Zhang Q L, Yue C Y, Zhang B, Wang Z H, Ying C M
Department of Clinical Laboratory,Obstetrics and Gynecology Hospital of Fudan University,Shanghai 200011,China.
Zhonghua Yu Fang Yi Xue Za Zhi. 2022 Jul 6;56(7):985-989. doi: 10.3760/cma.j.cn112150-20210714-00679.
To investigate the distribution and diagnostic value of serum anti-Müllerian hormone (AMH) in healthy women of childbearing age, women with polycystic ovary syndrome (PCOS), ovarian dysfunction (DOR) and premature ovarian failure (POF). This study retrospectively selected female patients of childbearing age who were treated in the affiliated Obstetrics and Gynecology Hospital of Fudan University from January to December 2019. According to different clinical manifestations, they were divided into 133 cases in PCOS group, 120 cases in DOR group and 134 cases in POF group. 125 healthy women in the same period were selected as the control group. The values of serum AMH, estradiol (E2), follicle stimulating hormone (FSH), luteinizing hormone (LH) and testosterone (T) were measured in the four groups. Single sample Kolmogorov-Smirnov test, one-way ANOVA, independent sample -test, Kruskal-Wallis test, Mann-Whitney test, logistic regression analysis and ROC curve were used for comparative analysis. The serum AMH levels of PCOS group, DOR group, POF group and control group were 9.10 (6.67, 11.49) ng/ml, 0.11 (0.05, 0.29) ng/ml, 0.03 (0.02, 0.06) ng/ml and 2.99 (1.57, 4.98) ng/ml, respectively [], the differences were statistically significant (<0.001). The basal endocrine levels including E2, FSH, LH and T also had significant differences between groups (<0.001). The results of multiple comparisons showed that there were significant differences in AMH and LH between DOR, POF and PCOS groups and the control group. The T level of PCOS group was significantly higher than that of the control group, the E2, LH and T levels of DOR group were significantly higher than that of the control group, and the FSH level of POF group was significantly higher than that of the control group (<0.05). The area under the curve (AUC) of AMH and AMH+LH in the diagnosis of PCOS were 0.905 and 0.922, the sensitivity was 82.7% and 85.0%, and the specificity was 88.0% and 88.8%. The AUC of DOR was 0.861 and 0.971, the sensitivity was 89.0% and 92.5%, and the specificity was 63.0% and 92.0%. The AUC of POF was 0.950 and 0.998, the sensitivity was 98.3% and 99.2%, and the specificity was 75.9% and 97.0%, respectively. The AUC of AMH and AMH+LH combined indexes in the differential diagnosis of DOR and POF were 0.768 and 0.937, the sensitivity was 70.3% and 95.5%, and the specificity was 73.9% and 80.8%.
为探讨血清抗苗勒管激素(AMH)在健康育龄女性、多囊卵巢综合征(PCOS)患者、卵巢功能障碍(DOR)患者及卵巢早衰(POF)患者中的分布情况及诊断价值。本研究回顾性选取2019年1月至12月在复旦大学附属妇产科医院就诊的育龄期女性患者。根据不同临床表现,将其分为PCOS组133例、DOR组120例、POF组134例。选取同期125例健康女性作为对照组。检测四组患者血清AMH、雌二醇(E2)、卵泡刺激素(FSH)、黄体生成素(LH)及睾酮(T)水平。采用单样本Kolmogorov - Smirnov检验、单因素方差分析、独立样本t检验、Kruskal - Wallis检验、Mann - Whitney检验、逻辑回归分析及ROC曲线进行对比分析。PCOS组、DOR组、POF组及对照组血清AMH水平分别为9.10(6.67,11.49)ng/ml、0.11(0.05,0.29)ng/ml、0.03(0.02,0.06)ng/ml及2.99(1.57,4.98)ng/ml[],差异有统计学意义(<0.001)。各组间包括E2、FSH、LH及T在内的基础内分泌水平也有显著差异(<0.001)。多重比较结果显示,DOR组、POF组与PCOS组及对照组之间的AMH和LH存在显著差异。PCOS组T水平显著高于对照组,DOR组E2、LH及T水平显著高于对照组,POF组FSH水平显著高于对照组(<0.05)。AMH及AMH + LH诊断PCOS的曲线下面积(AUC)分别为0.905和0.922,敏感度分别为82.7%和85.0%,特异度分别为88.0%和88.8%。DOR的AUC分别为0.861和0.971,敏感度分别为89.0%和92.5%,特异度分别为63.0%和92.0%。POF的AUC分别为0.950和0.998,敏感度分别为98.3%和99.2%,特异度分别为75.9%和97.0%。AMH及AMH + LH联合指标鉴别诊断DOR和POF的AUC分别为0.768和0.937,敏感度分别为70.3%和95.5%,特异度分别为73.9%和80.8%。