多囊卵巢综合征诊断中没有必要纳入代谢指标

摘要

目的 探讨在多囊卵巢综合征(PCOS)诊断中纳入代谢指标是否具有必要性.方法 以鹿特丹诊断为金标准,选择2013年1月至2014年7月在昆明医科大学第二附属医院妇科就诊并被确诊为PCOS患者51例作为病例组,选择同期来妇科就诊的非该病患者47例为对照组,利用单因素分析筛选的有意义变量,进行主成分Logistic回归分析建立联合生殖和代谢指标的诊断模型,进行ROC曲线分析、评价其真实性和可靠性,并与金标准进行一致性和差异性分析.结果 单因素分析筛选出13个有意义的变量.联合诊断模型的ROC曲线下面积(AUC)为0.976,P＜0.001,0.526为最佳诊断界值,此时对应的灵敏度、特异度和符合率分别为96.08％、93.62％和93.88％.可见联合诊断模型具有较高的真实性和可靠性.2种诊断方法具极好的一致性(Kappa =0.877,P＜0.001),不具差异性(x2=0.167,P=0.688).结论 在PCOS诊断中是否纳入代谢指标对PCOS的诊断没有影响,认为没有必要在PCOS诊断中纳入代谢指标.%Objective To discuss whether it is necessary to integrate metabolic indices into diagnosis of polycystic ovary syndrome (PCOS).Methods Taking ESHRE/ASRM diagnosis as the gold standard,51 women with PCOS and 47 women without PCOS were selected and divided into the intervention group and control group respectively from the Department of Gynecology in the Second Affiliated Hospital of Kunming Medical University between January 2013 and July 2014.Logistic regression based on principal component analysis and significant variables chosen through single factor analysis were used to establish the new diagnostic model which combined reproductive indices and metabolic indices.We evaluated the validity and reliability of the new diagnostic model by using ROC curve analysis.Finally,we analyzed the consistence and difference between the new diagnostic model and the gold standard.Results Thirteen significant variables were chosen using single factor analysis.ROC analysis showed that an area under the curve was 0.976 (P＜0.001) and the optimal cut-off point was 0.526 with a sensitivity of 96.08％,a specificity of 93.62％ and a consistency of93.88％.The new diagnostic model had superior validity and reliability.The two diagnostic methods had strong consistence (Kappa=0.877,P＜0.001) and no difference (x2=0.167,P=0.688).Conclusion Considering that the integration of metabolic indices does not change the diagnosis result,we come to a conclusion that it is unnecessary to integrate metabolic indices into diagnosis of PCOS.