联合LC-MS和化学发光免疫法分析不同类型PCOS的雄激素水平

Analysis of androgen levels in different types of PCOS by combined LC-MS and chemiluminescence immunoassay

目的:利用液相色谱-质谱联用(LC-MS)方法和化学发光免疫分析法测定不同临床类型PCOS患者的血清雄激素水平,分析中国PCOS女性的高雄激素血症的生化特点。方法:纳入有排卵障碍和多囊卵巢的PCOS患者149例,根据血清睾酮(T)和硫酸脱氢表雄酮(DHEAS)值及F-G多毛评分情况分为两组:高雄组55例,非高雄组94例。同期选取输卵管性不孕患者82例作为对照组。化学发光法测定性激素结合球蛋白(SHBG)水平,计算游离雄激素指数(FTI)。LC-MS法测定各组血清睾酮、雄烯二酮(AD)和脱氢表雄酮(DHEA)。结果:高雄组的血清T水平及FTI值显著高于非高雄组及对照组(P<0.05),非高雄组高于对照组(P<0.05);高雄组、非高雄组的DHEAS及AD水平均高于对照组(P<0.05);3组的DHEA水平比较,差异均无统计学意义。结论:血清T、AD、DHEAS及FTI均为诊断PCOS高雄激素血症的敏感指标;T及FTI是PCOS分型(高雄及非高雄)的主要依据;LC-MS和化学发光免疫分析法对PCOS高雄激素血症的诊断具有一致性。

Objective：A chemiluminescent immunoassay（ CI） in combination with liquid chromatography mass spectrometry（ LC-MS） was used for analysis of serum androgens of women with various clinical types of polycystic ovary syndrome（ PCOS）,and analyze the biochemical characteristics of hyperandrogenism in PCOS women.Methods：One hundred fortynine PCOS patients with ovulation disorder and polycystic ovaries were recruited.According to their serum Testosterone（ T） and dehydroepiandrosterone sulfate（ DHEAS） determined by chemiluminescent assay and their F-G hirsutism score,the subjects were then divided into 2subgroups：55 hyperandrogenism patients and 94 patients without hyperandrogenism.A control group was composed of 82 patients with tubal infertility.Sex hormone-binding globulin（ SHBG）levels was measured by chemiluminescent immunoassay and then free testosterone index（ FTI）was calculated.LC-MS was used to measure the levels of T,androstenedione（ AD） and dehydroepiandrosterone（ DHEA）.Results：Serum T and FTI in hyperandrogenic group were significantly higher than those in non-hyperandrogenic group and the control（ P0.05）.T and FTI in non-hyperandrogenic group were significantly higher than control group（ P0.05）.The average levels of DHEAS and AD in both PCOS group were higher than those control group（ P0.05）.However,the DHEA levels among the 3 groups did not show any significant differences.Conclusions：Based on these results,the levels of T,AD,DHEAS,and FTI in serum were specific parameters for the diagnosis of hyperandrogenism in PCOS patients.Among those parameters,the T level and FTI value were important factors for subtyping of PCOS patients（ hyperandrogenic or non-hyperandrogenic type）.The LC-MS based method showed agreement with chemiluminescent immunoassay on the diagnosis of hyperandrogenism in PCOS patients.