患有少/闭经和多囊卵巢的女性，无论其雄激素状态如何，对促性腺激素释放激素（GnRH）刺激的反应均相同：鹿特丹和雄激素过多协会诊断标准的比较

Women with oligo-/amenorrhoea and polycystic ovaries have identical responses to GnRH stimulation regardless of their androgen status: comparison of the Rotterdam and Androgen Excess Society diagnostic criteria.

作者信息

Lewandowski Krzysztof C, Cajdler-Luba Agata, Bieńkiewicz Małgorzata, Lewiński Andrzej

机构信息

Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, Poland.

出版信息

Neuro Endocrinol Lett. 2011;32(6):847-56.

PMID:22286802

Abstract

OBJECTIVE

As increased frequency of gonadotrophin-releasing hormone (GnRH) pulses is characteristic for polycystic ovary syndrome (PCOS), we assessed gonadotrophin response to GnRH in women with PCOS with normal and raised androgens and in regularly menstruating controls.

DESIGN, PATIENTS AND METHODS: The study involved 155 subjects: PCOS, n=121, age (mean±SD) 24.8±5.4 yrs, BMI 24.5±6.0 kg/m2, all with oligo-/amenorrhoea and PCO morphology, and 34 controls. Gonadotrophins were measured in early follicular phase after GnRH stimulation (0, 30 and 60 minutes).

RESULTS

Fifty four (41.9%) women with PCOS had androgens (testosterone, androstendione, dihydroepiandrosterone sulphate) within the reference range, and would fulfil the "Rotterdam", but not the Androgen Excess Society PCOS criteria. Baseline and stimulated LH concentrations were higher in PCOS (9.09±5.56 vs 4.83±1.71 IU/l, 35.48±31.4 vs 16.30±6.68 IU/l, 33.86±31.8 vs 13.45±5.2 IU/l, at 0, 30 and 60 min post GnRH, respectively, p<0.0001). An LH/FSH ratio in PCOS increased further after GnRH stimulation. ROC analysis revealed that LH30min/FSH30min >2.11 or LH60min/FSH60min >1.72 had 78.3% and 87.5% sensitivity and 81.7% and 81.3% specificity for diagnosis of PCOS. Both baseline and GnRH-stimulated LH and FSH concentrations were similar in women with PCOS and raised androgens and with androgens within the reference range (p=0.71 and p=0.20 for LH and FSH, respectively).

CONCLUSIONS

Regardless of their androgen status, women with PCO morphology and oligo-/amenorrhoea have higher baseline and GnRH-stimulated LH concentrations and higher GnRH-stimulated LH/FSH ratio than controls, suggestive of similar underlying mechanism accounting for menstrual irregularities. These observations support validity of PCOS diagnostic criteria based on the Rotterdam consensus.

摘要

目的

由于促性腺激素释放激素（GnRH）脉冲频率增加是多囊卵巢综合征（PCOS）的特征，我们评估了雄激素正常、升高的PCOS女性以及规律月经的对照者对GnRH的促性腺激素反应。

设计、患者和方法：该研究纳入155名受试者：PCOS患者121例，年龄（均值±标准差）24.8±5.4岁，体重指数（BMI）24.5±6.0kg/m²，均有月经稀发/闭经及多囊卵巢形态；34名对照者。在GnRH刺激后（0、30和60分钟）的卵泡早期测量促性腺激素。

结果

54名（41.9%）PCOS女性的雄激素（睾酮、雄烯二酮、硫酸脱氢表雄酮）在参考范围内，符合“鹿特丹”标准，但不符合雄激素过多协会的PCOS标准。PCOS患者的基础及刺激后的促黄体生成素（LH）浓度较高（GnRH刺激后0、30和60分钟时，分别为9.09±5.56 vs 4.83±1.71IU/L、35.48±31.4 vs 16.30±6.68IU/L、33.86±31.8 vs 13.45±5.2IU/L，p<0.0001）。GnRH刺激后PCOS患者的LH/FSH比值进一步升高。受试者工作特征（ROC）分析显示，LH30分钟/FSH30分钟>2.11或LH60分钟/FSH60分钟>1.72对PCOS诊断的敏感性分别为78.3%和87.5%，特异性分别为81.7%和81.3%。PCOS患者中雄激素升高者与雄激素在参考范围内者的基础及GnRH刺激后的LH和FSH浓度相似（LH和FSH的p值分别为0.71和0.20）。