根据不同的诊断标准对年轻不孕妇女多囊卵巢综合征的诊断：血清抗苗勒管激素的作用。
The diagnosis of PCOS in young infertile women according to different diagnostic criteria: the role of serum anti-Müllerian hormone.
机构信息
Section of Gynecology and Obstetrics, Academic Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
Section of Gynecology and Obstetrics, Department of Surgery, Tor Vergata University Hospital, Viale Oxford 81, 00133, Rome, Italy.
出版信息
Arch Gynecol Obstet. 2018 Jul;298(1):207-215. doi: 10.1007/s00404-018-4803-8. Epub 2018 May 25.
PURPOSE
To diagnose polycystic ovary syndrome (PCOS) in young infertile women using different diagnostic criteria. To define serum anti-Müllerian hormone (AMH) cutoff values for PCOS definition. To investigate the correlation between AMH and body mass index (BMI).
METHODS
Retrospective case-control study. A total of 140 infertile women (age 21-35 years) were enrolled. PCOS was defined according to the National Institutes of Health (NIH) criteria, the Rotterdam consensus criteria and the Androgen Excess and PCOS Society (AE-PCOS) criteria. ROC curve analysis was performed to define AMH thresholds for PCOS definition according to the three different diagnostic criteria. Correlation between AMH and BMI was investigated.
RESULTS
The prevalence of PCOS under the NIH criteria, the Rotterdam criteria and the AE-PCOS criteria was 27.1, 40 and 29.3%, respectively. The optimal thresholds of AMH to distinguish NIH PCOS from infertile controls was 5.20 ng/ml (AUC = 0.86, sensitivity 79%, specificity 80%); the best cutoff to detect Rotterdam PCOS was 4.57 ng/ml (AUC = 0.85, sensitivity 78%, specificity 81%); a cutoff of 4.85 ng/ml (AUC = 0.85, sensitivity 80%, specificity 78%) defined PCOS women according to AE-PCOS criteria. The prevalence of the syndrome became 37.1, 44.3 and 39.2% according to the three criteria, respectively, using AMH threshold between 4.57 and 5.20 ng/ml as an alternative to antral follicle count and/or hyperandrogenism.
CONCLUSION
Anti-Müllerian hormone may reconcile the three diagnostic criteria and allow the PCOS diagnosis in women with mild symptoms. No significant correlation was found between AMH and BMI in PCOS women and controls.
目的
使用不同的诊断标准诊断年轻不孕妇女的多囊卵巢综合征（PCOS）。定义用于 PCOS 定义的血清抗苗勒管激素（AMH）截断值。研究 AMH 与体重指数（BMI）之间的相关性。
方法
回顾性病例对照研究。共纳入 140 名不孕妇女（年龄 21-35 岁）。根据美国国立卫生研究院（NIH）标准、鹿特丹共识标准和雄激素过多和 PCOS 学会（AE-PCOS）标准定义 PCOS。进行 ROC 曲线分析，根据三种不同的诊断标准，定义 AMH 阈值用于 PCOS 定义。研究 AMH 与 BMI 之间的相关性。
结果
根据 NIH 标准、鹿特丹标准和 AE-PCOS 标准，PCOS 的患病率分别为 27.1%、40%和 29.3%。将 AMH 区分 NIH PCOS 与不孕对照组的最佳阈值为 5.20ng/ml（AUC=0.86，敏感性 79%，特异性 80%）；检测 Rotterdam PCOS 的最佳截断值为 4.57ng/ml（AUC=0.85，敏感性 78%，特异性 81%）；使用 AMH 截断值 4.85ng/ml（AUC=0.85，敏感性 80%，特异性 78%），可根据 AE-PCOS 标准定义 PCOS 妇女。根据三个标准，使用 AMH 截断值在 4.57 和 5.20ng/ml 之间的替代方法，如窦卵泡计数和/或高雄激素血症，该综合征的患病率分别为 37.1%、44.3%和 39.2%。
结论
抗苗勒管激素可以协调三种诊断标准，并允许对症状较轻的妇女进行 PCOS 诊断。在 PCOS 妇女和对照组中，未发现 AMH 与 BMI 之间存在显著相关性。
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