抗苗勒管激素在多囊卵巢综合征中的临床应用
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摘要
目的研究血清抗苗勒管激素(AMH)在多囊卵巢综合征(PCOS)诊断中的临床价值。方法选择2014年12月-2016年12月本院PCOS患者97例为研究组,分为多囊卵巢组(31例)、高雄激素组(37例)和经典组(29例);另收集90例月经正常妇女为对照组,比较各组血清AMH、性激素、糖代谢指标水平,测定BMI、卵巢体积及卵泡数。结果研究组AMH、总睾酮(T)、黄体生成素(LH)、LH/FSH比值、血糖(FPG)、胰岛素(FIN)、胰岛素抵抗指数(HOMA-IR)、卵泡数及卵巢体积高于对照组,差异均有统计学意义(P均<0.05);多囊样卵巢组T及AMH含量明显低于经典组及高雄激素组,差异有统计学意义(P均<0.05);研究组血清AMH水平与BMI呈负相关(P<0.05),与T、LH、LH/FSH比值、卵泡数目、HOMA-IR呈正相关(P均<0.05);AMH用于诊断PCOS的AUC值为0.893;当cut-off值为60.1 pmol/L,其敏感度为89.1%,特异度为80.5%。结论 PCOS患者血清AMH水平显著较高,可作为PCOS诊断和研究的重要指标。
Objective To evaluate the diagnosis value of anti-Mullerian hormone( AMH) for polycystic ovary syndrome( PCOS). Methods 97 PCOS patients were recruited as study group from our hospital during Dec. 2014-Dec. 2016,including polycystic ovary subgroup( 31 cases),high-testosterone subgroup( 37 cases) and the classic subgroup( 29 cases); meanwhile,90 women with normal menstrual cycle were selected in the control group. The BMI,ovarian volume and the number of small follicle among the different groups were compared and the levels of hormonal and metabolic parameters were detected.Results The values of AMH,total testosterone( T),luteinizing hormone( LH),FPG,insulinum( FIN) and LH/FSH ratio,HOMA-IR,total ovarian volume,mean number of small follicle in study group were significantly higher than those in control group,with the differences statistically significant( all P < 0. 05). The values of AMH and T in polycystic ovary subgroup were significantly lower than those in classic subgroup and high-testosterone subgroup,with the differences statistically significant( all P < 0. 05). Serum AMH in study group was negatively related to BMI( P < 0. 05) and positively related to T,LH,LH/FSH ratio,mean number of small follicle,HOMA-IR( all P < 0. 05). The area under the ROC curve for PCOS diagnosed by AMH was 0. 893. When the threshold of AMH for PCOS diagnosis was 60. 1 pmol/L,the sensitivity was 89. 1% and specificity was 80. 5%. Conclusion The serum levels of AMH are high in PCOS group and could be a important indicators for the diagnosis and research of PCOS.
Objective To evaluate the diagnosis value of anti-Mullerian hormone( AMH) for polycystic ovary syndrome( PCOS). Methods 97 PCOS patients were recruited as study group from our hospital during Dec. 2014-Dec. 2016,including polycystic ovary subgroup( 31 cases),high-testosterone subgroup( 37 cases) and the classic subgroup( 29 cases); meanwhile,90 women with normal menstrual cycle were selected in the control group. The BMI,ovarian volume and the number of small follicle among the different groups were compared and the levels of hormonal and metabolic parameters were detected.Results The values of AMH,total testosterone( T),luteinizing hormone( LH),FPG,insulinum( FIN) and LH/FSH ratio,HOMA-IR,total ovarian volume,mean number of small follicle in study group were significantly higher than those in control group,with the differences statistically significant( all P < 0. 05). The values of AMH and T in polycystic ovary subgroup were significantly lower than those in classic subgroup and high-testosterone subgroup,with the differences statistically significant( all P < 0. 05). Serum AMH in study group was negatively related to BMI( P < 0. 05) and positively related to T,LH,LH/FSH ratio,mean number of small follicle,HOMA-IR( all P < 0. 05). The area under the ROC curve for PCOS diagnosed by AMH was 0. 893. When the threshold of AMH for PCOS diagnosis was 60. 1 pmol/L,the sensitivity was 89. 1% and specificity was 80. 5%. Conclusion The serum levels of AMH are high in PCOS group and could be a important indicators for the diagnosis and research of PCOS.
引文
[1]杨小岗,王芳,武佳敏,等.血清抗苗勒管激素诊断多囊卵巢综合征的临床价值[J].中华临床医师杂志:电子版,2011,5(13):3721-3725.
[2]刘曼琳,杨冬梓.抗苗勒管激素的相关影响因素研究进展[J].中华妇产科杂志,2015,50(5):381-383.
[3]Pigny P,Jonard S,Robert Y,et al.Serum anti-Mullerian hormone as a surrogate for antral follicle count for definition of the polycystic ovary syndrome[J].J Clin Endocrinol Metab,2006,91(3):941-945.
