抗苗勒管激素和内分泌代谢指标在多囊卵巢综合征诊断中的应用  

Application of anti-Müllerian hormone and hormone metabolic parameters in the diagnosis of polycystic ovary syndrome

作　　者：陈颖 陆娄凯奕 张倩岚 岳朝艳[1] Chen Ying;Lu Loukaiyi;Zhang Qianlan;Yue Chaoyan(Shanghai Jiai Genetics Obstetrics ＆ IVF Institute-China USA Center,Obstetrics and Gynecology Hospital of Fudan University,Shanghai 200011,China)

机构地区：[1]中美合作上海集爱遗传与不育诊疗中心,复旦大学附属妇产科医院,200011

出　　处：《中华生殖与避孕杂志》2018年第10期847-851,共5页Chinese Journal of Reproduction and Contraception

摘　　要：目的建立用于检测多囊卵巢综合征(PCOS)患者的血清抗苗勒管激素(AMH)和其他激素代谢指标的临床截断值。方法本研究共纳入653名PCOS患者,同时纳入118名健康妇女作为对照组。分析血清AMH、卵泡刺激素(FSH)、黄体生成素(LH)、FSH/LH、催乳素(PRL)、雌二醇(E2)、睾酮(T)、硫酸脱氢表雄酮(DHEA-S)、性激素结合球蛋白(SHBG)、17α-OH孕酮(17α-OHP)、空腹胰岛素(INS)、空腹血糖(GLU)、胰岛素抵抗指数(HOMA-IR)的水平,通过受试者工作特征(ROC)曲线评估AMH、LH/FSH、T和INS诊断多囊卵巢的诊断效能。以AMH、LH/FSH、T和INS为自变量,建立logistic回归模型,并根据概率值拟合联合检测的ROC曲线。结果与对照相比,PCOS患者血清FSH、LH、LH/FSH、AMH、游离雄激素指数(FAI)、17α-OHP、空腹INS、T、SHBG、DHEA-S和HOMA-IR差异均有统计学意义(P均<0.05)。针对20～29岁的女性,AMH作为PCOS的诊断指标的临床截断值为8.16 mg/L,ROC曲线下面积为0.846,针对30～34岁女性的截断值为6.98 mg/L,ROC曲线下面积为0.845,针对35～39岁女性的截断值为5.65 mg/L,ROC曲线下面积为0.832。AMH、LH/FSH、T和INS联合检测PCOS的ROC曲线下面积为0.951。结论 20～29岁PCOS患者的AMH的截断值为8.16 mg/L,30～34岁为6.98 mg/L,35～39岁为5.65 mg/L。血清AMH、LH/FSH、T和INS可以作为PCOS诊断的有效检测指标,这些标志物的联合检测可以提高PCOS的诊断特异性和敏感性。ObjectiveTo establish the threshold of anti-Müllerian hormone （AMH） and other hormone metabolic parameters for detection of polycystic ovary syndrome （PCOS） in China. MethodsA total of 653 PCOS patients and 118 healthy controls were enrolled in this study. The serum AMH, follicle stimulating hormone （FSH）, luteinizing hormone（LH）, FSH/LH, prolactin （PRL）, estradiol （E2）, testosterone （T）, dehydroepiandrosterone sulfate （DHEA-S）, sex hormone binding globulin （SHBG）, 17α-OH progesterone （17α-OHP）, fasting insulin （INS）, fasting glucose （GLU） and HOMA-IR were analyzed and the diagnostic utility of AMH, LH/FSH, T and INS were established using receiver operator characteristic （ROC） curves. With AMH, LH/FSH, T and INS as independent variables, the logistic regression model was established, and the ROC curve of joint detection was fitted by the probability value in the model. ResultsThe serum level of FSH, LH, LH/FSH, AMH, free androgenindex （FAI）, 17α-OHP, fasting INS, T, SHBG, DHEA-S and HOMA-IR were changed in PCOS. The best compromise between sensitivity and specificity was found at an AMH cut-off level of 8.16 μg/L, 6.98 μg/L and 5.65 μg/L, and the area under the curve for AMH identifying polycystic ovaries were 0.846, 0.845 and 0.832 for 20-29, 30-34 and 35-39 years old women, respectively. The area under ROC curve of joint detection was 0.951. ConclusionThe cut-off level of AMH was 8.16 μg/L for PCOS during 20-29 years old, 6.98 μg/L for PCOS during 30-34 and 5.65 μg/L for PCOS during 35-39 years old women in China. Serum AMH, LH/FSH, T and INS had the capacity to act as a diagnostic test for PCOS. Combined detection of these markers can improve the diagnostic specificity and sensitivity of PCOS.

关 键 词：抗苗勒管激素(AMH) 多囊卵巢综合征(PCOS) 高雄激素血症 胰岛素抵抗(IR) 

分 类 号：R711.75[医药卫生—妇产科学]