Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box:19395-4763, 24 Parvaneh, Yaman Street, Velenjak, I.R, 1985717413, Tehran, Iran.
Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Reprod Biol Endocrinol. 2021 May 22;19(1):76. doi: 10.1186/s12958-021-00755-8.
The majority of available studies on the AMH thresholds were not age-specific and performed the receiver operating characteristic curve (ROC) analysis, based on variations in sensitivity and specificity rather than positive and negative predictive values (PPV and NPV, respectively), which are more clinically applicable. Moreover, all of these studies used a pre-specified age categorization to report the age-specific cut-off values of AMH.
A total of 803 women, including 303 PCOS patients and 500 eumenorrheic non-hirsute control women, were enrolled in the present study. The PCOS group included PCOS women, aged 20-40 years, who were referred to the Reproductive Endocrinology Research Center, Tehran, Iran. The Rotterdam consensus criteria were used for diagnosis of PCOS. The control group was selected among women, aged 20-40 years, who participated in Tehran Lipid and Glucose cohort Study (TLGS). Generalized additive models (GAMs) were used to identify the optimal cut-off points for various age categories. The cut-off levels of AMH in different age categories were estimated, using the Bayesian method.
Two optimal cut-off levels of AMH (ng/ml) were identified at the age of 27 and 35 years, based on GAMs. The cut-off levels for the prediction of PCOS in the age categories of 20-27, 27-35, and 35-40 years were 5.7 (95 % CI: 5.48-6.19), 4.55 (95 % CI: 4.52-4.64), and 3.72 (95 % CI: 3.55-3.80), respectively. Based on the Bayesian method, the PPV and NPV of these cut-off levels were as follows: PPV = 0.98 (95 % CI: 0.96-0.99) and NPV = 0.40 (95 % CI: 0.30-0.51) for the age group of 20-27 years; PPV = 0.96 (95 % CI: 0.91-0.99) and NPV = 0.82 (95 % CI: 0.78-0.86) for the age group of 27-35 years; and PPV = 0.86 (95 % CI: 0.80-0.94) and NPV = 0.96 (95 % CI: 0.93-0.98) for the age group of 35-40 years.
Application of age-specific cut-off levels of AMH, according to the GAMs and Bayesian method, could elegantly assess the value of AMH in discriminating PCOS patients in all age categories.
大多数关于 AMH 阈值的可用研究并非针对特定年龄，而是基于灵敏度和特异性的变化，而非阳性和阴性预测值（PPV 和 NPV）进行了受试者工作特征曲线（ROC）分析，而后者在临床上更适用。此外，所有这些研究都使用了预先指定的年龄分类来报告 AMH 的特定年龄截断值。
本研究共纳入 803 名女性，包括 303 名 PCOS 患者和 500 名月经正常无多毛的非对照女性。PCOS 组包括年龄在 20-40 岁的 PCOS 患者，她们被转诊到伊朗德黑兰生殖内分泌研究中心。使用 Rotterdam 共识标准诊断 PCOS。对照组选自年龄在 20-40 岁的女性，她们参加了德黑兰血脂和葡萄糖队列研究（TLGS）。使用广义加性模型（GAMs）确定不同年龄组的最佳截断点。使用贝叶斯方法估计不同年龄组中 AMH 的截断值。
基于 GAMs，确定了年龄为 27 岁和 35 岁时的两个 AMH（ng/ml）最佳截断值。在 20-27、27-35 和 35-40 岁的年龄组中，预测 PCOS 的截断值分别为 5.7（95%CI：5.48-6.19）、4.55（95%CI：4.52-4.64）和 3.72（95%CI：3.55-3.80）。基于贝叶斯方法，这些截断值的 PPV 和 NPV 如下：在 20-27 岁年龄组中，PPV=0.98（95%CI：0.96-0.99）和 NPV=0.40（95%CI：0.30-0.51）；在 27-35 岁年龄组中，PPV=0.96（95%CI：0.91-0.99）和 NPV=0.82（95%CI：0.78-0.86）；在 35-40 岁年龄组中，PPV=0.86（95%CI：0.80-0.94）和 NPV=0.96（95%CI：0.93-0.98）。
根据 GAMs 和贝叶斯方法应用特定年龄的 AMH 截断值，可以优雅地评估 AMH 在所有年龄组中区分 PCOS 患者的价值。
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