血清总睾酮/双氢睾酮值对多囊卵巢综合征合并肥胖的临床诊断意义

Clinical and diagnostic significance of testosterone to dihydrotestosterone ratio in patients with polycystic ovary syndrome complicated with obesity

目的:探究血清总睾酮(TT)与双氢睾酮(DHT)的比值(TT/DHT值)对多囊卵巢综合征(PCOS)合并肥胖的临床诊断意义。方法:选取60例PCOS患者为观察组,其中合并代谢综合征、肥胖和胰岛素抵抗者分别为24、41和31例,同时选择60例经诊断无雄激素过多或排卵功能异常的健康女性为对照组。两组分别检测黄体生成素、卵泡刺激素、雄烯二酮、TT、游离睾酮和DHT的水平,计算稳态胰岛素评价指数(HOMAIR)和TT/DHT值。结果:观察组血清雄烯二酮、游离睾酮、TT水平和TT/DHT值均明显高于对照组(P<0.05);TT/DHT值诊断PCOS的最佳临界值为4.215(敏感性55.0%,特异性86.7%,AUC值0.704)。此外,PCOS合并代谢综合征、肥胖和胰岛素抵抗者TT/DHT值均显著高于不合并者(P<0.001),而血清TT水平在肥胖与非肥胖患者之间无明显差异(P=0.12)。结论:血清TT/DHT值与PCOS患者各临床表型均密切相关。相较于血清TT水平,TT/DHT值更能作为肥胖合并PCOS的临床确诊指标。

Objective： To evaluate the clinical and diagnostic significance of testosterone to dihydrotestosterone ratio in patients with polycystic ovary syndrome（ PCOS） complicated with obesity.Methods： A total of 60 women with PCOS were selected as observation group and 50 healthy women without any evidence of androgen excess or ovulatory dysfunction were served as control group in this study.The levels of serum luteinizing hormone,follicle stimulating hormone,androstenedione,total testosterone（ TT）,free testosterone and dihydrotestosterone（ DHT）were measured in both groups and HOMA-IR as well as TT/DHT was calculated.Results： Compared with the control group, the serum levels of androstenedione, free testosterone, total TT and TT to DHT ratio were significantly higher in the observation group（ P 〈 0.05）.The best cutoff value for TT/DHT ratio to diagnose PCOS was 4.215（ sensitivity 55.0%,specificity 86.7%,and AUC 0.704）.In addition,the ratio was significantly higher in PCOS patients with metabolic syndrome,obesity or insulin resistance than PCOS patients without those diseases（ P 〈 0.001）.However there were significant differences in serum testosterone levels between obese and non-obese patients with PCOS（ P = 0.012）.Conclusion： There is a close relation between TT/DHT ratio and PCOS patients.Compared with serum testosterone,TT/DHT ratio may be a better biomarker for obese patients with PCOS.