Pankhurst Michael W, Shorakae Soulmaz, Rodgers Raymond J, Teede Helena J, Moran Lisa J
Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand.
Monash Centre for Health Research Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Victoria, Australia.
Fertil Steril. 2017 Nov;108(5):851-857.e2. doi: 10.1016/j.fertnstert.2017.08.012.
To compare total antimüllerian hormone (AMH), proAMH, AMH, and the ratio of the two forms in predictive models for polycystic ovary syndrome (PCOS) diagnosis. Total AMH consists of proAMH (inactive precursor) and AMH (receptor-competent), but neither isoform has been tested individually for their ability to predict PCOS diagnosis.
Cross-sectional study using biobanked samples collected between July 2008 and January 2010.
Not applicable.
PATIENT(S): Overweight, premenopausal women aged 18-45 years with PCOS (n = 45, with 21 fulfilling National Institutes of Health diagnostic criteria and 24 fulfilling European Society for Human Reproduction and Embryology/American Society for Reproductive Medicine (ESHRE) criteria, but not National Institutes of Health criteria) and without PCOS (n = 23 controls).
INTERVENTION(S): None.
MAIN OUTCOME MEASURE(S): Serum concentrations of proAMH and total AMH (proAMH and AMH combined) were determined by immunoassay. The AMH concentrations were calculated by subtraction ([AMH] = [total AMH] - [proAMH]). Relative levels of proAMH were expressed as the AMH prohormone index (API = [ProAMH]/[Total AMH] × 100).
RESULT(S): In women with PCOS, total AMH, proAMH, and AMH levels were higher, and the API was lower (P=.010), than in controls indicating increased conversion of proAMH to AMH. Receiver-operating characteristic analysis for proAMH (area under the curve [AUC] = 0.82), AMH (AUC = 0.86), and API (AUC = 0.70) did not improve the prediction for PCOS when compared with total AMH (AUC = 0.86).
CONCLUSION(S): The proAMH and AMH do not appear to improve the ability to predict a diagnosis of PCOS beyond total AMH assays. However, the ratio of inactive proAMH precursor to receptor-competent AMH (API) differs in women with PCOS relative to unaffected controls indicating that AMH signaling mechanisms may be altered in women with PCOS.
比较抗苗勒管激素（AMH）总量、前体抗苗勒管激素（proAMH）、AMH以及这两种形式的比例在多囊卵巢综合征（PCOS）诊断预测模型中的作用。AMH总量由proAMH（无活性前体）和AMH（具有受体活性）组成，但尚未单独检测这两种异构体预测PCOS诊断的能力。
采用2008年7月至2010年1月收集的生物样本库样本进行横断面研究。
不适用。
年龄在18 - 45岁之间的超重绝经前PCOS女性（n = 45，其中21例符合美国国立卫生研究院诊断标准，24例符合欧洲人类生殖与胚胎学会/美国生殖医学学会（ESHRE）标准，但不符合美国国立卫生研究院标准）以及无PCOS的女性（n = 23例对照）。
无。
采用免疫分析法测定血清proAMH和AMH总量（proAMH与AMH之和）。通过减法计算AMH浓度（[AMH]=[AMH总量]-[proAMH]）。proAMH的相对水平以AMH前体激素指数表示（API = [ProAMH]/[AMH总量]×100）。
与对照组相比，PCOS女性的AMH总量、proAMH和AMH水平更高，而API更低（P = 0.010），表明proAMH向AMH的转化增加。与AMH总量（曲线下面积[AUC]=0.86）相比，proAMH（AUC = 0.82）、AMH（AUC = 0.86）和API（AUC = 0.70）的受试者工作特征分析并未改善对PCOS的预测。
与AMH总量检测相比，proAMH和AMH似乎并未提高预测PCOS诊断的能力。然而，无活性proAMH前体与具有受体活性的AMH的比例（API）在PCOS女性中相对于未受影响的对照组有所不同，这表明PCOS女性的AMH信号传导机制可能发生了改变。
