Pigny P, Jonard S, Robert Y, Dewailly D
Laboratoire de Biochimie et Hormonologie, Parc Eurasanté, Centre Hospitalier Régional Universitaire, 59037 Lille cedex, France.
J Clin Endocrinol Metab. 2006 Mar;91(3):941-5. doi: 10.1210/jc.2005-2076. Epub 2005 Dec 20.
Despite its frequency, the polycystic ovary syndrome (PCOS) is still a difficult diagnosis in endocrinology, gynecology, and reproductive medicine. To help solve this issue, the Rotterdam consensus conference proposed to include the ultrasonographic follicle count as a new diagnostic criterion, in addition to hyperandrogenism and oligo-anovulation. Unfortunately, its assessment does not offer sufficient reliability worldwide.
The aim of our study was to check whether anti-Müllerian hormone (AMH) measurement in the serum could be a surrogate for antral follicle count in the diagnostic criteria of PCOS.
DESIGN, SETTING, AND PATIENTS: Serum AMH was measured with a second-generation immunoassay in a cohort of 73 PCOS patients and 96 controls, and its diagnostic power was evaluated by receiver operating characteristic curves. PCOS was diagnosed according to the Rotterdam definition.
Serum AMH levels were 3-fold higher in PCOS patients than in controls (81.6 vs. 33.5 pmol/liter; P < 0.001) and were significantly related to the follicle number in the two groups. The area under the receiver operating characteristic curve for the AMH assay was 0.851, indicating a good diagnostic potency. Setting the threshold at 60 pmol/liter offered the best compromise between specificity (92%) and sensitivity (67%).
The serum AMH level is an accurate marker of the ovarian early antral follicle number and offers a good diagnostic potency. In situations where accurate ultrasonographic data are not available, AMH could thus be used instead of the follicle count as a diagnostic criterion and incorporated as such in the Rotterdam definition of PCOS.
尽管多囊卵巢综合征（PCOS）发病率很高，但在内分泌学、妇科和生殖医学领域仍是一个难以诊断的疾病。为了帮助解决这一问题，鹿特丹共识会议提议，除高雄激素血症和少排卵外，将超声卵泡计数作为一项新的诊断标准。遗憾的是，其评估在全球范围内的可靠性不足。
我们研究的目的是检验血清中抗苗勒管激素（AMH）测量值是否可作为PCOS诊断标准中窦卵泡计数的替代指标。
设计、场所和患者：采用第二代免疫分析法对73例PCOS患者和96例对照者的血清AMH进行检测，并通过受试者工作特征曲线评估其诊断效能。PCOS根据鹿特丹定义进行诊断。
PCOS患者血清AMH水平比对照组高3倍（81.6对33.5 pmol/L；P<0.001），且与两组的卵泡数量显著相关。AMH检测的受试者工作特征曲线下面积为0.851，表明诊断效能良好。将阈值设定为60 pmol/L可在特异性（92%）和敏感性（67%）之间实现最佳折衷。
血清AMH水平是卵巢早期窦卵泡数量的准确标志物，具有良好的诊断效能。在无法获得准确超声数据的情况下，AMH可替代卵泡计数作为诊断标准，并纳入PCOS的鹿特丹定义中。
