Department of Laboratory Medicine, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
Department of Ultrasound, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
PLoS One. 2018 Aug 28;13(8):e0203129. doi: 10.1371/journal.pone.0203129. eCollection 2018.
We intended to establish the threshold for anti-Mullerian hormone (AMH) in the diagnosis of polycystic ovary syndrome (PCOS) in China.
A total of 771 women (653 with PCOS and 118 healthy controls) were enrolled. The serum AMH, follicle-stimulating hormone (FSH), luteinizing hormone (LH), FSH/LH, prolactin, estradiol, testosterone (T), dehydroepiandrosterone sulfate (DHEA-S), sex hormone-binding globulin (SHBG), 17α-OH progesterone (17α-OHP), fasting insulin (INS), fasting glucose, free androgen index (FAI%) and homeostasis model assessment for insulin resistance (HOMA-IR) index were analyzed, and the diagnostic utility of AMH, LH/FSH, T and INS was established using receiver operator characteristic (ROC) curves. With AMH, LH/FSH, T and INS as independent variables, a logistic regression model was established, and the ROC curve for combined detection was fitted with the probability value of the model.
The serum level of FSH, LH, LH/FSH, AMH, FAI%, 17α-OHP, fasting INS, T, SHBG, DHEA-S and HOMA-IR were altered in the PCOS patients. The best compromise between sensitivity and specificity was found at an AMH cut-off level of 8.16 ng/ml and 5.89 ng/ml for the age groups 20-29 and 30-39 years, with the corresponding area under the curve being 0.846 and 0.865 respectively. The area under the ROC curve for combined detection was 0.951, which was significantly greater than that of each index. Finally, the concentration of AMH was associated with FSH, LH, LH/FSH, T, and ovarian volume in PCOS patients.
The optimal AMH diagnostic threshold for PCOS was 8.16 ng/ml (20-29 years) and 5.89 ng/ml (30-39 years) in the Chinese population of this study. Moreover, serum AMH, LH/FSH, T and INS could be used in combination to improve the diagnostic specificity and sensitivity for the detection of PCOS.
本研究旨在建立中国人抗苗勒管激素（AMH）诊断多囊卵巢综合征（PCOS）的界值。
共纳入 771 名女性（653 名 PCOS 患者和 118 名健康对照者）。检测血清 AMH、卵泡刺激素（FSH）、黄体生成素（LH）、LH/FSH、催乳素、雌二醇、睾酮（T）、硫酸脱氢表雄酮（DHEA-S）、性激素结合球蛋白（SHBG）、17α-羟孕酮（17α-OHP）、空腹胰岛素（INS）、空腹血糖、游离雄激素指数（FAI%）和胰岛素抵抗稳态模型评估（HOMA-IR）指数，并采用受试者工作特征（ROC）曲线分析 AMH、LH/FSH、T 和 INS 的诊断效能。以 AMH、LH/FSH、T 和 INS 为自变量建立 logistic 回归模型，拟合模型概率值的联合检测 ROC 曲线。
PCOS 患者血清 FSH、LH、LH/FSH、AMH、FAI%、17α-OHP、空腹 INS、T、SHBG、DHEA-S 和 HOMA-IR 水平发生改变。在 20-29 岁和 30-39 岁年龄组中，AMH 截断值分别为 8.16ng/ml 和 5.89ng/ml 时，灵敏度和特异性达到最佳平衡，对应的曲线下面积分别为 0.846 和 0.865。联合检测的 ROC 曲线下面积为 0.951，显著大于各指标。最后，PCOS 患者 AMH 浓度与 FSH、LH、LH/FSH、T 和卵巢体积相关。
本研究中中国人群的 PCOS 最佳 AMH 诊断界值为 8.16ng/ml（20-29 岁）和 5.89ng/ml（30-39 岁）。此外，血清 AMH、LH/FSH、T 和 INS 联合使用可提高 PCOS 检测的诊断特异性和灵敏度。
