联合抗缪勒管激素、硫酸脱氢表雄酮与性激素诊断多囊卵巢综合征的探讨  

A Study of the Diagnosis Value by Combining Anti-Mullerian Hormone,Dehydroepiandrosterone Sulfate,and Sex Hormone in Polycystic Ovarian Syndrome

作　　者：史丽娜 谢飞 田野[1] 刘晴[1] 聂秋燕 王晓宁[1] 古媛[1] 韩旭 贺椒莉 谭延国[1] SHI Lina;XIE Fei;TIAN Ye;LIU Qing;NIE Qiuyan;WANG Xiaoning;GU Yuan;HAN Xu;HE Jiaoli;TAN Yanguo(Clinical Laboratory,Fu Xing Hospital,Capital Medical University,Beijing 100038,China)

机构地区：[1]首都医科大学附属复兴医院检验科,北京100038

出　　处：《标记免疫分析与临床》2024年第10期1770-1774,1786,共6页Labeled Immunoassays and Clinical Medicine

基　　金：北京市临床重点专科医学检验科培育项目(编号:京卫医[2020]129号)。

摘　　要：目的探讨抗缪勒管激素(AMH)、硫酸脱氢表雄酮(DHEA-S)与性激素联合检测对多囊卵巢综合征(PCOS)的诊断价值。方法选取PCOS患者、年龄匹配的健康女性各80例作为PCOS组和对照组。探讨两组血清AMH、DHEA-S、卵泡刺激素(FSH)、黄体生成素(LH)、LH/FSH、泌乳素(PRL)、雌二醇(E_(2))、孕酮(P)、睾酮(T)、性激素结合球蛋白(SHBG)、游离雄激素指数(FAI)水平的差异,以及各指标单独与联合检测对PCOS的诊断价值。结果(1)PCOS组与对照组血清AMH、DHEA-S、LH、LH/FSH、T、FAI、E_(2)水平均有显著差异(P<0.05)。(2)AMH和DHEA-S均为育龄女性发生PCOS的独立危险因素(P<0.001、P=0.022)。(3)PCOS组AMH分别与LH、LH/FSH和T水平呈正相关(r=0.356、0.288、0.292,P=0.001、0.01、0.009);DHEA-S水平分别与P、T和FAI呈正相关(r=0.255、0.522、0.404,P=0.022、<0.001、<0.001),与SHBG呈负相关(r=-0.224,P=0.046)。(4)AMH=6.065ng/mL时AUC(0.881)最大,诊断PCOS的灵敏度为75.0%、特异性92.3%;联合AMH和DHEA-S时AUC为0.933,灵敏度85.0%、特异性91.2%;5项指标联合(AMH+DHEA-S+LH/FSH+LH+E_(2))时AUC为0.95,灵敏度86.5%,特异性97.2%。7项指标联合AUC(0.95)虽无改变,但灵敏度88.8%,特异性93.7%。结论血清AMH、DHEA-S水平可作为育龄女性发生PCOS的独立危险因素;AMH与DHEA-S联合检测,或AMH、DHEA-S、性激素联合检测可在一定程度上提升PCOS患者的诊断效能。Objective To evaluate on the diagnosis value by combining AMH,DHEA-S,and sex hormone in PCOS.Methods A total of 80 patients with PCOS and 80 age-matched healthy women were selected as the PCOS group and control group,respectively.We evaluated the difference of AMH,DHEA-S,follicle stimulating hormone(FSH),luteinizing hormone(LH),LH/FSH,prolactin(PRL),estradiol(E_(2)),progesterone(P),testosterone(T),sex hormone binding(SHBG)and free testosterone index(FAI)in their serum level between these two groups,as well as their diagnostic value of single or joint use in PCOS patients.Results①There were significant differences in serum AMH,DHEA-S,LH,LH/FSH,T,FAI and E_(2)levels between PCOS group and the control group(P<0.05);②AMH and DHEA-S were both independent risk factors for PCOS women of reproductive age(P<0.001,P=0.022);③In PCOS group,the level of AMH was positively correlated with LH,LH/FSH and T(r=0.356,0.288,0.292;P=0.001,0.01,0.009);DHEA-S level was also positively correlated with P,T and FAI(r=0.255,0.522,0.404;P=0.022,<0.001,<0.001),but negatively correlated with SHBG(r=-0.224,P=0.046);④Area under the curve(AUC)was the largest(0.881)when AMH level was 6.065 ng/mL,with sensitivity of 75%and specificity of 92.3%for PCOS diagnosis;When both AMH and DHEA-S were utilized,AUC was 0.933,with sensitivity of 85%and specificity of 91.2%;ROC curve was 0.95,when 5 tests of AMH,DHEA-S,LH/FSH,LH,and E_(2)were combined,with sensitivity of 86.5%and specificity of 97.2%;AUC was also 0.95 when all of the 7 tests were combined,with sensitivity of 88.8%and specificity of 93.7%.Conclusion Both serum AMH and DHEA-S levels are independent risk factors for PCOS women of reproductive age.The joint use of AMH,DHEA-S,and other sex hormone could effectively improve the diagnosis efficiency for PCOS patients.

关 键 词：抗缪勒管激素 硫酸脱氢表雄酮 多囊卵巢综合征 性激素 

分 类 号：R711.5[医药卫生—妇产科学]