抗苗勒管激素在多囊卵巢综合征诊断中的价值：形态学描述能否被取代？
Anti-Mullerian hormone in the diagnosis of polycystic ovary syndrome: can morphologic description be replaced?
机构信息
Department of Obstetrics and Gynaecology, Hospital of Namsos, Nord-Troendelag Hospital Trust, Namsos, Norway.
出版信息
Hum Reprod. 2012 Aug;27(8):2494-502. doi: 10.1093/humrep/des213. Epub 2012 Jun 12.
STUDY QUESTION
Can anti-Müllerian hormone (AMH) level replace the morphologic description in the diagnosis of polycystic ovary syndrome (PCOS) and what is the relationship between AMH and different diagnostic criteria of PCOS?
SUMMARY ANSWER
AMH may be a good substitute for polycystic ovarian morphology (PCOM) in diagnosing PCOS.
WHAT IS KNOWN ALREADY
AMH has been suggested as an alternative to antral follicle count (AFC) in diagnosing PCOS. Cut-off values for AMH studied so far show an acceptable specificity but a rather poor sensitivity, leaving up to one-third of PCOS women undiagnosed.
STUDY DESIGN, SIZE, DURATION: We used data from a cross-sectional, case-control study on women with prior preterm birth and their controls, i.e. women with prior full-term birth. Among 262 women, 56 met the Rotterdam criteria (PCOS-R) and 44 the Androgen Excess-PCOS Society (PCOS-AES) criteria of PCOS.
PARTICIPANTS/MATERIALS, SETTING, METHODS: Fasting blood samples were collected, a transvaginal ultrasound investigation and a clinical examination were performed. PCOS-R and PCOS-AES were re-diagnosed by replacing PCOM with AMH. Main outcome measures were the prevalence of PCOS, PCOM, hirsutism, oligoamenorrhoea and serum levels of AMH and androgens.
MAIN RESULTS AND THE ROLE OF CHANCE
When replacing PCOM with AMH, the specificity and sensitivity for identifying PCOS were 97.1 and 94.6% according to the PCOS-R criteria and 97.2 and 95.5% according to the PCOS-AES criteria, respectively, at an AMH cut-off value of 20 pmol/l.
LIMITATIONS, REASONS FOR CAUTION: The results need to be confirmed when international standards and methods for AMH measurements are established.
WIDER IMPLICATIONS OF THE FINDINGS
AMH may be a good substitute for PCOM in diagnosing PCOS.
STUDY FUNDING/COMPETING INTEREST(S): This study was financed by the Cooperative of Central Norway Regional Health Authority and Norwegian University of Science and Technology. The authors have no interests to disclose.
TRIAL REGISTRATION NUMBER
This study is registered at www.clinicaltrials.gov as NCT01355536.
研究问题
抗缪勒管激素（AMH）水平能否替代多囊卵巢综合征（PCOS）的形态描述，以及 AMH 与 PCOS 的不同诊断标准之间有何关系？
总结答案
AMH 可能是诊断 PCOS 的多囊卵巢形态（PCOM）的良好替代物。
已知情况
已经提出 AMH 可替代窦卵泡计数（AFC）用于诊断 PCOS。迄今为止研究的 AMH 截断值具有可接受的特异性，但敏感性较差，导致多达三分之一的 PCOS 女性漏诊。
研究设计、规模、持续时间：我们使用了来自一项经前期早产妇女及其对照组（即经前期足月分娩妇女）的横断面病例对照研究的数据。在 262 名女性中，56 名符合 Rotterdam 标准（PCOS-R），44 名符合雄激素过多-多囊卵巢综合征协会（PCOS-AES）的 PCOS 标准。
参与者/材料、设置、方法：采集空腹血样，进行经阴道超声检查和临床检查。通过用 AMH 替代 PCOM 重新诊断 PCOS-R 和 PCOS-AES。主要观察指标为 PCOS、PCOM、多毛症、月经稀发和 AMH 及雄激素的血清水平。
主要结果和机会的作用
当用 AMH 替代 PCOM 时，根据 PCOS-R 标准，识别 PCOS 的特异性和敏感性分别为 97.1%和 94.6%，根据 PCOS-AES 标准分别为 97.2%和 95.5%，AMH 截断值为 20 pmol/L。
局限性、谨慎的原因：当建立 AMH 测量的国际标准和方法时，需要确认这些结果。
研究的影响
AMH 可能是诊断 PCOS 的 PCOM 的良好替代物。
研究资金/竞争利益：本研究由中央挪威区域卫生当局和挪威科技大学合作资助。作者没有利益冲突。
试验注册
该研究在 www.clinicaltrials.gov 上注册为 NCT01355536。
Zotero 插件