Robinson S, Rodin D A, Deacon A, Wheeler M J, Clayton R N
Endocrine Research Group, Clinical Research Centre, Harrow, Middlesex, UK.
Br J Obstet Gynaecol. 1992 Mar;99(3):232-8. doi: 10.1111/j.1471-0528.1992.tb14505.x.
To assess the frequency of abnormal values for hormone measurements commonly used in the biochemical diagnosis of polycystic ovary syndrome (PCOS).
Hormone measurements in 63 unselected women with clinical and ultrasound diagnosis of PCOS attending gynaecological and general endocrine clinics in a District General Hospital were compared with those from a group of 20 normal ovulatory controls in the early follicular phase of their cycles.
Serum levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), LH/FSH ratio, total testosterone, derived free testosterone, sex hormone binding globulin, androstenedione, and dehydroepiandrosterone (DHEA) were measured by radioimmunoassays. LH and FSH measured by two different assays.
The mean serum LH and LH/FSH ratio were significantly (P less than 0.01) higher in the women with PCOS compared with the normal group, but these two measurements were in the abnormal range for only 35% and 41-44%, respectively. Absolute gonadotrophin values were significantly different using the two assay methods, which employed the same reference preparation as standard. Mean serum total testosterone concentration was significantly higher in the PCOS group and was the most frequently (70%) abnormal biochemical marker for PCOS. Sex hormone binding globulin (SHBG) did not differ significantly between the two groups but showed a negative correlation with body mass index in women with PCOS. The combination of SHBG and testosterone to derive a free testosterone value did not further aid the biochemical diagnosis of PCOS. Androstenedione was significantly higher in the PCOS group than in the control group, with a frequency of 53%. There was no significant difference in DHEA-S between the two groups.
When typical ovarian ultrasound appearances plus the clinical features of oligomenorrhea and/or hirsuitism were used to define PCOS total testosterone was the best single hormonal marker of the condition. Testosterone, androstenedione or LH, either alone or in combination, were raised in 86% of women with PCOS and these should be the definitive hormonal tests. Using LH/FSH ratio as a biochemical criterion for diagnosis of PCOS should be abandoned because of its low sensitivity. To be of value the normal range for all hormones should be precisely defined in a group of regularly ovulating women in the early follicular phase of the cycle for the assay used in each laboratory.
评估多囊卵巢综合征（PCOS）生化诊断中常用激素测量值异常的频率。
将一家地区综合医院妇科和普通内分泌门诊的63例经临床和超声诊断为PCOS的未选择女性的激素测量值，与20例处于月经周期卵泡早期的正常排卵对照者的激素测量值进行比较。
采用放射免疫分析法测定血清促黄体生成素（LH）、促卵泡生成素（FSH）、LH/FSH比值、总睾酮、计算得出的游离睾酮、性激素结合球蛋白、雄烯二酮和脱氢表雄酮（DHEA）水平。LH和FSH采用两种不同的检测方法进行测量。
与正常组相比，PCOS女性的血清LH均值和LH/FSH比值显著更高（P<0.01），但这两项测量值分别仅在35%和41%-44%的患者中处于异常范围。使用两种采用相同标准品作为参考制剂的检测方法，促性腺激素的绝对值存在显著差异。PCOS组的血清总睾酮浓度均值显著更高，是PCOS最常出现异常（70%）的生化指标。两组间性激素结合球蛋白（SHBG）无显著差异，但在PCOS女性中SHBG与体重指数呈负相关。结合SHBG和睾酮计算游离睾酮值并不能进一步辅助PCOS的生化诊断。PCOS组的雄烯二酮显著高于对照组，异常频率为53%。两组间硫酸脱氢表雄酮（DHEA-S）无显著差异。
当采用典型的卵巢超声表现加上月经过少和/或多毛的临床特征来定义PCOS时，总睾酮是该疾病最佳的单一激素指标。单独或联合检测时，86%的PCOS女性的睾酮、雄烯二酮或LH升高，这些应作为确诊的激素检测项目。由于LH/FSH比值敏感性较低，不应再将其作为PCOS诊断的生化标准。为保证检测结果有价值，每个实验室应在一组处于月经周期卵泡早期的规律排卵女性中精确确定所有激素的正常范围。
