抗苗勒管激素与抑制素B对多囊卵巢综合征的临床预测价值

摘要

目的 通过分析多囊卵巢综合征(polycystic ovary syndrome,PCOS) 病人与对照组的抑制素B(inhibin B, INHB)、抗苗勒管激素(anti-Müllerian hormone, AMH) 及各项内分泌指标,探讨INHB、AMH对PCOS的临床预测价值及比较两组内分泌指标的特点.方法 选取2016年9月至2017年5月间在首都医科大学附属北京妇产医院内分泌科就诊的PCOS 病人567 例为研究组,取同期就诊的年龄、原发不孕与继发不孕病人或正常体检者53例作为对照组.测量所有参与者的身高、体质量,空腹抽血查INHB、AMH、卵泡刺激素(follicle-stimulating hormone, FSH)、黄体生成素(luteinizing hormone, LH) 、雌二醇(estradiol, E2)、睾酮(testosterone, T),分析PCOS组与对照组的血清INHB、AMH质量浓度及内分泌指标特点.结果 PCOS 组的血清AMH 质量浓度、LH、T、体质量指数(body mass index,BMI)均明显高于对照组,E2、FSH/LH低于对照组,且组间差异均有统计学意义(P<0.05).PCOS组的INHB质量浓度高于对照组,FSH低于对照组,组间差异均无统计学意义(P>0.05).AMH预测多囊卵巢综合征的最佳分界值(cut-off)值为4.84 μg/L,敏感度为84.48%,特异度为69.81%.INHB预测多囊卵巢综合征的cut-off 值为70.8 ng/L,敏感度为53.97%,特异度为67.92%,AMH与INHB联合预测(并联试验)多囊卵巢综合征的敏感度为90.29%,特异度为54.92%.结论 AMH预测PCOS的cut-off 值为4.84 μg/L,INHB预测PCOS的cut-off 值为70.8 ng/L,且AMH与INHB的联合检测(并列试验)敏感度高于AMH单项检测,这对临床PCOS的预测有很重要的指导意义.%Objective The present study aimed to investigate the effects of inhibin B (INHB), anti-Mullerian hormone (AMH) and various endocrine indicators in patients with polycystic ovary syndrome (PCOS) and control group, and to explore the clinical predictive value of INHB and AMH and compare the characteristics of endocrine indexes in two groups.Methods A total of 567 PCOS patients and 53 normal subjects as a control group were enrolled.Fasting blood samples for hormones [anti-Müllerian hormone(AMH), inhibinB(INHB), follicle-stimulating hormone (FSH),luteinizing hormone (LH), estradiol (E2) and testosterone (T)] were measured.Results The AMH concentration, LH, T and body mass index (BMI) in PCOS group were significantly higher than those in control group.The E2 and FSH/LH were lower than those in control group, and the difference was statistically significant (P<0.05).The concentration of INHB in PCOS group was higher than that in control group, FSH level was lower than that in control group, and there was no significant difference between the two groups (P> 0.05).Receiver operating characteristic (ROC) curve analysis of serum AMH and INHB in prediction of PCOS showed that the area under the ROC curve (AUC) value of the serum AMH level was 0.814, with a cut-off value of 4.84 μg/L.The sensitivity and specificity were 84.48% and 69.81%, respectively.The AUC value of serum INHB was 0.575, with a cut-off value of 70.8 ng/L, and the sensitivity and specificity were 53.97% and 67.92%, respectively.AMH and INHB combined prediction (Parallel Test) polycystic ovary syndrome sensitivity was 90.29%, specificity was 54.92%.Conclusion The cut-off value of AMH predicted PCOS was 4.84 μg/L, and the cut-off value of INHB predicted PCOS was 70.8 ng/L.The sensitivity of combined detection (Parallel Test)of AMH and INHB was higher than that of AMH single test.The prediction of PCOS will have a very important guiding significance.