Department of Endocrine Gynaecology and Reproductive Medicine, Hôpital Jeanne de Flandre, C.H.R.U., 59037 Lille, France.
J Clin Endocrinol Metab. 2010 Sep;95(9):4399-405. doi: 10.1210/jc.2010-0334. Epub 2010 Jul 7.
It is still debated whether clinical and/or biological indices of hyperandrogenism (HA) should be present to qualify a patient as having polycystic ovary syndrome (PCOS). We hypothesized that excessive follicle number (FN) assessed by ovarian ultrasonography and/or serum anti-Müllerian hormone (AMH) concentrations may be used as surrogates for the classical markers of HA.
Data were obtained from a database of clinical, hormonal, and ultrasound features that were consecutively recorded in 270 women with PCOS (defined using the Rotterdam Criteria) and 217 infertile nonhyperandrogenic normoovulatory women. These variables were submitted to principal component analysis, a multivariable statistical procedure that transforms a number of possibly correlated variables into a smaller number of uncorrelated variables called principal components (PC). Variables that aggregate in the same PC capture the same information.
In the control group, as expected, three independent PCs were identified: 1) the markers of the metabolic (i.e. insulin resistance) status; 2) those of the androgen status; and 3) those of the follicle status. In the PCOS group, the metabolic variables also aggregated in a first PC. Ovarian androgen and follicle markers aggregated in a second independent PC, with FN and serum AMH having the strongest correlation coefficients. A third PC summarized the adrenal contribution to the HA of PCOS. In both groups, the free androgen index correlated equally to the first and second PCs.
The similarity of the first PC between controls and PCOS supports the hypothesis that the metabolic anomaly of PCOS is neither intrinsic nor specific. Conversely, by gathering the androgen and follicle variables, the second PC in PCOS may be viewed as summarizing a specific ovarian anomaly. Because both FN and/or serum AMH were strongly correlated to the second PC along with androgens, they may be used equally as surrogates for the classical markers of ovarian HA. This reconciles the Rotterdam Consensus and other definitions for PCOS, especially in women having the Rotterdam PCOS phenotype without HA. We thus propose a simple strategy for the diagnosis of PCOS in clinical practice.
目前仍存在争议，即是否应存在临床和/或生物学高雄激素血症（HA）指标来确定患者患有多囊卵巢综合征（PCOS）。我们假设通过卵巢超声检查和/或血清抗苗勒管激素（AMH）浓度评估的卵泡过多（FN）可作为 HA 的经典标志物的替代指标。
数据来自临床、激素和超声特征数据库，这些特征连续记录在 270 名患有 PCOS（根据 Rotterdam 标准定义）和 217 名非高雄激素正常排卵不孕女性中。这些变量被提交给主成分分析，这是一种多变量统计程序，可将多个可能相关的变量转换为较少的不相关变量，称为主成分（PC）。聚集在同一 PC 中的变量捕获相同的信息。
在对照组中，如预期的那样，确定了三个独立的 PC：1）代谢（即胰岛素抵抗）状态的标志物；2）雄激素状态的标志物；和 3）卵泡状态的标志物。在 PCOS 组中，代谢变量也聚集在第一 PC 中。卵巢雄激素和卵泡标志物聚集在第二个独立的 PC 中，其中 FN 和血清 AMH 具有最强的相关系数。第三个 PC 总结了 PCOS 的 HA 中肾上腺的贡献。在两组中，游离雄激素指数与第一和第二 PC 的相关性相等。
对照组和 PCOS 组中第一 PC 的相似性支持了这样的假设，即 PCOS 的代谢异常既不是内在的也不是特异性的。相反，通过聚集雄激素和卵泡变量，PCOS 中的第二 PC 可以被视为总结了特定的卵巢异常。由于 FN 和/或血清 AMH 与雄激素一起与第二 PC 强烈相关，因此它们可以作为卵巢 HA 的经典标志物的同等替代指标。这调和了 Rotterdam 共识和其他 PCOS 定义，尤其是在没有 HA 的 Rotterdam PCOS 表型的女性中。因此，我们提出了一种在临床实践中诊断 PCOS 的简单策略。
