采用 LC-MS/MS 检测总睾酮和游离雄激素指数对多囊卵巢综合征及胰岛素抵抗的诊断价值。
Diagnostic value of total testosterone and free androgen index measured by LC-MS/MS for PCOS and insulin resistance.
机构信息
Department of Clinical Laboratory, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing, China.
Department of Gynecology, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing, China.
出版信息
J Clin Lab Anal. 2022 Nov;36(11):e24739. doi: 10.1002/jcla.24739. Epub 2022 Oct 18.
BACKGROUND
The objective of the study was to explore the clinical significance of steroid hormones in the diagnosis of PCOS and PCOS-related insulin resistance through liquid chromatography-mass spectrometry/mass spectrometry (LC-MS/MS) and chemiluminescent immunoassay (CLIA).
METHODS
The study included 114 patients with PCOS and 100 controls. Steroid hormone levels in serum were measured using LC-MS/MS and CLIA. The Bland-Altman method was used to check the consistency between the two methods. The diagnostic value of the LC-MS/MS method for female hyperandrogenemia and PCOS was evaluated.
RESULTS
Women with PCOS were younger than controls on average (p < 0.001). PCOS patients had higher luteal hormone (LH, p < 0.001), insulin (p = 0.002), estradiol (E2, p < 0.001), total testosterone (TT, p < 0.001), free androgen index (FAI, p = 0.021), dehydroepiandrosterone sulfate (DHEA, p = 0.021), insulin resistance index (HOMA-IR) (p = 0.034), and fasting glucose (p = 0.017) levels than controls as measured by CLIA. The diagnostic value of TT was the best, and the area under the AUC curve was 0.766. Women with PCOS had higher androstenedione (A2, p < 0.001), FAI (p < 0.001), TT (p < 0.001), and 17-hydroxyprogesterone (17-OHP, p < 0.001) levels than controls as measured by LC-MS/MS. The ROC curve showed that the diagnostic efficacy of A2, TT, and 17-OHP was 0.830, 0.851, and 0.714, respectively. The consistency of TT detected by LC-MS/MS and CLIA was poor according to the Bland-Altman method. Detected TT by LC-MS/MS had the highest diagnostic efficiency for PCOS. The diagnostic power of the LC-MS/MS results for PCOS-related insulin resistance was analyzed. The results showed that the FAI had the highest diagnostic power, with an ROC curve of 0.798.
CONCLUSION
LC-MS/MS is more sensitive and accurate than CLIA in the determination of serum TT and FAI. TT is more effective for the diagnosis of PCOS, whereas FAI is more valuable in the diagnosis of insulin resistance.
背景
本研究旨在通过液相色谱-质谱/质谱（LC-MS/MS）和化学发光免疫分析（CLIA）探讨类固醇激素在多囊卵巢综合征（PCOS）及 PCOS 相关胰岛素抵抗诊断中的临床意义。
方法
纳入 114 例 PCOS 患者和 100 例对照者，采用 LC-MS/MS 和 CLIA 检测血清中类固醇激素水平。采用 Bland-Altman 法比较两种方法的一致性。评估 LC-MS/MS 方法对女性高雄激素血症和 PCOS 的诊断价值。
结果
PCOS 患者的平均年龄显著小于对照组（p<0.001）。PCOS 患者的黄体生成素（LH）（p<0.001）、胰岛素（p=0.002）、雌二醇（E2）（p<0.001）、总睾酮（TT）（p<0.001）、游离雄激素指数（FAI）（p=0.021）、硫酸脱氢表雄酮（DHEA）（p=0.021）、胰岛素抵抗指数（HOMA-IR）（p=0.034）和空腹血糖（p=0.017）水平均显著高于对照组（均采用 CLIA 检测）。TT 的诊断价值最佳，ROC 曲线下面积为 0.766。LC-MS/MS 检测显示，PCOS 患者的雄烯二酮（A2）（p<0.001）、FAI（p<0.001）、TT（p<0.001）和 17-羟孕酮（17-OHP）（p<0.001）水平显著高于对照组。ROC 曲线显示，A2、TT 和 17-OHP 的诊断效能分别为 0.830、0.851 和 0.714。根据 Bland-Altman 法，LC-MS/MS 与 CLIA 检测 TT 的一致性较差。LC-MS/MS 检测 TT 对 PCOS 的诊断效率最高。分析 LC-MS/MS 结果对 PCOS 相关胰岛素抵抗的诊断能力。结果表明，FAI 的诊断效能最高，ROC 曲线下面积为 0.798。
结论
与 CLIA 相比，LC-MS/MS 检测血清 TT 和 FAI 更敏感、准确。TT 对 PCOS 的诊断更有效，而 FAI 对胰岛素抵抗的诊断更有价值。
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