质谱法与雄激素多指标联合检测在多囊卵巢综合征诊断中的应用  

Application of androgen multi-index combined detection by mass spectrometry in the diagnosis of polycystic ovarian syndrome

作　　者：马雪莲[1] 陆月红[2] 严李萍[2] 钦博 丁杰锋[1] 应群华[1] MA Xue-lian;LU Yue-hong;YAN Li-ping;QIN Bo;DING Jie-feng;YING Qun-hua(Department of Clinical Laboratory,Shaoxing Maternal and Child Health Care Hospital,Shaoxing,Zhejiang 312000,China;不详)

机构地区：[1]绍兴市妇幼保健院检验科,浙江绍兴312000 [2]绍兴市妇幼保健院生殖健康科,浙江绍兴312000

出　　处：《中国卫生检验杂志》2022年第18期2237-2241,共5页Chinese Journal of Health Laboratory Technology

基　　金：绍兴市科技局公益性技术应用研究计划项目(2018C3-0038)。

摘　　要：目的通过液相色谱-串联质谱法(LC-MS/MS)对多囊卵巢综合征(PCOS)患者进行雄激素多指标的联合检测,以提升PCOS的诊断率,并探讨实现PCOS高雄激素血症(HA)早期筛查的临床意义。方法LC-MS/MS法检测85例PCOS患者及40例对照女性各雄激素指标,绘制ROC曲线,计算曲线下面积(AUC),运用联合指标提升PCOS的诊断效能,并区分PCOS高雄激素血症的不同雄激素表型;比较LC-MS/MS法与化学发光法对HA的检出率,同时比较LC-MS/MS法筛选出的HA组和非HA组内分泌及代谢异常发生率。结果睾酮(T)、游离睾酮(FT)和雄烯二酮(A4)三联指标的AUC为0.856,诊断价值高,T、A4、FT、DHEAS、DHEA五联指标AUC为0.855,诊断价值较高,LC-MS/MS法检出HA患者40例(占40.00%),显著高于化学发光法检出的25例(占29.41%)(P<0.05),而由该法筛选出的HA组内分泌及代谢异常发生率显著高于非HA组。结论LC-MS/MS法与雄激素多指标联合检测灵敏性高、准确度好,优于单指标检测,能有效提升PCOS的诊断率,实现HA的早期筛查,预防远期并发症;同时该法能识别PCOS高雄激素血症的不同雄激素表型,有利于临床实施精准治疗。Objective Joint detection of androgen multi indicators by liquid chromatography-tandem mass spectrometry(LC-MS/MS)in patients with polycystic ovarian syndrome(PCOS)to improve the diagnostic rate of PCOS,and explore the clinical significance of achieving the early screening for PCOS hyperandrogenemia(HA).Methods LC-MS/MS method was adopted to detect each androgen indicator of 85 PCOS patients and 40 control women,the ROC curve was drawn to calculate the area under the curve(AUC);the combination indicators were used to improve the diagnostic efficacy of PCOS,and the different androgen phenotypes of PCOS hyperandrogenemia patients were distinguished;The detection rate of HA was compared between LC-MS/MS method and chemiluminescence method,and the incidence of endocrine and metabolic abnormalities between HA group and non-HA group screened by LC-MS/MS method was compared.Results The AUC of the triad indicator composed of T,FT and A4 is 0.856,which has a high diagnostic value.However,the AUC containing the five-linked indicator of T,A4,FT,DHEAS,DHEA was 0.855 with high diagnostic value.40 cases of HA patients(40.00%)were detected by LC-MS/MS method,significantly higher than the 25 cases detected by chemiluminescence(29.41%)(P<0.05),while the incidence of endocrine and metabolic abnormalities was significantly higher in the HA group than in the non-HA group screened by this method.Conclusion Joint detection of androgen multi indicators by LC-MS/MS method has high sensitivity and good accuracy,and better than single index detection,which can effectively improve the diagnostic rate of PCOS,realize the early screening of HA,and prevent the long-term complications.At the same time,this method can identify the different androgen phenotypes of PCOS hyperandrogenemia,which is conducive to the clinical implementation of precision treatment.

关 键 词：液相色谱-串联质谱法 多囊卵巢综合征 高雄激素血症 雄激素多指标联合检测 雄激素表型 

分 类 号：R711.75[医药卫生—妇产科学]