[4]Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group.Revised 2003 consensus on diagnostic criteria and longterm health risks related to polycystic ovary syndrome(PCOS)[J].Hum Reprod,2004,19(1):41-47.
[5]赵丽,吕时铭.抗苗勒管激素的研究与应用进展[J].中华检验医学杂志,2014,37(7):509-512.
[6]中华人民共和国卫生部.多囊卵巢综合征诊断:中华人民共和国卫生行业标准[J].中华妇产科杂志,2012,47(1):74-75.
[7]Rogerio AL.What are the key features of importance inpolycystic ovary syndrome?[J].Fertil Steril,2003,80(2):259-261.
[8]Pigny P,Merlen E,Robert Y,et al.Elevated serum level of antimullerian hormone in patients with polycystic ovary syndrome:relationship to the ovarian follicle excess and to the follicular arrest[J].J Clin Endocrinol Metab,2003,88(12):5957-5962.
[9]Lauritsen MP,Bentzen JG,Pinborg A,et al.The prevalence of polycystic ovary syndrome in a normal population according to the Rotterdam criteria venus revised criteria including anti—Mullerian hormone[J].Hum Repmd,2014,29(4):791-801.
[10]Li Y,Ma Y,Chen X,et al.Different diagnostic power of antiMullerian hormone in evaluating women with polycystic ovaries with and without hyperandrogenism[J].J Assist Reprod Genet,2012,29(10):1147-1151.
[11]王丽萍,方春霞,蔡文伟,等.PCOS患者AMH水平与肥胖、睾酮水平、胰岛素抵抗的相关性分析[J].浙江医学,2016,38(16):1354-1357.
[12]王秀梅.血清睾酮水平改变对多囊卵巢综合症的诊断价值[J].中国卫生检验杂志,2009,19(12):2859-2860.
[13]叶玲玲.多囊卵巢综合征患者血清脂联素水平与胰岛素抵抗的关系[J].中国卫生检验杂志,2012,22(11):2628-2629.
[14]刘艳君,贾婵维.抑制素B和抗苗勒管激素检测在辅助生殖技术中的应用[J].中华检验医学杂志,2017,40(3):158-161.
[15]陈子江.多囊卵巢综合征研究十年的回顾与挑战[J].中华妇产科杂志,2013,48(4):272-275.
[2]刘曼琳,杨冬梓.抗苗勒管激素的相关影响因素研究进展[J].中华妇产科杂志,2015,50(5):381-383.
[3]Pigny P,Jonard S,Robert Y,et al.Serum anti-Mullerian hormone as a surrogate for antral follicle count for definition of the polycystic ovary syndrome[J].J Clin Endocrinol Metab,2006,91(3):941-945.
[4]Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group.Revised 2003 consensus on diagnostic criteria and longterm health risks related to polycystic ovary syndrome(PCOS)[J].Hum Reprod,2004,19(1):41-47.
[5]赵丽,吕时铭.抗苗勒管激素的研究与应用进展[J].中华检验医学杂志,2014,37(7):509-512.
[6]中华人民共和国卫生部.多囊卵巢综合征诊断:中华人民共和国卫生行业标准[J].中华妇产科杂志,2012,47(1):74-75.
[7]Rogerio AL.What are the key features of importance inpolycystic ovary syndrome?[J].Fertil Steril,2003,80(2):259-261.
[8]Pigny P,Merlen E,Robert Y,et al.Elevated serum level of antimullerian hormone in patients with polycystic ovary syndrome:relationship to the ovarian follicle excess and to the follicular arrest[J].J Clin Endocrinol Metab,2003,88(12):5957-5962.
[9]Lauritsen MP,Bentzen JG,Pinborg A,et al.The prevalence of polycystic ovary syndrome in a normal population according to the Rotterdam criteria venus revised criteria including anti—Mullerian hormone[J].Hum Repmd,2014,29(4):791-801.
[10]Li Y,Ma Y,Chen X,et al.Different diagnostic power of antiMullerian hormone in evaluating women with polycystic ovaries with and without hyperandrogenism[J].J Assist Reprod Genet,2012,29(10):1147-1151.
[11]王丽萍,方春霞,蔡文伟,等.PCOS患者AMH水平与肥胖、睾酮水平、胰岛素抵抗的相关性分析[J].浙江医学,2016,38(16):1354-1357.
[12]王秀梅.血清睾酮水平改变对多囊卵巢综合症的诊断价值[J].中国卫生检验杂志,2009,19(12):2859-2860.
[13]叶玲玲.多囊卵巢综合征患者血清脂联素水平与胰岛素抵抗的关系[J].中国卫生检验杂志,2012,22(11):2628-2629.
[14]刘艳君,贾婵维.抑制素B和抗苗勒管激素检测在辅助生殖技术中的应用[J].中华检验医学杂志,2017,40(3):158-161.
[15]陈子江.多囊卵巢综合征研究十年的回顾与挑战[J].中华妇产科杂志,2013,48(4):272-275.