高雄激素和非高雄激素型多囊卵巢综合征患者血清抗苗勒管激素分泌特点及诊断效能比较  

Comparisons of Secretive Profile and Diagnostic Power of Anti-Mullerian Hormone in Women with Polycystic Ovaries With and Without Hyperandrogenism

作　　者：李轶[1] 李瑞岐[1] 欧颂邦 张宁峰[1] 陈向红[1] 张清学[1] 杨冬梓[1] 

机构地区：[1]中山大学孙逸仙纪念医院生殖医学中心,广东广州510120

出　　处：《实用妇产科杂志》2014年第2期111-115,共5页Journal of Practical Obstetrics and Gynecology

基　　金：国家自然科学基金(编号:81200417);教育部博士点新教师基金(编号:20120171120093);广东省自然基金博士启动项目(编号:S2012040007621);广东省医学科研基金(编号:B201204);中山大学青年教师培育项目(编号:B002012002);中山大学孙逸仙纪念医院"逸仙医学人才"培养计划;广州市珠江科技新星专项基金

摘　　要：目的:比较抗苗勒管激素(AMH)在高雄激素和非高雄激素型多囊卵巢综合征(PCOS)患者的分泌特点和诊断效能,对发病机制进行探讨。方法:纳入具有排卵障碍的PCOS患者131例(高雄组62例,非高雄组69例),另外纳入61例输卵管或男方因素不孕的患者为对照组。采用酶联免疫吸附法和化学发光法检测并比较3组患者血清中AMH、性激素、糖脂代谢等生化指标,采用ROC曲线评估AMH对PCOS患者的诊断效能;采用Pearman's相关法分析高雄和非高雄型PCOS患者血清AMH水平与其他各参数间的关系。结果:①PCOS患者血清AMH水平显著高于对照组(P<0.05),高雄组又显著高于非高雄组(P<0.05)。②AMH诊断高雄组PCOS患者的AUC为0.82,敏感性为82%,特异性为64%。AMH诊断非高雄组PCOS患者的AUC为0.66,敏感性为64%,特异性为62%。③高雄组PCOS患者AMH与FSH呈负相关(r=-0.42,P=0.05),与LH呈正相关(r=0.46,P<0.05)。非高雄组PCOS患者AMH与HDL呈负相关(r=-0.28,P<0.05),与BMI、空腹血糖和LDL呈正相关(r=0.26;r=0.27;r=0.29,P<0.05)。结论:AMH适合于诊断某种特定亚型如高雄激素型PCOS,对非高雄激素型PCOS的诊断准确性较低,由此也反映出两种亚型患者发病机制可能存在差异。Objective：To compare the secretory profiles and diagnostic power of anti-Mullerian hormone （AMH） for the PCOS patient with and without hyperandrogenism. Methods ：131 PCOS patients with oligo- menorrhea or amenorrhea（62 for hyperandrogenism （ HA ＋ ）and 69 for hyperandrogenism （HA-） were recrui- ted into the study as study group;61 infertility patients because of oviduct factors were included as control group. Pearman＇s analysis were used to evaluate the relationship between the levels of AMH and basal sexu- al hormones,glucose and lipid metabolic indicators. Results：①The AMH serum levels of PCOS patients were significantly higher than those of control group,with the highest AMH serum level in the HA ＋ group.②The area under curve for predicting PCOS patients in the HA ＋group was 0. 82, with a sensitivity of 82%, and specificity of 64%. The area under curve for predicting PCOS patients in the HA-group was 0.66,with a sen- sitivity of 64%, and specificity of 62%. ③ln the HA ＋ group, AMH was negatively associated with FSH （ r = - 0. 42, P = 0.05） and positively associated with LH （ r = - 0.46, P 〈 0.05 ）. In the HA-group, AMH was negatively associated with HDL（ r = -0, 28, P 〈 0.05）and positively associated with BMI ,fasting glucose andLDL（r=0.26;r=0.27;r=0.29,P〈0.05）. Conclusions：AMH is only suitable for predicting the PCOS pa- tients with hyperandrogenism. The diagnostic power of AMH is limited when used to predict patients without hyperandrogenism,which to some degree reflects the differences in pathophysiology between the two sub- types.

关 键 词：多囊卵巢综合征 抗苗勒管激素 高雄激素血症 卵泡发育 

分 类 号：R711.6[医药卫生—妇产科学]