여성 생식에서 Anti-Müllerian Hormone의 역할
Anti-Müllerian hormone and female reproduction
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Anti-Müllerian hormone (AMH)은 transforming growth factor (TGF)-β superfamily의 멤버 중 하나이다. AMH는 남성 태아의 고환에서 분비되어 Müllerian duct의 퇴화를 유발하는 역할을 하며, 여성에서는 난포의 과립막세포 (granulosa cell)에서 분비된다. 최근 들어 많은 연구 결과들이 발표되어 AMH가 난소기능의 유용한 지표로서 역할을 할 수 있다는 사실이 규명되었다. 혈중 AMH 농도는 나이에 따라 점차 감소하여 폐경 이후에는 검출되지 않으며, 생리주기에 따른 변화는 없다. 또한 AMH는 과배란유도의 여러 결과 지표들과 유의한 상관관계를 보인다. 많은 연구에서 AMH는 과배란유도 시 불량반응 (poor responder), 주기 취소, 난소과자극 증후군을 매우 효과적으로 예측할 수 있다는 사실이 입증되었다. 아울러 AMH는 난포발달에 있어 기능적인 역할을 가지고 있으며 난포상태를 반영하는 질적인 지표로서의 역할도 가지고 있다. 이 밖에도 AMH는 다낭성 난소증후군, 자궁내막증, 비만, 과립막세포 종양, 조기 난소부전증 등 다양한 질환과 관련하여 그 이용가치가 밝혀지고 있다. AMH는 여성 생식과 관련된 다양한 분야에 있어서 이용가치가 매우 높을 것으로 기대되는 지표이다. 본 논문에서는 난소기능 지표로서 AMH의 역할에 관한 최신 연구 결과들에 관하여 기술하고자 한다.
Abstract
Anti-Müllerian hormone (AMH), also called Müllerian-inhibiting substance, is a member of the transforming growth factor (TGF)-β superfamily. It is well known that AMH is expressed by Sertoli cells in fetal testis, and that it induces Müllerian duct degeneration during male fetal development. However, in females AMH is produced by granulosa cells of the ovarian follicles. Recently, numerous studies have demonstrated that AMH could be a useful marker of ovarian function. Serum AMH levels decrease progressively with age, become undetectable after menopause, and show high cycle-to-cycle reproducibility. It has been shown that AMH level is correlated with various outcomes of controlled ovarian hyperstimulation (COH). Many studies showed that AMH can discriminate very effectively poor responders, cycle cancellation, and ovarian hyperstimulation syndrome after COH. AMH also has a functional role in folliculogenesis and could be a qualitative marker of ovarian follicular states. In addition, AMH has been associated with various clinical statuses such as polycystic ovarian syndrome, endometriosis, obesity, granulosa cell tumor, and premature ovarian failure. AMH is an effective and promising biomarker of various conditions in female reproduction. In this article, current research results on role of AMH as a marker of ovarian function and dysfunction are discussed.
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