significantly lower than that in the peripheral precocious puberty group(2.68±2.38 VS 3.29±2.61,Z=-2.277,P<0.05).In the central precocious puberty group,AMH concentration was positively correlated with Vut(r = 0.203),and negatively correlated with BA,LH,and FSH(r =-0.155,-0.247,-0.347,respectively)(P < 0.05).There was no statistical correlation with age,Vov and E2(P > 0.05).5.AMH concentration in the slowly progressive early puberty group was positively correlated with Vut(r = 0.261)and negatively correlated with BA,LH,and FSH(r =-0.140,-0.158,-0.259,respectively)(P< 0.05).There was no statistical correlation with age,Vov and E2(P> 0.05).6.AMH concentration in the arly and fast puberty group was significantly lower than that of slowly progressive early puberty at the same stage(2.52±2.50 VS 3.93±3.16,H=7.012,P<0.05).There was a negative correlation between AMH concentration and age,BA,Vov,LH,FSH(r =-0.305,-0.279,-0.425,-0.458,-0.336,respectively)(P< 0.05).There was no statistical correlation with Vut and E2(P> 0.05).7.In the normal puberty group,AMH concentration was negatively correlated with age,BA,Vov,LH,FSH,and E2(r =-0.194、-0.332、-0.348、-0.416、-0.533、-0.205,respectively)(P < 0.05).There was no statistical correlation between Vut and Vut(P> 0.05).Conclusions1.The lowest AMH concentration is found in mini-puberty.The concentration of AMH in arly and fast puberty is significantly lower than that in peripheral precocious puberty,central precocious puberty,slowly progressive early puberty and normal puberty.2.AMH concentration are increased in mini-puberty compare with the healthy girls of same age,which may inhibit sexual development through negative feedback.3.Rapid maturation of HPGA can lead to a temporary decrease in AMH concentration,which may be related to the redistribution of follicle pool.4.In the mini-puberty group and the central precocious puberty group,AMH has a self-regulating effect,leading to the normal development of sexual development.5.There is a negative correlation between AMH concentration and FSH at all stages;and a positive correlation between AMH concentration and Vov,Vut,E2,BA and age in the incomplete HPGA startup group,In the complete HPGA initiated group.there is a negative correlation with Vov,LH,FSH,E2,BA and age.6.The various correlations between AMH and sexual development indexes are existed in different developmental stages,which may be related to the developmental periods of organism and the developmental state of follicles.